Cerebral small vessel disease affects small penetrating terminal arterioles supplying deep white matter and basal ganglia, and can lead to both lacunar infarcts and diffuse white matter lesions (WML). Hypertension, diabetes mellitus and atherosclerosis are considered the main risk factors for small vessel disease, but genetic factors have been implied as well. 1 Pseudoxanthoma elasticum (PXE), known also as Grönblad-Strandberg syndrome, is a rare heritable systemic connective tissue disorder, characterized by progressive proteoglycan ABSTRACT: Background: Cerebral small vessel disease is rarely described in association with pseudoxanthoma elasticum (PXE), a hereditary connective tissue disorder with skin, eye and vascular manifestations. This autosomally inherited elastic tissue disease has been attributed to mutations in the ABCC6 gene located on chromosome 16p13.1. Different stroke mechanisms are suggested in PXE patients, arterial hypertension and accelerated atherosclerosis being the leading ones. Case Descriptions: Case 1: A 49-year-old man with history of mild hypertension presented with recurrent transient ischemic attacks. At the age of 42, evaluation for progressive visual loss and skin changes led to diagnosis of PXE. Brain magnetic resonance imaging (MRI) disclosed multiple lacunar infarctions and confluent periventricular white matter lesions (WML). Case 2: A 71-year-old woman with history of mild hypertension suffered rightsided stroke. Diagnosis of PXE was made at the age of 48 due to severe visual loss and skin changes. Brain MRI revealed multiple lacunar infarctions and subcortical ischemic leukoencephalopathy. Case 3: A 47-year-old woman with prominent skin changes and bilateral amblyopia developed right-sided weakness. Skin biopsy confirmed PXE. Several lacunar infarcts in deep white matter and pons were revealed on MRI. Discussion: We present three patients with clinical and histopathological features of PXE who presented with multiple lacunar strokes, two with extensive confluent WML. These cases illustrate that PXE is a rare but significant risk factor for small vessel disease and stroke in patients of all age groups. Occlusive small vessel disease and subsequent lacunar infarcts and WML represent important PXE manifestations.RÉSUMÉ: Maladie des petits vaisseaux cérébraux dans le pseudo xanthome élastique : à propos de trois observations. Introduction: Une maladie des petits vaisseaux cérébraux associée au pseudo xanthome élastique (PXÉ), une maladie héréditaire autosomique du tissus conjonctif impliquant la peau, les yeux et les vaisseaux a rarement été décrite. Elle est due à une mutation du gène ABCC6 qui est situé sur le chromosome 16p13,1. On a suggéré que plusieurs mécanismes différents pouvaient être en cause chez les patients qui ont un PXÉ et des accidents vasculaires cérébraux, dont l'hypertension artérielle et une athérosclérose accélérée. Observations: Premier cas: Il s'agit d'un homme âgé de 49 ans ayant une histoire d'hypertension légère, qui a consulté pour des accidents isché...