This article presents current achievements and challenges related to one of the most important neurological diseases of the 21st century, i.e. the sporadic cerebral small vessel disease (sCSVD). The aim is to discuss threats posed by clinical consequences of the disease. Small cerebral vascular disease is an important clinical entity not only from neurological but also from a general medical perspective. Epidemiological studies have shown that sCSVD is the most common vascular disease of the central nervous system and the main cause of cognitive deficits. It is also probably one of the most important pathological processes responsible for the brain aging. Despite the significant prevalence of cCSVD especially in the elderly and its significant clinical consequences, etiopathogenesis and optimal treatment of sCSVD have not yet been clearly defined.