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In this retrospective observational study, the authors assessed how DMV integrity relates to MRI-based SVD severity markers and glymphatic function assessed by DTI measures in patients with a recent small subcortical infarct. DMV disruption demonstrated a weak association with SVD, influenced by confounding factors, and a strong relationship with microstructural WM integrity and free water content, suggesting the potential involvement of extracellular fluid in mechanisms leading to vein disruption.