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Background Novel stroke risk factors, like occupation, are under exploration. We investigate if specific occupational exposures and settings increase the risk of small vessel disease (SVD), including SVD-related strokes.Methods We performed a systematic review on stroke-occupation associations and analysed data from Lothian stroke services patients presenting with mild ischaemic stroke (modified Rankin Scale ≤2). We used Magnetic Resonance Imaging and enquired about occupational status. We assessed relationships between high-risk occupations (per Control of Substances Hazardous to Health guidelines) and standard occupational classifications (per Standard Occupational Classifications criteria) against white matter hyperintensities (WMH) volumes, SVD score, and stroke subtype.Results Our review identified 37 papers on occupations/broad classifications (n=13), psychosocial work-factors (n=11), and occupational exposure to hazardous substances (n=13). Data analysis from 414 participants showed after adjusting for confounders, high-risk occupations, such as drivers and engineers, were linked to higher SVD scores (OR=1.64, 95% CI 1.07-2.54, n=357, p=0.02) but not stroke subtype (OR=1.03, 95% CI 0.64-1.67, n=358, p=0.90) or WMH volume (%intracranial volume) (beta=-0.003, 95% CI -0.015-0.008, n=357, p=0.60). No associations were found for standard occupational classifications.Conclusions Our review shows limited data on stroke-occupation interactions. High-risk occupations may be linked to SVD development, warranting further studies on exposures.s2026438@ed.ac.uk