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leukoaraiosis

Diffuse subcortical white matter disease seen on magnetic resonance neuroimaging. see MRI cerebral white matter lesion Etiology: - risk factors likely related to underlying vascular mechanism - hypertension - smoking - diabetes mellitus - hyperhomocysteinemia - cardiovascular disease - vascular dementia - frontotemporal dementia - Alzheimer's disease [6] Epidemiology: - commonly noted on magnetic resonance imaging studies of the brain in elderly Clinical manifestations: - incontinence - difficulty in walking - cognitive impairment - subcortical dementia - executive dysfunction - case described as gradual onset [3] Radiology: - magnetic resonance imaging: white matter hyperintensites Comparative biology: - pericyte degeneration disrupts white-matter microcirculation, resulting in accumulation of fibrin deposits from the blood, ischemia, loss of myelin, axons & oligodendrocytes, disrupting brain circuitry without neuronal loss [5]

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MRI cerebral white matter lesion (white matter hyperintensity)

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2352
  2. Inzitari D et al Changes in white matter as determinant of global functional decline in older independent outpatients: Three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ 2009 Jul 6; 339:b2477 PMID: 19581317 http://dx.doi.org/10.1136/bmj.b2477
  3. NEJM Question of the Week. Dec 6, 2016 http://knowledgeplus.nejm.org/question-of-week/1365/
  4. Vermeer SE et al. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 2003 Mar 28; 348:1215. PMID: 12660385 Free full text http://www.nejm.org/doi/full/10.1056/NEJMoa022066
  5. Montagne A, Nikolakopoulou AM, Zhao Z et al Pericyte degeneration causes white matter dysfunction in the mouse central nervous system. Nature Medicine Feb 5, 2018 PMID: 29400711 https://www.nature.com/articles/nm.4482
  6. Huynh K et al. Clinical and biological correlates of white matter hyperintensities in patients with behavioral-variant frontotemporal dementia and Alzheimer disease. Neurology 2021 Feb 17; [e-pub] https://n.neurology.org/content/96/13/e1743