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MRI cerebral white matter lesion (white matter hyperintensity)

Etiology: 1) microvascular ischemia (leukoaraiosis) 2) common in patients with migraine [8] 3) hypertension [10] (see SPRINT study); antihypertensives [13] 4) behavioral variant frontotemporal dementia with more leukoaraiosis than Alzheimer's disease [12] Epidemiology: - black persons may be more likely to show white matter hyperintensities during midlife than Latinex or white persons [14] Pathology: 1) strongly correlated with retinopathy 2) associated with increased incidence of ischemic stroke 3) white matter hyperintensities on MRI of the brain portend increased mortality in community-dwelling elderly, independently of hypertension, age, coronary artery disease [3] 4) associated with hypoperfusion of deep white matter [4] 5) associated with cognitive impairment & functional decline [5,11] - leukoaraiosis is more prominent in expected areas of cortical thinning within the anterior brain regions in behavioral variant frontotemporal dementia & in posterior brain regions in Alzheimer's disease [12] - areas of leukoaraiosis also seen in the precuneus in behavioral variant frontotemporal dementia & in the bilateral temporal pole in Alzheimer's disease after adjustments for cortical thinning [12] - shared patterns of leukoaraiosis correlate with attention, language, & visuospatial impairments in behavioral variant frontotemporal dementia & Alzheimer's disease [12] 6) associated with late-life depression [6] * leukoaraiosis Differential diagnosis: - parafalcine meningioma Management: - prevention: improving cardiovascular health may reduce risk of MRI cerebral white matter hyperintensities [9,15] - more favorable cardiovascular health profile* is associated with slower white matter hyperintensity progression [15] - genetic risk* is associated with faster white matter hyperintensity progression, except if favorable global or behavioral cardiovascular health profile [15] * cardiovascular health profile determined by - 4 behavioral factors: - smoking, physical activity, dietary habits, body-mass index [15] - 3 biological factors: - total serum cholesterol, blood pressure, fasting plasma glucose from Life's Simple 7 [15] * genetic risk scores determined by the presence of risk alleles for - hypertension, diabetes, or dyslipidemia

Related

brain aging cerebral white matter leukoaraiosis magnetic resonance imaging (MRI, diffusion-weighted MRI)

General

brain lesion

References

  1. Journal Watch 22(16):127, 2002 Wong TY, Klein R, Sharrett AR et al Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA 288:67, 2002 PMID: 12090864
  2. Lewis AM, Layzer R, Engstrom JW, Barbaro NM, Chin CT. Magnetic image resonance neurography in extraspinal sciatica. Arch Neurol 2006, 63:1469 PMID: 17030664
  3. Inzitari D, Simoni M, Pracucci G, Poggesi A, Basile AM, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O'Brien J, Barkhof F, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L; LADIS Study Group. Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes: the LADIS study. Arch Intern Med. 2007 Jan 8;167(1):81-8. PMID: 17210882 - Pantoni L, Basile AM, Pracucci G, Asplund K, Bogousslavsky J, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O'brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D. Impact of age-related cerebral white matter changes on the transition to disability -- the LADIS study: rationale, design and methodology. Neuroepidemiology. 2005;24(1-2):51-62. PMID: 15459510 [PubMed - indexed for MEDLINE] - Basile AM, Pantoni L, Pracucci G, Asplund K, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D; LADIS Study Group. Age, hypertension, and lacunar stroke are the major determinants of the severity of age-related white matter changes. The LADIS (Leukoaraiosis and Disability in the Elderly) Study. Cerebrovasc Dis. 2006;21(5-6):315-22. Epub 2006 Feb 14. PMID: 16490940 [PubMed - indexed for MEDLINE] - Pantoni L, Poggesi A, Basile AM, Pracucci G, Barkhof F, Chabriat H, Erkinjuntti T, Ferro JM, Hennerici M, O'Brien J, Schmidt R, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D; LADIS Study Group. Leukoaraiosis predicts hidden global functioning impairment in nondisabled older people: the LADIS (Leukoaraiosis and Disability in the Elderly) Study. J Am Geriatr Soc. 2006 Jul;54(7):1095-101. PMID: 16866681
  4. Holland CM et al. Spatial distribution of white-matter hyperintensities in Alzheimer disease, cerebral amyloid angiopathy, and healthy aging. Stroke 2008 Apr; 39:1127. PMID: 18292383
  5. 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
  6. Aizenstein HJ et al. fMRI correlates of white matter hyperintensities in late-life depression. Am J Psychiatry 2011 Jul 28 PMID: 21799066
  7. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010; 341:c3666 PMID: 20660506
  8. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018
  9. Williamson W, Lewandowski AJ, Forkert ND et al. Association of cardiovascular risk factors with MRI indices of cerebrovascular structure and function and white matter hyperintensities in young adults. JAMA. 2018 Aug 21;320(7):665-673. PMID: 30140877 https://jamanetwork.com/journals/jama/fullarticle/2697697
  10. SPRINT MIND Investigators for the SPRINT Research Group, Nasrallah IM, Auchus AP, Chelune G et al. Association of intensive vs standard blood pressure control with cerebral white matter lesions. JAMA 2019 Aug 13; 322:524-534. PMID: 31408137 https://jamanetwork.com/journals/jama/article-abstract/2747671 - Prabhakaran S. Blood pressure, brain volume and white matter hyperintensities, and dementia risk. JAMA 2019 Aug 13; 322:512-513 PMID: 31408120 https://jamanetwork.com/journals/jama/article-abstract/2747651
  11. Anand SS, Friedrich MG, Desai D et al. Reduced cognitive assessment scores among individuals with magnetic resonance imaging-detected vascular brain injury. Stroke 2020 Apr; 51:1158. PMID: 32126938 https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.028179
  12. 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
  13. Messerli FH, Bavishi C, Messerli AW, Siontis GCM On Cerebrotoxicity of Antihypertensive Therapy and Risk Factor Cosmetics. Eur Heart J. 2021;42(7):758-760. PMID: 33369623 https://www.medscape.com/viewarticle/948862
  14. Kneisel K Brain Aging in Black Adults Shows Accelerated Pattern Starting in Midlife. Links between age and MRI measures similarly strong in both mid- and late life. MedPage Today November 14, 2022 https://www.medpagetoday.com/neurology/dementia/101731
  15. Li Y et al. Association between behavioral, biological, and genetic markers of cardiovascular health and MRI markers of brain aging: A cohort study. Neurology 2022 Nov 1; [e-pub]. PMID: 36319110 https://n.neurology.org/content/100/1/e38