White matter hyperintensities

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Brain with white matter hyperintensities - transverse MRI T1 spin echo TE/TR 8.1/621
Brain with white matter hyperintensities - transverse MRI T2 turbo spin echo TE/TR 101/4140
Brain with white matter hyperintensities - transverse MRI T2 turbo inversion recovery magnitude TE/TR/TI 111/9000/2500
White matter hyperintensities are a common change on neuroimaging of the adult ageing brain, with less than 2% older than 75 years having none[1]. They tend to progress with time [2].
Box Plot of change with age in normal adults of total volume of white matter hyperdensities to help illustrate how common this abnormality is with age[3]
The clinical correlation with higher neurological function can be poor[4] although there is a tendency of studies to report slowing of responses [5] particularily in men. In men hypertension and heart disease are associated, in women smoking [6]. They are found in conditions such as Binswanger's disease (Subcortical arteriosclerotic encephalopathy) where the periventricular white matter changes has been termed leukoareosis. Associations with any cause death [7] and stroke[8]have been reported although they are common in ill health in both sexes and perhaps the association is with hypoperfusion from any cause[9].

Associations

  • Increased risk stroke (HR = 3.3, 95% confidence interval 2.6 - 4.4)[10]
  • Increased risk dementia (HR = 1.9, 95% confidence interval 1.3 to 2.8)[10]
  • Increased risk mortality (HR = 2.0, 95% confidence interval 1.6 to 2.7)[10]

References

  1. Vernooij MW, Ikram MA, Tanghe HL et al. Incidental Findings on Brain MRI in the General Population. NEJM 2007;357:1821-1828
  2. Sachdev P, Wen W, Chen X, Brodaty H. Progression of white matter hyperintensities in elderly individuals over 3 years. Neurology. 2007 Jan 16; 68(3):214-22.(Link to article – subscription may be required.)
  3. Vernooij MW, Ikram MA, Tanghe HL et al. Incidental Findings on Brain MRI in the General Population. NEJM 2007;357:1821-1828
  4. Garde E, Mortensen EL, Krabbe K, Rostrup E, Larsson HB. Relation between age-related decline in intelligence and cerebral white-matter hyperintensities in healthy octogenarians: a longitudinal study. Lancet. 2000 Aug 19; 356(9230):628-34.
  5. Sachdev PS, Wen W, Christensen H, Jorm AF. White matter hyperintensities are related to physical disability and poor motor function. Journal of neurology, neurosurgery, and psychiatry. 2005 Mar; 76(3):362-7.(Link to article – subscription may be required.)
  6. Sachdev PS, Parslow R, Wen W, Anstey KJ, Easteal S. Sex differences in the causes and consequences of white matter hyperintensities. . 2007 Oct 18.(Epub ahead of print) (Link to article – subscription may be required.)
  7. Kerber KA, Whitman GT, Brown DL, Baloh RW. Increased risk of death in community-dwelling older people with white matter hyperintensities on MRI. Journal of the neurological sciences. 2006 Dec 1; 250(1-2):33-8.(Link to article – subscription may be required.)
  8. Wen W, Sachdev PS. Extent and distribution of white matter hyperintensities in stroke patients: the Sydney Stroke Study. Stroke; a journal of cerebral circulation. 2004 Dec; 35(12):2813-9.(Link to article – subscription may be required.)
  9. Wen W, Sachdev P, Shnier R, Brodaty H. Effect of white matter hyperintensities on cortical cerebral blood volume using perfusion MRI. NeuroImage. 2004 Apr; 21(4):1350-6.(Link to article – subscription may be required.)
  10. a b c 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 doi:10.1136/bmj.c3666