Leukoaraiosis is a particular abnormal change in appearance of white matter near the lateral ventricles. It is often seen in aged individuals, but sometimes in young adults.[1][2] On MRI, leukoaraiosis changes appear as white matter hyperintensities (WMHs) in T2 FLAIR images.[3][4] On CT scans, leukoaraiosis appears as hypodense periventricular white-matter lesions.[5]
Axial T2 FLAIR sequence MR image of a middle-aged man with leukoaraiosis.MRI image: Leukoaraiosis in a 90-year-old patient with cerebral atrophy.Head CT showing periventricular white matter lesions.
The term "leukoaraiosis" was coined in 1986[6][7] by Hachinski, Potter, and Merskey as a descriptive term for rarefaction ("araiosis") of the white matter, showing up as decreased density on CT and increased signal intensity on T2/FLAIR sequences (white matter hyperintensities) performed as part of MRI brain scans.
These white matter changes are also commonly referred to as periventricular white matter disease, or white matter hyperintensities (WMH), due to their bright white appearance on T2 MRI scans. Many patients can have leukoaraiosis without any associated clinical abnormality. However, underlying vascular mechanisms are suspected to be the cause of the imaging findings. Hypertension, smoking, diabetes,[3]hyperhomocysteinemia, and heart diseases are all risk factors for leukoaraiosis.
Leukoaraiosis has been reported to be an initial stage of Binswanger's disease but this evolution does not always happen.
The blue arrows indicate leucoaraiosis. In the left image these may well represent transependymal CSF diapedesis due to normal pressure hydrocephalus, which in turn is suggested by the narrowed superior CSF spaces and acute callosal angle. The unilateral occurrence of these alterations in right image suggests they are probably due to vascular encephalopathy.
White matter hyperintensities can be caused by a variety of factors, including ischemia, micro-hemorrhages, gliosis, damage to small blood vessel walls, breaches of the barrier between the cerebrospinal fluid and the brain, or loss and deformation of the myelin sheath.[8][9] Multiple small vessel infarcts in the subcortical white matter can cause the condition, often the result of chronic hypertension leading to lipohyalinosis of the small vessels. Patients may develop cognitive impairment and dementia.[10][11]
Special casesEdit
Ischaemic leukoaraiosis has been defined as the leukoaraiosis present after a stroke.[12]
Diabetes-associated leukoaraiosis has been reported[13]
CuRRL syndrome: increased Cup: Disc Ratio, Retinal GanglionCell Complex thinning, Radial Peripapillary Capillary Network Density Reduction and Leukoaraiosis[2]
CADASIL is a hereditary cerebrovascular disorder associated with T2-hyperintense white matter lesions that have a greater extent and earlier age of onset than age-related leukoaraiosis.
^Putaala J., Kurkinen M., Tarvos V., Salonen O., Kaste M., Tatlisumak T. (2009). "Silent brain infarcts and leukoaraiosis in young adults with first-ever ischemic stroke". Neurology. 72 (21): 1823–1829. doi:10.1212/WNL.0b013e3181a711df. PMID 19470964. S2CID 593328.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^ abAik Kah, Tan (2018). "CuRRL Syndrome: A Case Series" (PDF). Acta Scientific Ophthalmology. 1 (3): 9–13.
^ abHabes M, Erus G, Toledo JB, Zhang T, Bryan N, Launer LJ, Rosseel Y, Janowitz D, Doshi J, Van der Auwera S, von Sarnowski B, Hegenscheid K, Hosten N, Homuth G, Völzke H, Schminke U, Hoffmann W, Grabe H, Davatzikos C (2016). "White matter hyperintensities and imaging patterns of brain ageing in the general population". Brain. 139 (Pt 4): 1164–79. doi:10.1093/brain/aww008. PMC5006227. PMID 26912649.
^Yan, Shenqiang; Wan, Jinping; Zhang, Xuting; Tong, Lusha; Zhao, Song; Sun, Jianzhong; Lin, Yuehan; Shen, Chunhong; Lou, Min (2014). "Increased Visibility of Deep Medullary Veins in Leukoaraiosis: A 3-T MRI Study". Frontiers in Aging Neuroscience. 6: 144. doi:10.3389/fnagi.2014.00144. PMC4074703. PMID 25071553.
^Kobari M, Meyer JS, Ichijo M, Oravez WT (1990). "Leukoaraiosis: correlation of MR and CT findings with blood flow, atrophy, and cognition". AJNR Am J Neuroradiol. 11 (2): 273–81. PMC8334682. PMID 2107711.
^Hachinski, VC; Potter, P; Merskey, H (1986). "Leuko-araiosis: An ancient term for a new problem". The Canadian Journal of Neurological Sciences. 13 (4 Suppl): 533–34. doi:10.1017/S0317167100037264. PMID 3791068. S2CID 38151019.
^Hachinski, V. C.; Potter, P.; Merskey, H. (1987). "Leuko-Araiosis". Archives of Neurology. 44 (1): 21–23. doi:10.1001/archneur.1987.00520130013009. PMID 3800716.
^Raz N, Yang Y, Dahle CL, Land S (2012). "Volume of white matter hyperintensities in healthy adults: contribution of age, vascular risk factors, and inflammation-related genetic variants". Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease. 1822 (3): 361–69. doi:10.1016/j.bbadis.2011.08.007. PMC3245802. PMID 21889590.
^Lin, Jing; Wang, Dilong; Lan, Linfang; Fan, Yuhua (2017). "Multiple Factors Involved in the Pathogenesis of White Matter Lesions". BioMed Research International. 2017: 9372050. doi:10.1155/2017/9372050. ISSN 2314-6141. PMC5339523. PMID 28316994.
^Fauci, Anthony S.; Braunwald, Eugene; Weiner, Charles; Kasper, Dennis L.; Hauser, Stephen L.; Longo, Dan L.; Jameson, J. Larry; Loscalzo, Joseph (2008). Harrison's Principles of Internal Medicine (17th ed.). New York: McGraw-Hill. ISBN978-0-07-149619-3.[page needed]
^Hu, He-Ying; Ou, Ya-Nan; Shen, Xue-Ning; Qu, Yi; Ma, Ya-Hui; Wang, Zuo-Teng; Dong, Qiang; Tan, Lan; Yu, Jin-Tai (January 2021). "White matter hyperintensities and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 36 prospective studies". Neuroscience and Biobehavioral Reviews. 120: 16–27. doi:10.1016/j.neubiorev.2020.11.007. ISSN 1873-7528. PMID 33188821. S2CID 226301188.
^O'Sullivan M, Morris RG, Huckstep B, Jones DK, Williams SCR, Markus HS (2004). "Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis". J Neurol Neurosurg Psychiatry. 75 (3): 441–47. doi:10.1136/jnnp.2003.014910. PMC1738975. PMID 14966162.{{cite journal}}: CS1 maint: multiple names: authors list (link)
^Maldjian JA, Whitlow CT, Saha BN, Kota G, Vandergriff C, Davenport EM, Divers J, Freedman BI, Bowden DW. "Automated White Matter Total Lesion Volume Segmentation in Diabetes". AJNR Am J Neuroradiol. 2013 Jul 18
Further readingEdit
Pantoni, L.; Garcia, J. H. (1995). "The Significance of Cerebral White Matter Abnormalities 100 Years After Binswanger's Report : A Review". Stroke. 26 (7): 1293–301. doi:10.1161/01.STR.26.7.1293. PMID 7604429.
Pantoni, L; Inzitari, D (1998). "New clinical relevance of leukoaraiosis. European Task Force on Age-Related White Matter-Changes" (PDF). Stroke. 29 (2): 543. doi:10.1161/01.str.29.2.543. PMID 9472903.
Werder, SF (2010). "Cobalamin deficiency, hyperhomocysteinemia, and dementia". Neuropsychiatric Disease and Treatment. 6: 159–95. doi:10.2147/ndt.s6564. PMC2874340. PMID 20505848.
Wikimedia Commons has media related to Leukoaraiosis.
October 15, 2023
leukoaraiosis, particular, abnormal, change, appearance, white, matter, near, lateral, ventricles, often, seen, aged, individuals, sometimes, young, adults, leukoaraiosis, changes, appear, white, matter, hyperintensities, wmhs, flair, images, scans, leukoaraio. Leukoaraiosis is a particular abnormal change in appearance of white matter near the lateral ventricles It is often seen in aged individuals but sometimes in young adults 1 2 On MRI leukoaraiosis changes appear as white matter hyperintensities WMHs in T2 FLAIR images 3 4 On CT scans leukoaraiosis appears as hypodense periventricular white matter lesions 5 Axial T2 FLAIR sequence MR image of a middle aged man with leukoaraiosis MRI image Leukoaraiosis in a 90 year old patient with cerebral atrophy Head CT showing periventricular white matter lesions The term leukoaraiosis was coined in 1986 6 7 by Hachinski Potter and Merskey as a descriptive term for rarefaction araiosis of the white matter showing up as decreased density on CT and increased signal intensity on T2 FLAIR sequences white matter hyperintensities performed as part of MRI brain scans These white matter changes are also commonly referred to as periventricular white matter disease or white matter hyperintensities WMH due to their bright white appearance on T2 MRI scans Many patients can have leukoaraiosis without any associated clinical abnormality However underlying vascular mechanisms are suspected to be the cause of the imaging findings Hypertension smoking diabetes 3 hyperhomocysteinemia and heart diseases are all risk factors for leukoaraiosis Leukoaraiosis has been reported to be an initial stage of Binswanger s disease but this evolution does not always happen Contents 1 Causes 2 Special cases 3 See also 4 References 5 Further readingCauses Edit nbsp The blue arrows indicate leucoaraiosis In the left image these may well represent transependymal CSF diapedesis due to normal pressure hydrocephalus which in turn is suggested by the narrowed superior CSF spaces and acute callosal angle The unilateral occurrence of these alterations in right image suggests they are probably due to vascular encephalopathy White matter hyperintensities can be caused by a variety of factors including ischemia micro hemorrhages gliosis damage to small blood vessel walls breaches of the barrier between the cerebrospinal fluid and the brain or loss and deformation of the myelin sheath 8 9 Multiple small vessel infarcts in the subcortical white matter can cause the condition often the result of chronic hypertension leading to lipohyalinosis of the small vessels Patients may develop cognitive impairment and dementia 10 11 Special cases EditIschaemic leukoaraiosis has been defined as the leukoaraiosis present after a stroke 12 Diabetes associated leukoaraiosis has been reported 13 CuRRL syndrome increased Cup Disc Ratio Retinal GanglionCell Complex thinning Radial Peripapillary Capillary Network Density Reduction and Leukoaraiosis 2 CADASIL is a hereditary cerebrovascular disorder associated with T2 hyperintense white matter lesions that have a greater extent and earlier age of onset than age related leukoaraiosis See also EditHyperintensities Binswanger s disease Demyelinating diseaseReferences Edit Putaala J Kurkinen M Tarvos V Salonen O Kaste M Tatlisumak T 2009 Silent brain infarcts and leukoaraiosis in young adults with first ever ischemic stroke Neurology 72 21 1823 1829 doi 10 1212 WNL 0b013e3181a711df PMID 19470964 S2CID 593328 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint multiple names authors list link a b Aik Kah Tan 2018 CuRRL Syndrome A Case Series PDF Acta Scientific Ophthalmology 1 3 9 13 a b Habes M Erus G Toledo JB Zhang T Bryan N Launer LJ Rosseel Y Janowitz D Doshi J Van der Auwera S von Sarnowski B Hegenscheid K Hosten N Homuth G Volzke H Schminke U Hoffmann W Grabe H Davatzikos C 2016 White matter hyperintensities and imaging patterns of brain ageing in the general population Brain 139 Pt 4 1164 79 doi 10 1093 brain aww008 PMC 5006227 PMID 26912649 Yan Shenqiang Wan Jinping Zhang Xuting Tong Lusha Zhao Song Sun Jianzhong Lin Yuehan Shen Chunhong Lou Min 2014 Increased Visibility of Deep Medullary Veins in Leukoaraiosis A 3 T MRI Study Frontiers in Aging Neuroscience 6 144 doi 10 3389 fnagi 2014 00144 PMC 4074703 PMID 25071553 Kobari M Meyer JS Ichijo M Oravez WT 1990 Leukoaraiosis correlation of MR and CT findings with blood flow atrophy and cognition AJNR Am J Neuroradiol 11 2 273 81 PMC 8334682 PMID 2107711 Hachinski VC Potter P Merskey H 1986 Leuko araiosis An ancient term for a new problem The Canadian Journal of Neurological Sciences 13 4 Suppl 533 34 doi 10 1017 S0317167100037264 PMID 3791068 S2CID 38151019 Hachinski V C Potter P Merskey H 1987 Leuko Araiosis Archives of Neurology 44 1 21 23 doi 10 1001 archneur 1987 00520130013009 PMID 3800716 Raz N Yang Y Dahle CL Land S 2012 Volume of white matter hyperintensities in healthy adults contribution of age vascular risk factors and inflammation related genetic variants Biochimica et Biophysica Acta BBA Molecular Basis of Disease 1822 3 361 69 doi 10 1016 j bbadis 2011 08 007 PMC 3245802 PMID 21889590 Lin Jing Wang Dilong Lan Linfang Fan Yuhua 2017 Multiple Factors Involved in the Pathogenesis of White Matter Lesions BioMed Research International 2017 9372050 doi 10 1155 2017 9372050 ISSN 2314 6141 PMC 5339523 PMID 28316994 Fauci Anthony S Braunwald Eugene Weiner Charles Kasper Dennis L Hauser Stephen L Longo Dan L Jameson J Larry Loscalzo Joseph 2008 Harrison s Principles of Internal Medicine 17th ed New York McGraw Hill ISBN 978 0 07 149619 3 page needed Hu He Ying Ou Ya Nan Shen Xue Ning Qu Yi Ma Ya Hui Wang Zuo Teng Dong Qiang Tan Lan Yu Jin Tai January 2021 White matter hyperintensities and risks of cognitive impairment and dementia A systematic review and meta analysis of 36 prospective studies Neuroscience and Biobehavioral Reviews 120 16 27 doi 10 1016 j neubiorev 2020 11 007 ISSN 1873 7528 PMID 33188821 S2CID 226301188 O Sullivan M Morris RG Huckstep B Jones DK Williams SCR Markus HS 2004 Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis J Neurol Neurosurg Psychiatry 75 3 441 47 doi 10 1136 jnnp 2003 014910 PMC 1738975 PMID 14966162 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint multiple names authors list link Maldjian JA Whitlow CT Saha BN Kota G Vandergriff C Davenport EM Divers J Freedman BI Bowden DW Automated White Matter Total Lesion Volume Segmentation in Diabetes AJNR Am J Neuroradiol 2013 Jul 18Further reading EditPantoni L Garcia J H 1995 The Significance of Cerebral White Matter Abnormalities 100 Years After Binswanger s Report A Review Stroke 26 7 1293 301 doi 10 1161 01 STR 26 7 1293 PMID 7604429 Pantoni L Inzitari D 1998 New clinical relevance of leukoaraiosis European Task Force on Age Related White Matter Changes PDF Stroke 29 2 543 doi 10 1161 01 str 29 2 543 PMID 9472903 Werder SF 2010 Cobalamin deficiency hyperhomocysteinemia and dementia Neuropsychiatric Disease and Treatment 6 159 95 doi 10 2147 ndt s6564 PMC 2874340 PMID 20505848 nbsp Wikimedia Commons has media related to Leukoaraiosis 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