leukoaraiosis

{{short description|Type of white matter abnormality near the lateral ventricles}}

File:Periventricular white matter lesions (annotated).jpg showing periventricular white matter lesions.]]

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.{{cite journal | doi = 10.1212/WNL.0b013e3181a711df | volume=72 | title=Silent brain infarcts and leukoaraiosis in young adults with first-ever ischemic stroke | year=2009 | journal=Neurology | pages=1823–1829 | author=Putaala J., Kurkinen M., Tarvos V., Salonen O., Kaste M., Tatlisumak T.| issue=21 | pmid=19470964 | s2cid=593328 }}{{Cite journal|last=Aik Kah|first=Tan|date=2018|title=CuRRL Syndrome: A Case Series|url=https://actascientific.com/ASOP/pdf/ASOP-01-0016.pdf|journal=Acta Scientific Ophthalmology|volume=1|issue=3|pages=9–13}} On MRI, leukoaraiosis changes appear as white matter hyperintensities (WMHs) in T2 FLAIR images.{{cite journal |vauthors=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, Völzke H, Schminke U, Hoffmann W, Grabe H, Davatzikos C | title=White matter hyperintensities and imaging patterns of brain ageing in the general population | journal= Brain | volume=139 | issue=Pt 4 | year=2016 | pages=1164–79 | url= | doi=10.1093/brain/aww008 | pmid=26912649| pmc=5006227 }}{{Cite journal | doi=10.3389/fnagi.2014.00144| pmid=25071553| pmc=4074703|title = Increased Visibility of Deep Medullary Veins in Leukoaraiosis: A 3-T MRI Study| journal=Frontiers in Aging Neuroscience| volume=6| pages=144|year = 2014|last1 = Yan|first1 = Shenqiang| last2=Wan| first2=Jinping| last3=Zhang| first3=Xuting| last4=Tong| first4=Lusha| last5=Zhao| first5=Song| last6=Sun| first6=Jianzhong| last7=Lin| first7=Yuehan| last8=Shen| first8=Chunhong| last9=Lou| first9=Min| doi-access=free}} On CT scans, leukoaraiosis appears as hypodense periventricular white-matter lesions.{{cite journal |vauthors=Kobari M, Meyer JS, Ichijo M, Oravez WT |title=Leukoaraiosis: correlation of MR and CT findings with blood flow, atrophy, and cognition |journal=AJNR Am J Neuroradiol |volume=11 |issue=2 |pages=273–81 |year=1990 |pmid=2107711 |pmc=8334682 }}

The term "leukoaraiosis" was coined in 1986{{cite journal |pmid=3791068 |year=1986 |last1=Hachinski |first1=VC |last2=Potter |first2=P |last3=Merskey |first3=H |title=Leuko-araiosis: An ancient term for a new problem |volume=13 |issue=4 Suppl |pages=533–34 |journal=The Canadian Journal of Neurological Sciences|doi=10.1017/S0317167100037264 |s2cid=38151019 |doi-access=free }}{{cite journal |doi=10.1001/archneur.1987.00520130013009 |title=Leuko-Araiosis |year=1987 |last1=Hachinski |first1=V. C. |last2=Potter |first2=P. |last3=Merskey |first3=H. |journal=Archives of Neurology |volume=44 |pages=21–23 |pmid=3800716 |issue=1}} 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, 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.

Causes

File:Normal pressure hydrocephalus versus atrophy.jpg, 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.{{cite journal |vauthors=Raz N, Yang Y, Dahle CL, Land S | title=Volume of white matter hyperintensities in healthy adults: contribution of age, vascular risk factors, and inflammation-related genetic variants | journal=Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease | volume=1822 | issue=3 | year=2012 | pages=361–69 | pmc=3245802 | doi=10.1016/j.bbadis.2011.08.007 | pmid=21889590}}{{Cite journal|last1=Lin|first1=Jing|last2=Wang|first2=Dilong|last3=Lan|first3=Linfang|last4=Fan|first4=Yuhua|date=2017|title=Multiple Factors Involved in the Pathogenesis of White Matter Lesions|journal=BioMed Research International|volume=2017|pages=9372050|doi=10.1155/2017/9372050|issn=2314-6141|pmc=5339523|pmid=28316994|doi-access=free }} 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.{{cite book |first1=Anthony S. |last1=Fauci |first2=Eugene |last2=Braunwald |first3=Charles |last3=Weiner |first4=Dennis L. |last4=Kasper |first5=Stephen L. |last5=Hauser |first6=Dan L. |last6=Longo |first7=J. Larry |last7=Jameson |first8=Joseph |last8=Loscalzo |year=2008 |title=Harrison's Principles of Internal Medicine |edition=17th |publisher=McGraw-Hill |location=New York |isbn=978-0-07-149619-3}}{{Page needed|reason=was "Harrison Principles of Internal Medicine 17th edition pg.2521", but there are not this many pages in the book.|date=February 2012}}{{Cite journal|last1=Hu|first1=He-Ying|last2=Ou|first2=Ya-Nan|last3=Shen|first3=Xue-Ning|last4=Qu|first4=Yi|last5=Ma|first5=Ya-Hui|last6=Wang|first6=Zuo-Teng|last7=Dong|first7=Qiang|last8=Tan|first8=Lan|last9=Yu|first9=Jin-Tai|date=January 2021|title=White matter hyperintensities and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 36 prospective studies|url=https://pubmed.ncbi.nlm.nih.gov/33188821|journal=Neuroscience and Biobehavioral Reviews|volume=120|pages=16–27|doi=10.1016/j.neubiorev.2020.11.007|issn=1873-7528|pmid=33188821|s2cid=226301188 }}

Special cases

Ischaemic leukoaraiosis has been defined as the leukoaraiosis present after a stroke.{{cite journal | author = O'Sullivan M, Morris RG, Huckstep B, Jones DK, Williams SCR, Markus HS | year = 2004 | title = Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis | journal = J Neurol Neurosurg Psychiatry | volume = 75 | issue = 3| pages = 441–47 | doi = 10.1136/jnnp.2003.014910 | pmid = 14966162 | pmc = 1738975 }}
Diabetes-associated leukoaraiosis has been reportedMaldjian 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
CuRRL syndrome: increased Cup: Disc Ratio, Retinal GanglionCell Complex thinning, Radial Peripapillary Capillary Network Density Reduction and Leukoaraiosis
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.

leukoaraiosis

Causes

Special cases

See also

References

Further reading