Leukoaraiosis

Causes

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. 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.

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.

Special cases

• Ischaemic leukoaraiosis has been defined as the leukoaraiosis present after a stroke.
• Diabetes-associated leukoaraiosis has been reported
• 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.

References

References

1. 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.
2. Aik Kah, Tan. (2018). "CuRRL Syndrome: A Case Series". Acta Scientific Ophthalmology.
3. (2016). "White matter hyperintensities and imaging patterns of brain ageing in the general population". [[Brain (journal).
4. (2014). "Increased Visibility of Deep Medullary Veins in Leukoaraiosis: A 3-T MRI Study". Frontiers in Aging Neuroscience.
5. (1990). "Leukoaraiosis: correlation of MR and CT findings with blood flow, atrophy, and cognition". AJNR Am J Neuroradiol.
6. (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]].
7. (2017). "Multiple Factors Involved in the Pathogenesis of White Matter Lesions". BioMed Research International.
8. (February 2012). "Harrison's Principles of Internal Medicine". McGraw-Hill.
9. (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.
10. 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.
11. 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