May 1, 2012

Age-related White Matter Changes

MR FLAIR images show multiple FLAIR hyperintense foci in bilateral periventricular and deep white matter in a 77-year-old patient.

  • Several possible mechanisms but at present it is believed to be an incomplete ischemia mainly related to cerebral small vessel arteriolosclerosis
  • Pathology: partial loss of myelin, axons, oligodendroglial cells; mild reactive gliosis, astrocytic gliosis, stenosis of arterioles from hyaline fibrosis
  • Important substrates for cognitive impairment and functional loss in the elderly
  • Very common in elderly with hypertension, diabetes, hyperlipidemai
  • Ill-defined hypodensities on CT
  • T1 hypointensities, T2/PD/FLAIR hyperintensities. FLAIR best to demonstrate severity of disease
  • When the largest lesion is adjacent to ventricles, it's called periventricular white matter changes
  • On diffusion tensor MRI, there is elevation of diffusivity and reduced fractional anisotrophy (FA) meaning impaired white matter integrity

Xiong YY, Mok V. Age-related white matter changes. J Aging Res 2011

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