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  • Updated 07.23.2023
  • Released 02.18.2005
  • Expires For CME 07.23.2026

White matter abnormalities in the brain



The presence of white matter abnormalities in the brain of both symptomatic and asymptomatic individuals has been a source of interest for over a century. CT and MRI detection of these lesions has become more sensitive than even autopsy. Clinical studies have associated these lesions with cognitive decline, gait impairment, and increased cerebrovascular disease and death risk. The etiology of white matter abnormalities varies from cerebrovascular disease to metabolic and demyelinating disorders. This article primarily focuses on cerebrovascular disease.

Key points

• White matter abnormalities are present in at least 10% of individuals older than 65 years of age.

• These lesions correlate with an increased risk of cognitive impairment, stroke, and death.

• The causes of white matter abnormalities are many and not fully understood.

Historical note and terminology

In 1894, Binswanger described a male with syphilis who suffered from leg weakness, arm tremors, progressive cognitive decline, including speech and memory, depression, and personality change (12; 13). Although autopsy demonstrated white matter atrophy, Binswanger did not realize the significance of this finding (145). In 1902, Alzheimer described a similar case and attributed the white matter changes to arteriosclerosis of the long, penetrating vessels (02; 146). It was not until 1962 that Binswanger's case was diagnosed as syphilis, and the term “subcortical arteriosclerotic encephalopathy” was proposed to describe cerebral arteriosclerosis affecting vessels of the white matter and subcortical grey matter (124).

CT brain scan, followed by MRI, revealed cerebral white matter changes in both asymptomatic and cognitively impaired individuals (140; 185; 20; 59). These changes appear as hypodensities on CT and are described as white matter lucencies, leukoencephalopathy, or leukoaraiosis. On T2-weighted MRI, these lesions appear hyperintense and are called white matter abnormalities, white matter hyperintensities, cerebral white matter changes, or unidentified bright objects. MRI is more sensitive to these changes (58). Therefore, these white matter changes will be referred to herein as white matter abnormalities.

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