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Department of Neurology (Drs. Fazekas, Offenbacher, Schmidt, G. Kleinert, Payer, and Lechner), Magnetic Resonance Institute (Drs. Fazekas, Offenbacher, Schmidt, Payer, and Lechner), and Institute of Pathology, Laboratory of Neuropathology (Drs. R. Kleinert and Radner), Karl-Franzens University, Graz, Austria.
We related the histopathologic changes associated with incidental white matter signal hyperintensities on MRIs from 11 elderly patients (age range, 52 to 82 years) to a descriptive classification for such abnormalities. Punctate, early confluent, and confluent white matter hyperintensities corresponded to increasing severity of ischemic tissue damage, ranging from mild perivascular alterations to large areas with variable loss of fibers, multiple small cavitations, and marked arteriolosclerosis. Microcystic infarcts and patchy rarefaction of myelin were also characteristic for irregular periventricular high signal intensity. Hyperintense periventricular caps and a smooth halo, however, were of nonischemic origin and constituted areas of demyelination associated with subependymal gliosis and discontinuity of the ependymal lining. Based on these findings, our classification appears to reflect both the different etiologies and severities of incidental MRI signal abnormalities, if it is modified to treat irregular periventricular and confluent deep white matter hyperintensities together.
Address correspondence and reprint requests to Dr. Franz Fazekas, Department of Neurology, Karl-Franzens University, Auenbruggerplatz 22, A-8036 Graz, Austria.
Received November 25,1992. Accepted for publication in final form January 25, 1993.
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S. R. Waldstein, E. L. Siegel, D. Lefkowitz, K. J. Maier, J. R. Pelletier Brown, A. M. Obuchowski, and L. I. Katzel Stress-Induced Blood Pressure Reactivity and Silent Cerebrovascular Disease Stroke, June 1, 2004; 35(6): 1294 - 1298. [Abstract] [Full Text] [PDF]
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M. Maruyama, T. Matsui, H. Tanji, M. Nemoto, N. Tomita, M. Ootsuki, H. Arai, and H. Sasaki Cerebrospinal Fluid Tau Protein and Periventricular White Matter Lesions in Patients With Mild Cognitive Impairment: Implications for 2 Major Pathways Arch Neurol, May 1, 2004; 61(5): 716 - 720. [Abstract] [Full Text] [PDF]
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M O'Sullivan, R G Morris, B Huckstep, D K Jones, S C R Williams, and H S Markus Diffusion tensor MRI correlates with executive dysfunction in patients with ischaemic leukoaraiosis J. Neurol. Neurosurg. Psychiatry, March 1, 2004; 75(3): 441 - 447. [Abstract] [Full Text] [PDF]
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P. Sachdev, W. Wen, R. Shnier, and H. Brodaty Cerebral Blood Volume in T2-Weighted White Matter Hyperintensities Using Exogenous Contrast Based Perfusion MRI J Neuropsychiatry Clin Neurosci, February 1, 2004; 16(1): 83 - 92. [Abstract] [Full Text] [PDF]
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A. Hassan, B. J. Hunt, M. O'Sullivan, R. Bell, R. D'Souza, S. Jeffery, J. M. Bamford, and H. S. Markus Homocysteine is a risk factor for cerebral small vessel disease, acting via endothelial dysfunction Brain, January 1, 2004; 127(1): 212 - 219. [Abstract] [Full Text] [PDF]
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M. J. Firbank, T. Minett, and J. T. O'Brien Changes in DWI and MRS associated with white matter hyperintensities in elderly subjects Neurology, October 14, 2003; 61(7): 950 - 954. [Abstract] [Full Text] [PDF]
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G B Frisoni, P h Scheltens, S Galluzzi, F M Nobili, N C Fox, P H Robert, H Soininen, L-O Wahlund, G Waldemar, and E Salmon Neuroimaging tools to rate regional atrophy, subcortical cerebrovascular disease, and regional cerebral blood flow and metabolism: consensus paper of the EADC J. Neurol. Neurosurg. Psychiatry, October 1, 2003; 74(10): 1371 - 1381. [Abstract] [Full Text] [PDF]
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M. O'Sullivan, P. M. Rich, T. R. Barrick, C. A. Clark, and H. S. Markus Frequency of Subclinical Lacunar Infarcts in Ischemic Leukoaraiosis and Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy AJNR Am. J. Neuroradiol., August 1, 2003; 24(7): 1348 - 1354. [Abstract] [Full Text] [PDF]
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D. M. Mezzapesa, M. A. Rocca, E. Pagani, G. Comi, and M. Filippi Evidence of Subtle Gray-Matter Pathologic Changes in Healthy Elderly Individuals With Nonspecific White-Matter Hyperintensities Arch Neurol, August 1, 2003; 60(8): 1109 - 1112. [Abstract] [Full Text] [PDF]
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R. H.C. Bisschops, C. J.M. Klijn, L. J. Kappelle, A. C. van Huffelen, and J. van der Grond Collateral flow and ischemic brain lesions in patients with unilateral carotid artery occlusion Neurology, May 13, 2003; 60(9): 1435 - 1441. [Abstract] [Full Text] [PDF]
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J. S. Pekala, A. C. Mamourian, H. A. Wishart, W. F. Hickey, and J. D. Raque Focal Lesion in the Splenium of the Corpus Callosum on FLAIR MR Images: A Common Finding with Aging and after Brain Radiation Therapy AJNR Am. J. Neuroradiol., May 1, 2003; 24(5): 855 - 861. [Abstract] [Full Text] [PDF]
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A. Hassan, B. J. Hunt, M. O'Sullivan, K. Parmar, J. M. Bamford, D. Briley, M. M. Brown, D. J. Thomas, and H. S. Markus Markers of endothelial dysfunction in lacunar infarction and ischaemic leukoaraiosis Brain, February 1, 2003; 126(2): 424 - 432. [Abstract] [Full Text] [PDF]
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P. Kapeller, R. Barber, R.J. Vermeulen, H. Ader, P. Scheltens, W. Freidl, O. Almkvist, M. Moretti, T. del Ser, P. Vaghfeldt, et al. Visual Rating of Age-Related White Matter Changes on Magnetic Resonance Imaging: Scale Comparison, Interrater Agreement, and Correlations With Quantitative Measurements Stroke, February 1, 2003; 34(2): 441 - 445. [Abstract] [Full Text] [PDF]
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Y. Tsushima, J. Aoki, and K. Endo Brain Microhemorrhages Detected on T2*-Weighted Gradient-Echo MR Images AJNR Am. J. Neuroradiol., January 1, 2003; 24(1): 88 - 96. [Abstract] [Full Text] [PDF]
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W.T. Longstreth Jr, C. Dulberg, T. A. Manolio, M. R. Lewis, N. J. Beauchamp Jr, D. O'Leary, J. Carr, and C. D. Furberg Incidence, Manifestations, and Predictors of Brain Infarcts Defined by Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study Stroke, October 1, 2002; 33(10): 2376 - 2382. [Abstract] [Full Text] [PDF]
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Y. Ge, R. I. Grossman, J. S. Babb, M. L. Rabin, L. J. Mannon, and D. L. Kolson Age-Related Total Gray Matter and White Matter Changes in Normal Adult Brain. Part I: Volumetric MR Imaging Analysis AJNR Am. J. Neuroradiol., September 1, 2002; 23(8): 1327 - 1333. [Abstract] [Full Text] [PDF]
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 A. J. Thomas, J. T. O'Brien, S. Davis, C. Ballard, R. Barber, R. N. Kalaria, and R. H. Perry Ischemic Basis for Deep White Matter Hyperintensities in Major Depression: A Neuropathological Study Arch Gen Psychiatry, September 1, 2002; 59(9): 785 - 792. [Abstract] [Full Text] [PDF]
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M. O'Sullivan, D. J. Lythgoe, A. C. Pereira, P. E. Summers, J. M. Jarosz, S. C.R. Williams, and H. S. Markus Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis Neurology, August 13, 2002; 59(3): 321 - 326. [Abstract] [Full Text] [PDF]
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T. Y. Wong, R. Klein, A. R. Sharrett, D. J. Couper, B. E. K. Klein, D.-P. Liao, L. D. Hubbard, T. H. Mosley, and for the ARIC Investigators Cerebral White Matter Lesions, Retinopathy, and Incident Clinical Stroke JAMA, July 3, 2002; 288(1): 67 - 74. [Abstract] [Full Text] [PDF]
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P. J. Harrison The neuropathology of primary mood disorder Brain, July 1, 2002; 125(7): 1428 - 1449. [Abstract] [Full Text] [PDF]
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K. Meguro, H. Ishii, S. Yamaguchi, J. Ishizaki, M. Shimada, M. Sato, R. Hashimoto, Y. Shimada, M. Meguro, A. Yamadori, et al. Prevalence of Dementia and Dementing Diseases in Japan: The Tajiri Project Arch Neurol, July 1, 2002; 59(7): 1109 - 1114. [Abstract] [Full Text] [PDF]
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H Yamauchi, H Fukuda, and C Oyanagi Significance of white matter high intensity lesions as a predictor of stroke from arteriolosclerosis J. Neurol. Neurosurg. Psychiatry, May 1, 2002; 72(5): 576 - 582. [Abstract] [Full Text] [PDF]
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