Should we standardize PhD training in neuroscience? TE
http://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI. White matter lesions are much more common in older or elderly people. Before Non-specific white matter lesions are sometimes seen in people withmigraine. (A) Mean childhood IQ (average from measurements at ages 7, 9 and 11) for each of the WMH volume groups. Armstrong NJ, Mather KA, Sargurupremraj M, Knol MJ, Malik R, Satizabal CL, Yanek LR, Wen W, Gudnason VG, Dueker ND, Elliott LT, Hofer E, Bis J, Jahanshad N, Li S, Logue MA, Luciano M, Scholz M, Smith AV, Trompet S, Vojinovic D, Xia R, Alfaro-Almagro F, Ames D, Amin N, Amouyel P, Beiser AS, Brodaty H, Deary IJ, Fennema-Notestine C, Gampawar PG, Gottesman R, Griffanti L, Jack CR Jr, Jenkinson M, Jiang J, Kral BG, Kwok JB, Lampe L, C M Liewald D, Maillard P, Marchini J, Bastin ME, Mazoyer B, Pirpamer L, Rafael Romero J, Roshchupkin GV, Schofield PR, Schroeter ML, Stott DJ, Thalamuthu A, Trollor J, Tzourio C, van der Grond J, Vernooij MW, Witte VA, Wright MJ, Yang Q, Morris Z, Siggurdsson S, Psaty B, Villringer A, Schmidt H, Haberg AK, van Duijn CM, Jukema JW, Dichgans M, Sacco RL, Wright CB, Kremen WS, Becker LC, Thompson PM, Mosley TH, Wardlaw JM, Ikram MA, Adams HHH, Seshadri S, Sachdev PS, Smith SM, Launer L, Longstreth W, DeCarli C, Schmidt R, Fornage M, Debette S, Nyquist PA. Stroke. Requests require a concept paper describing the purpose of data access, ethical approval at the applicants university and provision for secure data access. Psychiatry Res. White matter hyperintensities (WMH) are very frequent in older adults and associated with worse cognitive performance. 25-year-old female patient, not known to have any chronic illness, presented with migraine without aura for 6-year duration of grade II severity, not responding to medical treatment. Studies have found that white matter lesions appear in some degree on brain scans of most older adults but less often in younger people. They are associated with subtle functional impairment and higher prevalence of neuropsychiatric disorders. government site. abnormal structure and function of myelin, usually secondary to a hereditary disorder. This tissue contains millions of nerve fibers, or. While there is robust evidence that WMHs are related to cognitive decline in older adults (Debette and Markus, 2010; Prins and Scheltens, 2015), our study provides initial evidence that this relationship begins by midlife. Gray matter reduction is correlated with white matter hyperintensity volume: a voxel-based morphometric study in a large epidemiological sample. Methods: Sixty volunteers from a tertiary headache center were . The cohort represents the full range of socioeconomic status in the general population of South Island, New Zealand (Poulton et al., 2015). Second, WMH volume was log-transformed for normality. "However, in many cases, the white matter. Published by Oxford University Press on behalf of the Guarantors of Brain. Background: White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. Sometimes, white matter disease, particularly when it is severe, caninterfere with the way the brain works and the processes that it controls, including thinking and walking. White matter is the deepest part of the brain that contains millions of nerve fibres connecting other parts of the brain and spinal cord. Sex and total brain volume were used as covariates in all analyses. Traumatic brain injury (TBI) is a leading cause of death and disability in the U.S., contributing to about 30 percent of all injury deaths, according to the CDC. Close more info about Differentiating Multiple Sclerosis Mimics on MRI. We'll send you our print magazine 6x per year! The accurate diagnosis of multiple sclerosis (MS) typically presents several challenges: There is no definitive test for the disease, and symptoms vary widely between patients. Abnormalities in white matter, known as lesions, are most often seen as bright areas or spots on MRI scans of the brain. I had a followed up lumbar punction which was negative for MS. At the time I experience paresthesia on my right thigh, which are gone now. However, an accurate diagnosis can be made only after thorough review of images obtained from the entire brain and by understanding the clinical context, Drs Lange and Melisaratos concluded. (C) Association between WMH volume and cognitive decline. Sometimes, white matter lesions are caused by inflammation of the brain. The pathogenesis of many white matter diseases remains poorly understood. The cohort matches the New Zealand National Health and Nutrition Survey on adult health indicators (e.g. They can reflect normal aging; white matter deteriorates as people age. Is it meaningful? First visit: Unauthorized use of these marks is strictly prohibited. doi: 10.7759/cureus.18708. Do you want to book the appointment in any case? Conclusion By means of comparative image analysis and the recognition of characteristic lesion patterns, taking into account anatomical principles and pathophysiological processes, the differential diagnostic classification of cerebral white matter lesions and associated diseases can be significantly facilitated. Al-Hashel JY, Alroughani R, Gad K, Al-Sarraf L, Ahmed SF. White matter hyperintensities proliferate as the brain ages and are associated with increased risk for cognitive decline as well as Alzheimers disease and related dementias. HHS Vulnerability Disclosure, Help This site needs JavaScript to work properly. The dataset reported in the current article is not publicly available due to the lack of informed consent and ethical approval but is available from the corresponding author on reasonable request by qualified scientists. Genetic and Environmental Effects on the Development of White Matter Hyperintensities in a Middle Age Twin Population. Preparation for kNN classification feature, Preparation for kNN classification feature space: ( a ) A candidate WMH cluster, Some kNN classification results. BMI = body mass index. (/?<0.002) was detected in the 51-70-year-old group with WMLs (Table 1). The mean age of the study population was 63.3 years (range, 45.7 to 96.7), and 1049 of the subjects (52.4%) were women. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r = 0.331, p = 0.001) and the duration since migraine onset (r = 0.264, p = 0.012). coined the term leuko-araiosis (white matter rarefaction) to describe and define it. The first possibility is that children with lower IQs tend to be born into or seek out environments that lead to higher rates of neurodegeneration (e.g. 40 years) with no typical vascular risk factors and/or with a suggestive family history, clinicians should con-sider a monogenic small-vessel disease (Case 4). Longitudinal studies have shown that WMHs tend to grow and expand from existing lesions and that higher baseline volumes predict faster accumulation of WMHs and more rapid cognitive decline in older adults (Maillard et al., 2012; Prins and Scheltens, 2015). 150. official website and that any information you provide is encrypted MRI of her brain showed diffuse hyperintensities on T 2-weighted and fluid attenuated inversion recovery images in the bilateral cerebral white matter.Laboratory examination revealed sustained high levels of serum KL-6. Neuromyelitis optica spectrum disorders (NMOSD) also share several characteristics with MS and need to be ruled out. These abnormalities can also be seen in elderly people and patients with stroke and dementia. 2013;34(11):2972-2985. doi:10.1002/hbm.22119 . Bethesda, MD 20894, Web Policies By continuing to use our site, you consent to the use of these cookies. Clipboard, Search History, and several other advanced features are temporarily unavailable. Very often the lesions themselves don't cause any noticeable problems. The .gov means its official. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com. Rhrig L, Sperber C, Bonilha L, Rorden C, Karnath HO. Dr Schiess added that ancillary testing, including blood work, CSF findings, optical coherence tomography (OCT), and evoked potentials can also facilitate diagnosis. (B) Log-transformation of the volume distribution in A. Monophasic lesions of the CNS white matter as occurred in our IBD cases have also been documented, although less frequently. White matter lesions can be seen in a range of neurologic disorders, most often with vascular diseases such as stroke, migraine, and multiple sclerosis (MS). This finding suggests at least two potential pathways for the development of WMHs. Neurology. Risk factors of white matter hyperintensities in migraine patients. Additional support was provided by the Jacobs Foundation. Longstreth
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, Reduced coupling between offline neural replay events and default mode network activation in schizophrenia, Cognitive correlates of antisaccade behaviour across multiple neurodegenerative diseases, Uncovering spatiotemporal patterns of atrophy in progressive supranuclear palsy using unsupervised machine learning, Brain-derived neurotrophic factor released from blood platelets prevents dendritic atrophy of lesioned adult central nervous system neurons. Intervention efforts targeting WMHs as a surrogate biomarker in older adults have had mixed results (Prins and Scheltens, 2015). The left column presents a raw FLAIR image for three representative participants with low, intermediate and high WMH load. The clinical presentation of characteristic focal neurologic attacks as well as ruling out other MS mimics is essential to making an accurate diagnosis, she told Neurology Advisor. e.g. Maillard
For further information, read our Privacy Policy. Geissler et al1 reported that 42% of patients with Crohn's disease (CD) and 46% with ulcerative colitis (UC) have small white-matter lesions (WML) on magnetic resonance imaging (MRI) brain scans. White spots on a brain MRI are not always a reason to worry. Axial . Youve read {{metering-count}} of {{metering-total}} articles this month. Background: Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. Difficulty performing two or more activities at once, such as walking and talking at the same time. Brain scans requested in this situation can be reassuring but they may show unexpected or incidental findings. In a population-representative birth cohort of individuals now in midlife, we found that WMHs are (i) common, (ii) associated with cognitive abilities in childhood and midlife and (iii) associated with cognitive decline from childhood to midlife. Incidental white matter hyperintensities are common in brains of healthy individuals in their 60s and may be seen as early as the 30s and 40s. Diagnosing Organic Causes of Schizophrenia Spectrum Disorders: Findings from a One-Year Cohort of the Freiburg Diagnostic Protocol in Psychosis (FDPP). More recent MRI technology has enabled doctors to study them more carefully and to recognize them as indicators of illness. All variables were z-transformed so that the resulting betas () were standardized, allowing direct comparisons of effect sizes across regressions. He then completed a PhD on inflammation and cytokine regulation in stroke and undertook specialist training as a clinical lecturer in neurology at the Walton Centre for Neurology & Neurosurgery in Liverpool. Fourth, the association between volume and change in IQ was tested using ordinary least squares multiple regression. All statistical analyses were done using R (v.3.4.5). 2007 Jan 16;68(3):214-22. doi: 10.1212/01.wnl.0000251302.55202.73. One way to avoid getting lesions is to keep your brain as healthy as possible by preventing or controlling high blood pressure, diabetes, and other vascular risk factors. , Viqar F, Zimmerman ME, Narkhede A, Tosto G, Benzinger TLS, et al. There is confluence (merging together) so that there is a cloud surrounding the upper ventricles. His areas of expertise include vascular neurology, stroke, cerebrovascular disease, late-onset epilepsy, migraine and neurological disorders. An official website of the United States government. Sample sizes for each group from the lowest to the highest WMH volume were 57, 65, 128, 336, 133, 83 and 41. Deterioration of the white matter happens with ageing and can be seen on brain scans as white matter lesions (abnormal areas). This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Genetic factors, alone or in interaction with environmental factors, appear to be important. Department of Psychology & Neuroscience, Duke University. Case 4 A 32-year-old woman born of consanguineous parents gave a 3-year history of slowly progressive gait distur-bance, headaches and subcortical cognitive dysfunc-tion. 3B) and individuals with the highest volume had adult IQs that were 8.91 points lower than those with the lowest volume. Please login or register first to view this content. Ferreira Tt C, Massas M, Pinto F, Caador N, Silva AL. Larger WMH volume was associated with lower IQ in childhood ( = 0.08, 95% CI = 0.15 to 0.02; P=0.013; Fig. Recent findings: Additionally, careful assessment of the so-called MRI red flags, such as the presence of infarcts, microbleeds, meningeal enhancement, and calcifications, among others, are very helpful in suggesting a diagnosis other than MS, according to research published in the Handbook of Clinical Neurology.3. results of a one-year exercise intervention. White matter hyperintensities are of presumed vascular origin and are frequently observed in older adults as well as in patients with AD (Brickman, Muraskin, & Zimmerman, 2009; Dadar et al., 2015). Our results demonstrate that a link between white matter hyperintensities and early signs of cognitive decline is detectable decades before clinical symptoms of dementia emerge. The right column presents UBO labelling (red) of WMHs in the raw images from the left column. Due to their compounding growth during aging, WMHs may be especially useful for selecting individuals in midlife who are at the highest risk for future cognitive decline and who may most benefit from early prevention. We found that white matter hyperintensities were common at age 45 and that white matter hyperintensity volume was modestly associated with both lower childhood ( = 0.08, P=0.013) and adult IQ (=0.15, P<0.001). Here, we tested the hypotheses that WMHs are detectable in midlife and already associated with cognitive decline from childhood in a population-representative birth cohort aged 45years. Lastly, participants with larger WMH volume experienced more cognitive decline by midlife ( = 0.09, 95% CI = 0.13 to 0.02; P<0.001; Fig. Write by: . , Liu T, Zhu W, Koncz R, Liu H, Lee T, et al. For example, lesions in the brain cause multiple sclerosis. Periventricular white matter lesions Periventricular white matter changes (3-13 mm from the ventricular surface) are thought to be haemodynamically determined rather than only related to small vessel disease 8. Neuroimage Clin. Purpose of review: Regression of leukoaraiosis in 20%40% of affected patients over a period of several years with . Despite VDC33 and VDC66, VFLAIR remained a significant predictor on overall performance over the follow-up period in VADAS and executive functions. CONCLUSIONS: Even in relatively healthy 43- to 56-year-old subjects with small white matter lesion burden, structural and functional MR imaging in penumbral tissue reveals significant signal abnormalities versus white matter lesions and other normal WM. Note that UBO labelling in septal regions was removed from the estimation of WMH volume using an exclusion mask. Distribution of WMHs in 45-year-old participants from the Dunedin Study. Top Doctors. The cohort is primarily white (93%), which matches the demographics of the South Island (Poulton et al., 2015). is supported by the National Science Foundation Graduate Research Fellowship (Grant No. Scenario 5: Patient with a lung mass and brain lesions. Schindler LS, Subramaniapillai S, Barth C, van der Meer D, Pedersen ML, Kaufmann T, Maximov II, Linge J, Leinhard OD, Beck D, Gurholt TP, Voldsbekk I, Suri S, Ebmeier KP, Draganski B, Andreassen OA, Westlye LT, de Lange AG. 3C). We found that 218 (50.9%) subjects had WMHs. Neurology. Tracy dArbeloff, Maxwell L Elliott, Annchen R Knodt, Tracy R Melzer, Ross Keenan, David Ireland, Sandhya Ramrakha, Richie Poulton, Tim Anderson, Avshalom Caspi, Terrie E Moffitt, Ahmad R Hariri, White matter hyperintensities are common in midlife and already associated with cognitive decline, Brain Communications, Volume 1, Issue 1, 2019, fcz041, https://doi.org/10.1093/braincomms/fcz041. 2022 Apr 29;22(1):159. doi: 10.1186/s12883-022-02680-8. First, descriptive statistics was generated for the sample as a whole (Table1). 2022 Oct 10;58(10):1425. doi: 10.3390/medicina58101425. This is important because even sub-clinical cognitive decline impacts daily functioning and psychological well-being (Tucker-Drob, 2011). J
Each participant was scanned using a Siemens Skyra 3T scanner equipped with a 64-channel head/neck coil at the Pacific Radiology imaging centre in Dunedin, New Zealand. Alijanpourotaghsara A, Strelnikov D, Piroska M, Szalontai L, Forgo B, Jokkel Z, Persely A, Hernyes A, Kozak LR, Szabo A, Maurovich-Horvat P, Tarnoki AD, Tarnoki DL. Some studies have found that white matter lesions tend to be seen on the majority of brain scans in older adults but are far less frequently seen on brain scans in younger people. As such, white matter hyperintensities have been targeted as a surrogate biomarker in intervention trials with older adults. Inaccurate MRI interpretation is the most common cause of incorrect diagnoses in patients with MS, underscoring the critical importance of the physicians familiarity with MS mimics.2 Taking a thorough medical history focused on questioning the patient about prior neurological episodes that might have been overlooked or dismissed by the patient remains crucial in any assessment for MS, said Nicoline Schiess MD, MPH, an assistant professor of neurology at Johns Hopkins University Multiple Sclerosis Center. Scanned participants did not differ from other living participants on childhood social economic status (SES) or childhood intelligent quotient (IQ) (see attrition analysis in the Supplementary material). 2021 Oct 12;13(10):e18708.