Uncertainty of leukoencephalopathies: a case report

Abstract Background Adult-onset leukoencephalopathies are a group of heterogeneous disorders characterized by white matter abnormalities. Leukoencephalopathy is usually encountered in children, but here we report a case with adult-onset leukoencephalopathy. Also, we explore this concept of uncertainty in medicine by discussing the approach to this case that has multiple possible etiologies. Case presentation A 70-year-old Caucasian male presented with a subacute onset of cognitive impairment and mood disturbances associated with behavioral changes. Neuroimaging demonstrated high-intensity lesions involving cerebral white matter. Progressive dementia and cognitive decline followed. Multiple possible etiologies are discussed based on the patient presentation and risk factors. Conclusion Adult-onset leukoencephalopathy can become a diagnostic challenge. Certain approaches need to be developed to explore the uncertainty of such conditions and to improve diagnostic yield.

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Vascular lesions and functional limitations among older adults: does depression make a difference?

International Psychogeriatrics ◽

10.1017/s1041610214000829 ◽

2014 ◽

Vol 26 (9) ◽

pp. 1501-1509 ◽

Cited By ~ 5

Author(s):

Celia F. Hybels ◽

Carl F. Pieper ◽

Lawrence R. Landerman ◽

Martha E. Payne ◽

David C. Steffens

Keyword(s):

Risk Factors ◽

Older Adults ◽

White Matter ◽

Functional Impairment ◽

Functional Limitations ◽

Late Life ◽

Cognitive Status ◽

Cerebral White Matter ◽

Late Life Depression ◽

Increased Risk

ABSTRACTBackground:The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.Methods:The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.Results:In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.Conclusions:These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

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CNS demyelination in monoclonal gammopathy of undetermined significance (MGUS): possible cause of a dementia syndrome

European Psychiatry ◽

10.1016/0924-9338(96)80458-5 ◽

1996 ◽

Vol 11 (1) ◽

pp. 46-49 ◽

Cited By ~ 1

Author(s):

H Hampel ◽

C Schneider ◽

C Hock ◽

F Müller-Spann ◽

M Ackenheil

Keyword(s):

White Matter ◽

Monoclonal Gammopathy ◽

Demyelinating Disease ◽

Cerebral White Matter ◽

Progressive Dementia ◽

Dementia Syndrome ◽

Cns Demyelination ◽

Possible Cause ◽

Undetermined Significance

SummaryIn acquired peripheral demyelinating disease only few publications point out the possibility of simultaneous involvement of the CNS. We describe two patients with chronic polyneuropathy and monoclonal gammopathy of undetermined significance (MGUS) developing a progressive dementia syndrome with extensive cerebral white matter alterations.

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Vascular risk factors, atherosclerosis, cerebral white matter lesions and cerebral perfusion in a population-based study

European Journal of Nuclear Medicine ◽

10.1007/bf00834530 ◽

1996 ◽

Vol 23 (6) ◽

pp. 675-682 ◽

Cited By ~ 26

Author(s):

J. J. Claus ◽

M. M. B. Breteler ◽

D. Hasan ◽

E. P. Krenning ◽

M. L. Bots ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

Cerebral Perfusion ◽

White Matter Lesions ◽

Population Based ◽

Vascular Risk Factors ◽

Cerebral White Matter ◽

Vascular Risk ◽

Population Based Study ◽

Cerebral White Matter Lesions

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Silent Cerebral White Matter Lesions and Their Relationship With Vascular Risk Factors in Middle-Aged Predialysis Patients With CKD

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2005.10.029 ◽

2006 ◽

Vol 47 (2) ◽

pp. 241-250 ◽

Cited By ~ 46

Author(s):

Alberto Martinez-Vea ◽

Esther Salvadó ◽

Alfredo Bardají ◽

Cristina Gutierrez ◽

Ana Ramos ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

White Matter Lesions ◽

Vascular Risk Factors ◽

Cerebral White Matter ◽

Vascular Risk ◽

Middle Aged ◽

Cerebral White Matter Lesions

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The Association between Cerebral White Matter Lesions and Plasma Omega-3 to Omega-6 Polyunsaturated Fatty Acids Ratio to Cognitive Impairment Development

BioMed Research International ◽

10.1155/2015/153437 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Michihiro Suwa ◽

Shigeru Yamaguchi ◽

Tsuyoshi Komori ◽

Sachiko Kajimoto ◽

Masaya Kino

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Cognitive Function ◽

White Matter ◽

White Matter Lesions ◽

White Matter Hyperintensity ◽

Cerebral White Matter ◽

Omega 3 ◽

Arachidonic Acids ◽

Low Serum

Objective. Cerebral white matter hyperintensity (WMH) with magnetic resonance imaging (MRI) has a potential for predicting cognitive impairment. Serum polyunsaturated fatty acid (PUFA) levels are important for evaluating the extent of atherosclerosis. We investigated whether abnormal PUFA levels affected WMH grading and cognitive function in patients without significant cognitive impairment.Methods. Atherosclerotic risk factors, the internal carotid artery (ICA) plaque, and serum ratios of eicosapentaenoic to arachidonic acids (EPA/AA) and docosahexaenoic to arachidonic acids (DHA/AA) were assessed in 286 patients. The relationship among these risk factors, WMH, and cognitive function was evaluated using WMH grading and the Mini-Mental State Examination (MMSE).Results. The development of WMH was associated with aging, hypertension, ICA plaques, and a low serum EPA/AA ratio (<0.38, obtained as the median value) but was not related to dyslipidemia, diabetes, smoking, and a low serum DHA/AA ratio (<0.84, obtained as the median value). In addition, the MMSE score deteriorated slightly with the progression of WMH (29.7 ± 1.0 compared to 28.4 ± 2.1,P<0.0001).Conclusions. The progression of WMH was associated with a low serum EPA/AA ratio and accompanied minimal deterioration in cognitive function. Sufficient omega-3 PUFA intake may be effective in preventing the development of cognitive impairment.

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A High Burden of Cerebral white Matter Lesion: Evidences from 9 Asian Cities

10.21203/rs.3.rs-124194/v1 ◽

2020 ◽

Author(s):

Bonnie Yin Ka Lam ◽

Brian Yiu ◽

Encarnita Ampil ◽

Christopher Li-Hsian Chen ◽

Yustiani Dikot ◽

...

Keyword(s):

Risk Factors ◽

White Matter ◽

Cognitive Performance ◽

Small Vessel Disease ◽

White Matter Lesion ◽

Large Population ◽

Significant Risk ◽

Cerebral White Matter ◽

Age Related ◽

Asian Cities

Abstract Background Age-related white matter lesion (WML) is considered a manifestation of sporadic cerebral small vessel disease and an important pathological substrate for dementia. Asia is notable for its large population with a looming dementia epidemic. Yet, the burden of WML and its associated risk factors across different Asian societies are unknown. Methods Subjects from 9 Asian cities (Bangkok, Bandung, Beijing, Bengaluru, Hong Kong, Kaohsiung, Manila, Seoul, and Singapore) were recruited (n = 5,701) and classified into i) stroke/transient ischemic attack (TIA), ii) Alzheimer’s disease (AD)/mild cognitive impairment (MCI), or iii) control groups. Data on vascular risk factors and cognitive performance were collected. The severity of WML was visually rated on MRI or CT. ResultsThe prevalence of moderate-to-severe WML was the highest in subjects with stroke/TIA (43.3 %). Bandang Indonesia showed the highest prevalence of WML, adjusted for age, sex, education and disease groups. Hypertension and hyperlipidemia were significant risk factors for WML, and WML was negatively associated with MMSE in all groups. ConclusionsWML is highly prevalent in Asia and is associated with increasing age, hypertension, hyperlipidemia and worse cognitive performance. Concerted efforts to prevent WML will alleviate the huge dementia burden in the rapidly aging Asian societies.

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Cerebral white matter damage in the preterm infant: pathophysiology and risk factors

Seminars in Neonatology ◽

10.1053/siny.2001.0043 ◽

2001 ◽

Vol 6 (2) ◽

pp. 121-133 ◽

Cited By ~ 51

Author(s):

Elie Saliba ◽

Stéphane Marret

Keyword(s):

Risk Factors ◽

White Matter ◽

Preterm Infant ◽

Cerebral White Matter ◽

White Matter Damage

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Association of enlarged perivascular spaces and anticoagulant-related intracranial hemorrhage

Neurology ◽

10.1212/wnl.0000000000010788 ◽

2020 ◽

Vol 95 (16) ◽

pp. e2192-e2199 ◽

Cited By ~ 1

Author(s):

Jonathan G. Best ◽

Carmen Barbato ◽

Gareth Ambler ◽

Houwei Du ◽

Gargi Banerjee ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

White Matter ◽

Basal Ganglia ◽

Intracranial Hemorrhage ◽

Cox Regression ◽

Significant Risk ◽

Cerebral White Matter ◽

Perivascular Spaces ◽

Univariable Analysis

ObjectiveTo investigate whether enlarged perivascular spaces (PVS) within the basal ganglia or deep cerebral white matter are risk factors for intracranial hemorrhage in patients taking oral anticoagulants (OACs), independent of established clinical and radiologic risk factors, we conducted a post hoc analysis of Clinical Relevance of Microbleeds in Stroke (CROMIS-2) (atrial fibrillation [AF]), a prospective inception cohort study.MethodsPatients with atrial fibrillation and recent TIA or ischemic stroke underwent standardized MRI prior to starting OAC. We rated basal ganglia PVS (BGPVS) and centrum semiovale PVS (CSOPVS), cerebral microbleeds (CMBs), white matter hyperintensities, and lacunes. We dichotomized the PVS rating using a threshold of >10 PVS in the relevant region of either cerebral hemisphere. The primary outcome was symptomatic intracranial hemorrhage (sICH). We identified risk factors for sICH using Cox regression.ResultsA total of 1,386 participants with available clinical and imaging variables were followed up for a mean of 2.34 years; 14 sICH occurred (11 intracerebral). In univariable analysis, diabetes, CMB presence, lacune presence, and >10 BGPVS, but not CSOPVS, were associated with sICH. In a multivariable model incorporating all variables with significant associations in univariable analysis, >10 BGPVS (hazard ratio [HR] 8.96, 95% [CI] 2.41–33.4, p = 0.001) and diabetes (HR 3.91, 95% CI 1.34–11.4) remained significant risk factors for sICH.ConclusionEnlarged BGPVS might be a novel risk factor for OAC-related ICH. The strength of this association and potential use in predicting ICH in clinical practice should be investigated in larger cohorts.

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