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Thursday, April 24, 2014
NetWellness receives many questions about small vessel ischemic disease (which is also called white matter disease or periventricular white matter change.) Although we cannot provide you with an interpretation of your specific MRI findings, we have put together some information that will hopefully help you understand the report.
"White matter change" is a very common finding on an MRI scan. Frequently, these changes are seen in patients who have/have had hypertension, stroke, migraine headaches, or other medical conditions.
As the brain ages, we tend to see a change in appearance around the fluid filled spaces (the ventricles). These changes are thought to be the long-term effects of atherosclerosis which cause less blood flow in these brain regions. Less blood flow means that the brain tissue can be irreversibly injured, which is referred to as "ischemic injury."
Some MRI reports may state that "perivascular chronic ischemic white matter disease of aging" is seen. We do know that we see increasing amount of these changes with age and see greater amounts of change in patients who have high blood pressure and diabetes. In a sense, this is the "end effect" on the brain of having risk factors such as hypertension or diabetes, although not all patients with either condition have such changes. Importantly, patients with these changes do not necessarily have any neurologic problems as a result, unless the changes are very severe. These changes accumulate slowly over time and the brain is able to compensate so that no function is lost.
There is some evidence to believe that having white matter changes does lead to a slightly increased risk of stroke. It is always worthwhile to work with your doctors to ensure that you are doing all that you can to reduce your total risk for stroke or heart attacks.
When blood flow to the brain is suddenly stopped, this is a stroke. A stroke is accompanied by clinical symptoms such as weakness on one side, slurred speech, visual problems, or problems with thinking or language. For example, a MRI report might mention left sided brain changes that suggest the appearance of a stroke. If this is the cause of a patient?s symptoms, you would expect to see findings such as a drooping of the right side of the face or perhaps slower/less movement on that side (because the left side of the brain controls the right side of the body).
High blood pressure is the single most important risk factor for stroke, and in a patient with diabetes it is crucial to control the blood pressure for optimal prevention of future strokes. Other important risk factors for stroke include high cholesterol, smoking, obesity, and physical inactivity. It is important to work with your physician to control these risk factors, which will lessen your chances of having a stroke or a heart attack.
If you want to seek an opinion from a specialist, it would be best to see a neurologist. Some neurologists have had special training in stroke, although stroke is a common problem and certainly any neurologist could provide an opinion.
This article is a NetWellness exclusive.
Last Reviewed: Dec 26, 2007
Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati