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Stroke

Diffuse white matter changes

11/09/2007

Question:

My husband is a 56y/o male w/hx of total frontal sinus ablation, HTN, diabetes both controlled A1C 6.6; previous triglicerides had reached 1500 now down to normal on meds. has frequent H/A had MRI impession was diffuse white matter changes most of these are small, but there are from 30-50 in the centrum semiovale areas bilaterally. A demyelinating process is strongly suspected. post contrast images demonstrate no enhancing abnormality to suggest an inflammatory, neoplastic, or ischemic process. sagital T-1 weighted images demonstrate deepening of the sulci and increased ventricular size. Axial images demonstrate ethmoid and particularly frontal sinusitis bilaterally. T-2 weighted and FLAIR images demonstrate mild periventricular white matter changes which are fairly diffuse in the centrum semiovale. He was also exposed to agent orange in Viet Nam. For his age this seems like a great deal more lesions than you would see in an elderly person that has had HTN. What do you think we are looking towards with his progression. He had an MRI a couple of yrs ago and at that time there were a couple of noted lesions that was said to be vascular in nature r/t to his HTN and diabetes. Could this truly be a demylenating progress or is it a progression of atheroscerosis. If demylenating, what possable dx and physical/mental changes could we be looking at. We are scheduled to see a neurologist, but are living in a small rural area that has very limited choices in care.

Answer:

White matter changes are extremely common on patients with hypertension and possibly the cause in your husband's case. However, given the relatively young age of your husband, it is prudent to exclude other etiologies before we say it is hypertension related. I strongly suggest evaluation by a stroke neurologist who will be able to determine the cause of these white matter changes especially that your husband is relatively young.

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Response by:

Yousef  Mohammad, MD, MSc Yousef Mohammad, MD, MSc
Assistant Professor
Director, Stroke Fellowship Program
College of Medicine
The Ohio State University