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PubMed1996

Alterations of the blood-brain barrier and glial cells in white-matter lesions in cerebrovascular and Alzheimer's disease patients.

BACKGROUND AND PURPOSE: The underlying cause of white-matter lesions, which are frequent findings in cerebrovascular disease (CVD) and Alzheimer's disease (AD), remains uncertain. We performed immunohistochemical analysis of serum protein extravasation to investigate the function of the blood-brain barrier in white-matter lesions. METHODS: White-matter lesions were estimated by use of Kluver-Barrera staining in patients diagnosed clinicopathologically as having ischemic CVD (n = 14) and AD (n = 12) and from nonneurological control subjects (n = 6). Axonal damages were investigated by use of immunohistochemistry for amyloid protein precursor. Alteration of the blood-brain barrier was examined with fibrinogen and immunoglobulins used as markers. The numbers of HLA-DR-positive microglia and glial fibrillary acidic protein-positive astroglia were examined comparatively. RESULTS: White-matter lesions were graded as normal (grade 0) in 14 of the 32 cases (44%), slight (grade I) in 10 cases (31%), moderate (grade II) in 6 cases (19%), and severe (grade III) in 2 cases (6%). Amyloid precursor protein was accumulated most frequently in grade II white-matter lesions. Immunohistochemistry for serum proteins labeled astroglial cell bodies and their processes, which seemed to have sequestered extravasated proteins. The groups with detectable white-matter lesions had significantly higher grading scores for fibrinogen and immunoglobulins than the control group (P < .05). Although the higher scores for serum protein extravasation were statistically significant in ischemic CVD cases (P < .05), there was no significant increase in AD cases. Activated microglia and astroglia were more numerous in the groups with white-matter lesions in both ischemic CVD and AD cases, although this increase in the number of astroglia was not evident in regions with clasmatodendrosis. CONCLUSIONS: Dysfunction of the blood-brain barrier is more prominent in white-matter lesions seen in ischemic CVD than in AD and may have a role in the pathogenesis of cerebrovascular white-matter lesions.

Aged↗
PubMed2000

Aortic atherosclerosis at middle age predicts cerebral white matter lesions in the elderly.

BACKGROUND AND PURPOSE: MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with cognitive impairment and dementia. A relation between atherosclerosis and white matter lesions was found in some small cross-sectional studies. However, atherosclerosis is a gradual process that starts early in life. We investigated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions. METHODS: We randomly sampled subjects between 60 and 90 years old from 2 population-based follow-up studies in which subjects had their baseline examinations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 to 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were rated in the deep subcortical and periventricular regions separately. Aortic atherosclerosis was assessed on abdominal radiographs that were obtained from 276 subjects in midlife and 531 subjects in late life. RESULTS: The presence of aortic atherosclerosis during midlife was significantly associated with the presence of periventricular white matter lesions approximately 20 years later (adjusted relative risk, 2.4; 95% CI, 1.2 to 5.0); the relative risks increased linearly with the severity of aortic atherosclerosis. No association was found between midlife aortic atherosclerosis and subcortical white matter lesions (adjusted relative risk, 1.1; 95% CI, 0.5 to 2.3) or between late-life aortic atherosclerosis and white matter lesions. CONCLUSIONS: The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife. The critical period for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable.

Age Factors↗
PubMed2000

White matter injury in spinal cord ischemia: protection by AMPA/kainate glutamate receptor antagonism.

BACKGROUND AND PURPOSE: Spinal cord ischemia is a serious complication of surgery of the aorta. NMDA receptor activation secondary to ischemia-induced release of glutamate is a major mechanism of neuronal death in gray matter. White matter injury after ischemia results in long-tract dysfunction and disability. The AMPA/kainate receptor mechanism has recently been implicated in white matter injury. METHODS: We studied the effects of AMPA/kainate receptor blockade on ischemic white matter injury in a rat model of spinal cord ischemia. RESULTS: Intrathecal administration of an AMPA/kainate antagonist, 6-nitro-7-sulfamoyl-(f)-quinoxaline-2, 3-dione (NBQX), 1 hour before ischemia reduced locomotor deficit, based on the Basso-Beattie-Bresnahan scale (0=total paralysis; 21=normal) (sham: 21+/-0, n=3; saline: 3.7+/-4.5, n=7; NBQX: 12. 7+/-7.0, n=7, P<0.05) 6 weeks after ischemia. Gray matter damage and neuronal loss in the ventral horn were evident after ischemia, but no difference was noted between the saline and NBQX groups. The extent of white matter injury was quantitatively assessed, based on axonal counts, and was significantly less in the NBQX as compared with the saline group in the ventral (sham: 1063+/-44/200x200 microm, n=3; saline: 556+/-104, n=7; NBQX: 883+/-103, n=7), ventrolateral (sham: 1060+/-135, n=3; saline: 411+/-66, n=7; NBQX: 676+/-122, n=7), and corticospinal tract (sham: 3391+/-219, n=3; saline: 318+/-23, n=7; NBQX: 588+/-103, n=7) in the white matter on day 42. CONCLUSIONS: Results indicate severe white matter injury in the spinal cord after transient ischemia. NBQX, an AMPA/kainate receptor antagonist, reduced ischemia-induced white matter injury and improved locomotor function.

Animals↗
PubMed1997

Planum temporale asymmetry reversal in schizophrenia: replication and relationship to gray matter abnormalities.

OBJECTIVE: The planum temporale, the posterior superior surface of the superior temporal gyrus, is a highly lateralized brain structure involved with language. In schizophrenic patients the authors previously found consistent reversal of the normal left-larger-than-right asymmetry of planum temporale surface area. The original subjects plus new patients and comparison subjects participated in this effort to replicate and extend the prior study. METHOD: High-resolution magnetic resonance imaging of 28 schizophrenic patients and 32 group-matched normal subjects was performed. The authors measured planum temporale surface area, gray matter volume underlying the planum temporale, and gray matter thickness. Asymmetry indices for areas and volumes were calculated. RESULTS: Overall gray matter and total brain volume were not significantly smaller in the patients than in the comparison subjects. As previously reported, there was striking reversal of the normal asymmetry for planum temporale surface area in the male and female schizophrenic subjects. Bilaterally, gray matter volume beneath the planum temporale was smaller in the schizophrenic patients, and the gray matter thickness of the right planum temporale was only 50% of the comparison value. Volume of planum temporale gray matter did not show significant asymmetry in either group. CONCLUSIONS: This study extends the finding of reversed planum temporale surface area asymmetry in schizophrenic patients and clarifies its relationship to underlying gray matter volume. Although right planum temporale surface area is larger than normal in schizophrenia, gray matter volume is less than the comparison value; thus, gray matter thickness is substantially less than normal.

Adult↗
PubMed2003

Distribution of microtubule-associated protein MAP2-immunoreactive interstitial neurons in the parahippocampal white matter in subjects with schizophrenia.

OBJECTIVE: Evidence suggests that schizophrenia is a neurodevelopmental disorder that may involve abnormal connectivity between various cortical and subcortical brain areas. The parahippocampal gyrus is an area important for higher cognition in which a variety of cytoarchitectural, neuronal morphometric, and innervation abnormalities in schizophrenia have been reported. Previous studies have reported abnormal distributions of interstitial white matter neurons in prefrontal, parietal, and temporal neocortices, which suggests that schizophrenia may be related to prenatal disturbances in the cortical subplate, a transitory structure involved in the formation of connections in the developing cortex from which the interstitial white matter neurons derive. Abnormalities in the distribution of interstitial white matter neurons in the parahippocampal gyrus in schizophrenia may indicate an alteration in the migration of subplate neurons or in the pattern of programmed cell death that could lead to defective cortical circuitry and impaired cognition. METHOD: The authors used a monoclonal antibody against the microtubule-associated protein MAP2 to label interstitial white matter neurons in the anterior region of the parahippocampal gyrus from 41 individuals with schizophrenia and 15 comparison subjects. The distribution of MAP2-labeled neurons in relation to the gray matter/white matter boundary was determined by computer-assisted microscopy. RESULTS: The number of interstitial white matter neurons decreased with increasing white matter depth in both groups, but significantly more slowly in the schizophrenia group, with interstitial white matter neurons located deeper in white matter in schizophrenia subjects. CONCLUSIONS: These findings indicate there is an abnormality in the residua of the cortical subplate in the anterior region of the adult parahippocampal gyrus in schizophrenia subjects.

Adult↗
PubMed2001

Water diffusion is elevated in widespread regions of normal-appearing white matter in multiple sclerosis and correlates with diffusion in focal lesions.

Pathological changes in the normal-appearing white matter in multiple sclerosis are well recognised, but their relationship to pathology in focal lesions is not well understood. Magnetic resonance diffusion imaging is sensitive to abnormalities in the integrity, size and geometry of water spaces in brain tissue. This study investigated the anatomical distribution of normal-appearing white matter diffusion abnormalities and their relationship to diffusion in focal lesions in multiple sclerosis (MS). The average apparent diffusion coefficient (ADCav) was measured by three-axis echoplanar diffusion imaging in normal-appearing white matter regions and lesions throughout the brain in 40 patients, and in white matter in 14 matched controls. The correlation between the ADCav in normal-appearing white matter and lesions was determined. In controls and patients, diffusion was highest in the corpus callosum. Patients had a higher mean ADCav than controls in widespread regions including the corpus callosum, cerebellar, temporal and occipital normal-appearing white matter. Mean normal-appearing white matter ADCav correlated strongly with mean lesion ADCav (r = 0.67, P < 0.001). This study demonstrates that water diffusion is elevated in widespread areas of normal-appearing white matter in MS, and is correlated with diffusion in lesions. These findings suggest that the pathogenetic mechanisms causing tissue damage in lesions and normal-appearing white matter are at least partly linked.

Adult↗
PubMed1998

Microstructural development of human newborn cerebral white matter assessed in vivo by diffusion tensor magnetic resonance imaging.

Alterations of the architecture of cerebral white matter in the developing human brain can affect cortical development and result in functional disabilities. A line scan diffusion-weighted magnetic resonance imaging (MRI) sequence with diffusion tensor analysis was applied to measure the apparent diffusion coefficient, to calculate relative anisotropy, and to delineate three-dimensional fiber architecture in cerebral white matter in preterm (n = 17) and full-term infants (n = 7). To assess effects of prematurity on cerebral white matter development, early gestation preterm infants (n = 10) were studied a second time at term. In the central white matter the mean apparent diffusion coefficient at 28 wk was high, 1.8 microm2/ms, and decreased toward term to 1.2 microm2/ms. In the posterior limb of the internal capsule, the mean apparent diffusion coefficients at both times were similar (1.2 versus 1.1 microm2/ms). Relative anisotropy was higher the closer birth was to term with greater absolute values in the internal capsule than in the central white matter. Preterm infants at term showed higher mean diffusion coefficients in the central white matter (1.4 +/- 0.24 versus 1.15 +/- 0.09 microm2/ms, p = 0.016) and lower relative anisotropy in both areas compared with full-term infants (white matter, 10.9 +/- 0.6 versus 22.9 +/- 3.0%, p = 0.001; internal capsule, 24.0 +/- 4.44 versus 33.1 +/- 0.6% p = 0.006). Nonmyelinated fibers in the corpus callosum were visible by diffusion tensor MRI as early as 28 wk; full-term and preterm infants at term showed marked differences in white matter fiber organization. The data indicate that quantitative assessment of water diffusion by diffusion tensor MRI provides insight into microstructural development in cerebral white matter in living infants.

Anisotropy↗
PubMed2006

Evolution of magnetic resonance imaging changes associated with cerebral hypoxia-ischemia and a relatively selective white matter injury in neonatal rats.

We hypothesized that a combination of quantitative magnetic resonance imaging (MRI) sequences would detect a differential evolution of hypoxic-ischemic changes in white matter compared with gray matter in a recently developed model of unilateral mild cerebral hypoxia-ischemia in the 7-d-old rat. Using this model, which involved unilateral carotid artery occlusion and exposure to hypoxia for 45-50 min, maps of apparent diffusion coefficients of water (ADC), T1, T2, and cerebral blood flow (CBF) were acquired either before hypoxia-ischemia or at 1, 24, or 48 h and at 7 d post-hypoxia-ischemia followed by brain processing for histology. At 1 h post-hypoxia-ischemia, MRI changes in white matter ipsilateral to the hypoxia-ischemia were not as pronounced as those in gray matter. However, increases in T1, T2 and ADC and decreases in CBF within white matter enhanced over time, with changes being maximal at 48 h post-hypoxia-ischemia, whereas changes in the cortical gray matter normalized over this time. By 7 d post-hypoxia-ischemia, there were no differences in ADC, T1, T2, or CBF between hemispheres despite there being histologic changes in white matter within the hypoxic-ischemic hemisphere including increased glial proliferation and reactivity, reduced myelin basic protein, and increased cell death. The results demonstrate that increases in ADC and T2 observed subacutely in the days following hypoxia-ischemia are associated with rather selective white matter damage and suggest that diffuse white matter hyperintensities and increased ADC reported in infants are transient MRI changes post- hypoxia-ischemia.

Animals↗
PubMed2006

Gray and white matter brain atrophy and neuropsychological impairment in multiple sclerosis.

BACKGROUND: The relationship of gray and white matter atrophy in multiple sclerosis (MS) to neuropsychological and neuropsychiatric impairment has not been examined. METHODS: In 40 patients with MS and 15 age-/sex-matched normal controls, the authors used SPM99 to obtain whole brain normalized volumes of gray and white matter, as well as measured conventional lesion burden (total T1 hypointense and FLAIR hyperintense lesion volume). The whole brain segmentation was corrected for misclassification related to MS brain lesions. To compare the effects of gray matter, white matter, and lesion volumes with respect to brain-behavior relationships, the MS group (disease duration = 11.2 +/- 8.8 years; EDSS score = 3.3 +/- 1.9) underwent neuropsychological assessment, and was compared to a separate, larger group of age-/sex-matched normal controls (n = 83). RESULTS: The MS group had smaller gray (p = 0.009) and white matter volume (p = 0.018), impaired cognitive performance (verbal memory, visual memory, processing speed, and working memory) (all p < 0.0001), and greater neuropsychiatric symptoms (depression, p < 0.0001; dysphoria, p < 0.0001; irritability, p < 0.0001; anxiety, p < 0.0001; euphoria, p = 0.006; agitation, p = 0.02; apathy, p = 0.02; and disinhibition, p = 0.11) vs controls. Hierarchical stepwise regression analysis revealed that whole gray and white matter volumes accounted for greater variance than lesion burden in explaining cognitive performance and neuropsychiatric symptoms. White matter volume was the best predictor of mental processing speed and working memory, whereas gray matter volume predicted verbal memory, euphoria, and disinhibition. CONCLUSION: Both gray and white brain matter atrophy contribute to neuropsychological deficits in multiple sclerosis.

Atrophy↗
PubMed1995

Histopathologic correlates of white matter changes on MRI in Alzheimer's disease and normal aging.

We investigated the histopathologic correlates of white matter changes in Alzheimer's disease (AD) patients (n = 6) and controls (n = 9) using postmortem MRI. White matter changes were rated on a 0 to 3 scale in 51 regions. Histopathologically, we subjectively rated the loss of myelinated axons in the deep and periventricular white matter, denudation of the ventricular ependyma, gliosis, width of the perivascular spaces, and leptomeningeal congophilic angiopathy; we measured structural changes in the walls of the blood vessels in the white matter in micrometers. The AD brains displayed significantly more white matter hyperintensities on MRI than controls. Histopathologically, the denudation of the ventricular ependyma and the gliosis were significantly more severe in AD than in controls, and there was a trend toward more loss of myelinated axons in the deep white matter in the AD brains (p = 0.07). The MRI abnormalities correlated with the loss of myelinated axons in the deep white matter (r' = 0.37; p < 0.01) and with the denudation of the ventricular lining (r' = 0.54; p < 0.01). We could not find any evidence for arteriolosclerosis, but the mean thickness of the adventitia of the arteries of the deep white matter in AD almost doubled the value in control brains (p = 0.0009). We conclude that white matter abnormalities in AD patients and controls consist of loss of myelinated axons, probably caused by arterial changes and breakdown of the ventricular lining. Since imaging/histopathologic correlation was similar in AD patients and controls, these changes probably represent some form of accelerated aging.

Aged↗
PubMed1998

The behavioral neurology of cerebral white matter.

Behavioral neurology has primarily focused on brain-behavior relations as revealed by disorders of the cerebral cortex and subcortical gray matter. Disorders of cerebral white matter have received less attention. This article considers the contribution of cerebral white matter to normal behavioral function and the effects of white matter disorders on behavior. Diffuse dysfunction is more common than focal impairment, and the term white matter dementia has been proposed as a clinical entity. Conventional neuroimaging has enabled more accurate identification of white matter regions participating in neurobehavioral operations, and newer imaging techniques may define white matter connectivity within and between the hemispheres. As an essential component of neural networks, cerebral white matter contributes to cognitive and emotional functions, and lesions of white matter disconnect these networks to produce neurobehavioral syndromes.

Behavior↗
PubMed1999

Value of magnetization transfer contrast as a sensitive technique to reflect histopathological changes in the white matter adjacent to the frontal horns of lateral ventricles.

The purpose of this study is to evaluate the usefulness of magnetization transfer contrast (MTC) as a technique to reflect histopathological changes in the white matter adjacent to the frontal horns of the lateral ventricles. Radiological-pathological correlation was performed in six patients who underwent Magnetic Resonance (MR) examination prior to death and in whom postmortem examinations of the brain were obtained. The extent and the severity of degeneration in the white matter adjacent to the frontal horns were evaluated histopathologically, and compared with those observed on the conventional proton density (PD) weighted MR images (Group 1). Changes in the white matter of another 35 patients were classified into three types according to the pattern of high signals adjacent to the frontal horns on conventional PD weighted MR images, and magnetization transfer ratio (MTR) in the white matter adjacent to the frontal horns was calculated from multi-slice and single-slice FSE images (Group 2). The relationship between signal intensities and MTR in the white matter adjacent to the frontal horns was evaluated. The extent of degeneration in the white matter adjacent to the frontal horns was classified into mild, moderate and severe types on the basis of stainin for myelins, axons and astrocytes. In Group 1, histopathological findings indicated a difference in severity of degeneration in the white matter adjacent to the frontal horns among the three types, while no significant differences were noted in the signals on PD weighted MR images. In Group 2, MTR showed significant differences in the signal intensities in the white matter adjacent to the frontal horns (p < 0.01) between the three types, while conventional PD weighted MR images failed to differentiate between them. In conclusion, MT imaging is a sensitive technique to evaluate the histopathological changes in the white matter adjacent to the frontal horns that cannot be detected by conventional MR imaging.

Adult↗
PubMed1982

Performance of calves fed milk replacer once daily at various fluid intakes and dry matter concentrations.

Ninety-six Holstein calves were fed 1 of 12 liquid diets once daily under two feeding options. Diets consisted of milk replacer (22% crude protein, 10% fat) fed at fluid intakes of 6, 8, and 10% body weight and dry matter concentrations of 10, 13, 16, and 19%. Feeding options consisted of calculating fluid intake and dry matter concentration based on initial weight and holding this constant through weaning or adjusting weekly according to change in body weight. Water and a complete calf starter (minimum 15% crude protein) were available ad libitum. Calves were weaned abruptly at 4 wk of age and observed until 6 wk of age for immediate postweaning performance. Fluid intake and dry matter concentration had a positive effect on weight gain during wk 0 to 4. However, during the immediate postweaning period, gain decreased in calves previously fed replacer at the higher intake. Overall gain (wk 0 to 6) was not affected by fluid intake or dry matter concentration. Starter intake decreased with increasing fluid intake or dry matter concentration during wk 4 and wk 0 to 4. Total intakes of dry matter were not affected by treatment. Incidence of scours increased linearly with dry matter concentration, and both fluid intake and dry matter concentration had a positive linear effect on fecal score and duration of scours. Feeding option had no effect on any measures. Calves fed replacer containing between 10 and 13% dry matter and offered at 8% body weight had fewer intestinal disturbances during the replacer feeding period and obtained recommended gains over the entire 6 wk.

Animals↗
PubMed1994

Anaerobic glycolysis preceding white-matter destruction in experimental neonatal hydrocephalus.

The metabolic changes in neonatal hydrocephalus that lead to permanent brain injury are not clearly defined, nor is the extent to which these changes can be prevented by a cerebrospinal fluid shunt. To clarify these processes, cerebral glucose utilization was examined using [14C]2-deoxyglucose autoradiography in 1-month-old kittens, kaolin-induced hydrocephalic littermates, and hydrocephalic kittens in which a ventriculoperitoneal shunt had been inserted 10 days after kaolin injection. The hydrocephalic kittens showed thinning of the cerebral mantle and an anterior-to-posterior gradient of enlargement of the ventricular system, with a ventricle:brain ratio of 24% for the frontal and 35% for the occipital horns compared with control (< 0.5%) and shunted (< 5%) animals. White matter in hydrocephalic animals was edematous. Myelination was delayed in the periventricular region and in the cores of the cerebral gyri. Glucose utilization in hydrocephalic and shunted animals was unchanged from control animals in all gray-matter regions examined. However, in hydrocephalic animals, the frontal white matter exhibited a significant increase in glucose utilization (25 mumol.100 gm-1.min-1) in the cores of gyri compared with normal surrounding white-matter values (14.8 mumol.100 gm-1.min-1). Very low values (mean 4 mumol.100 gm-1.min-1) were found in areas corresponding to severe white-matter edema, and these areas were surrounded by a halo of increased activity (24 mumol.100 gm-1.min-1). In contrast, cytochrome oxidase activity in white matter was homogeneous. Shunting resulted in restoration of the cerebral mantle thickness, a return to normal levels of glucose utilization in the white matter, and an improvement in myelination. It is suggested that the areas of increased glucose utilization seen in the white matter represent anaerobic glycolysis which, if untreated, progresses to infarction. The pattern of this increased glucose utilization matches that of expected myelination and, during this period of high energy demand, white matter may be susceptible to the hypoperfusion associated with hydrocephalus.

Anaerobiosis↗
PubMed2005

Competitiveness and dry matter allocation of oilseed rape (Brassica napus L.) and two mustards (Sinapis alba L. and S. arvensis L.) under water stress conditions.

In Morocco, oilseed rape is commonly exposed to mustards competition which are not totally controlled by herbicides. To understand the competitiveness of each species, growth parameters should be studied notably dry matter allocation. The objective of this study was to confirm the competitiveness of oilseed rape with regard to Sinapis alba and S. arvensis and to investigate how the dry matter is allocated. A pot experiment was undertaken with a quartz sand as substrate. Two plant densities were tested (one and two plants). The binary density was either a monoculture or a mixture. Half the pots were maintained at field moisture capacity and the other half was irrigated up to 70% of its water holding capacity. Dry matter allocation of each species at density two was compared to that of the same species at density one. Results of replacement series diagrams and those of the relative crowding coefficient (based on total dry matter) showed that Brassica napus was more competitive than S. alba. S. arvensis was the least competitive. Under competition, B. napus irrigated at water holding capacity allocated more dry matter to stem when compared to its dry matter at density one. Under the same condition, when reducing water supply, B. napus allocated more dry matter to leaves. In case of S. alba, dry matter percent in leaves and roots were respectively low and high in normally irrigated plant and inversely under water shortage. S. arvensis allocated high and low dry matter percent respectively to root than to leaves when sufficiently irrigated. But no clear tendency was noticed under water shortage, for this species.

Brassica napus↗
PubMed1990

[The significance of cerebral white matter lesions in vascular dementia--from psychiatric aspects].

The significance of cerebral white matter lesions in vascular dementia was mentioned, based on the findings of 50 autopsied cases at Yokuhukai Geriatric Hospital. Neuropathology of vascular dementia is classified to 5 types, i.e. 1) lacunar type, 2) cortical type, 3) cortico-white matter type, 4) white matter type, and 5) Binswanger type. Our findings on 50 patients revealed no lacunar type, cortical type in 8 cases, cortico-white matter type in 19, white matter type in 9, and Binswanger type in 14. The fact that 42 patients out of 50 showed some lesions involving the cerebral white matter suggested the important role of the white matter lesions in the pathogenesis of dementia of vascular type. Our cases also indicated that Binswanger type be commonly observed, although dementia of this type has been thought to be very rare since Binswanger (1894) and Alzheimer (1902) had reported similar patients. The patients with cerebral white matter lesions develop more marked dementia, especially of frontal and parieto-occipital type, than ones with cortical lesions, but the characteristics of symptoms of white matter and Binswanger type remain to be fully clarified.

Aged↗
PubMed1995

White matter changes caused by chronic solvent abuse.

PURPOSE: To examine the brain damage of solvent abusers in Japan, where pure industrial toluene is frequently abused. METHODS: Twenty solvent abusers 17 to 33 years of age with 7.2 +/- 4.0 years of abuse were examined with a 1.5-T MR imaging system. RESULTS: White matter hyperintensities in cerebrum, brain stem, and cerebellum on T2-weighted images were found in seven cases. The extent of white matter change was most clearly shown on proton density-weighted images. The patients with restricted white matter change and intermediate white matter change showed white matter hyperintensities in the brain stem and cerebellum on T2-weighted images, in some cases, with additional hypointensities in the corresponding T1-weighted images. These patients had mainly abused pure toluene. The patients with diffuse white matter change showed obvious brain atrophy, including hippocampal atrophy and thinning of the corpus callosum. These patients had mainly abused lacquer thinner. CONCLUSION: There are some patients with restricted but severe enough change to cause the neurologic symptoms in specific regions, such as the brain stem and/or cerebellum, before the brain atrophy becomes apparent. This suggests that the restricted white matter change represents not only an early change of diffuse white matter change, but at least in some cases also represents a qualitatively different change than that of diffuse white matter change. We suggest that pure toluene has a possible relation to this qualitative difference.

Adolescent↗
PubMed1994

Deep gray matter involvement in children with acute disseminated encephalomyelitis.

PURPOSE: To review the frequency, distribution, and extent of deep gray matter disease in children with acute disseminated encephalomyelitis. METHODS: The MR examinations of 10 patients, who were discharged with the clinical diagnosis of acute disseminated encephalomyelitis between 1986 and 1992, were retrospectively reviewed. Locations of abnormal signal in the cerebral and cerebellar cortices, white matter, and deep gray matter nuclei were recorded. Precontrast and postcontrast images were compared, when available, to assess degree of enhancement (if any). RESULTS: Six patients had foci of prolonged T2 relaxation in the deep gray matter, ranging in size from less than 1 cm to 4 cm. The caudate heads were involved in 4 patients, caudate body in 3, globus pallidus in 3, putamina in 3, and thalami in 4. In 1 patient, the thalami were involved nearly symmetrically, with mild mass effect. Asymmetric subcortical white matter involvement was present as well. Prolonged T2 relaxation was present within the cerebral cortex in 4 patients and was associated with subcortical white matter abnormality in 3 and more central white matter disease in 1. Nine of 10 patients demonstrated foci of T2 prolongation in white matter, most commonly involving the subcortical region, corona radiata, and centrum semiovale. Three patients also had periventricular foci. Of the 3 patients receiving gadolinium, one showed no enhancement. Two of the patients showed enhancement of some but not all lesions. One patient, who had normal brain MR findings and symptoms of myelopathy, underwent spine MR which demonstrated focal linear areas of T2 prolongation in the spinal cord at levels C-1 to C-2 and T-6. CONCLUSION: Involvement of deep gray matter was common in our small series. The finding of T2 prolongation in these structures does not preclude the diagnosis of acute disseminated encephalomyelitis in the proper clinical setting. Because thalamic involvement is reported to be rare in multiple sclerosis, it may prove useful in distinguishing between acute disseminated encephalomyelitis and the initial presentation of multiple sclerosis.

Adolescent↗