Wednesday, August 17, 2022

What Does White Matter Changes In The Brain Mean

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Increasing And Improving White Matter

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Some research has found that physical exercise, in particular, cardiorespiratory activities and weight resistance training, was correlated with improved white matter integrity in the brains of those who participated in those studies.

Physical exercise has also been connected to a decreased risk of dementia as well as a slower cognitive decline in people who already have been diagnosed with Alzheimer’s or another kind of dementia.

Other research found that when adults learned new skills, the amount of white matter in their brains increased. This was true for learning to read as an adult and learning to juggle.

Additionally, white matter increased relative to the number of hours that professional musicians practiced their instruments.

White matter functioning was also improved by the practice of meditation, and the difference was observed in as little as in two to four weeks.

How To Strengthen White Matter

For white matter disease specifically, there is not a cure but there are treatments that can be used to manage the experienced symptoms. Physical therapy is a common treatment that can help with any balance or walking difficulties someone may develop.

Similarly, managing vascular health could also be an effective way to manage symptoms of white matter disease. not smoking and regulating blood pressure may help to slow the progression of the disease.

To strengthen white matter, there is support for the use of physical exercise, especially aerobic and weight resistance training. Physical exercise has also been linked to decreasing the likelihood of developing conditions with cognitive decline, such as dementia and Alzheimerâs.

As evident from the previously discussed neuroimaging studies, learning a new skill appears to positively influence white matter. A suggestion to strengthen white matter could be to pick up a new skill, such as learning to play an instrument or learn a language.

Completing relaxation exercises such as meditation or mindfulness training have also been suggested to strengthen white matter functioning. Studies have found that completing two to four weeks of meditation practice was enough to observe differences in white matter.

Also, ensuring a helmet is worn when completing activities such as cycling also minimizes the risk of damage to the brain.

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Wanted: A Behavioral Neurology Of White Matter

The study of higher functions in humans requires consideration of all the brains neural tissues. Long neglected as a contributor to the organization of cognitive and emotional operations, white matter is the object of intense, intriguing, and increasingly fruitful efforts to improve our understanding. Studying people with white matter disorders to correlate their brain lesions with specic behavior changes promises a wealth of insights. Increasingly, this method will be complemented by sophisticated neuroimaging techniques that yield detailed visualization of white matter tracts as they participate in the cognitive and emotional operations of distributed neural networks.

In practical terms, an appreciation of the brain-behavioral importance of white matter disorders can greatly benet patients, especially as early recognition and treatment often determine an outcome. In theoretical terms, further study of white matter and its disorders expands our knowledge of the brain as an extraordinarily complex structure in which the connectivity provided by white matter is central to cognition, emotion, and consciousness itself.

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Is It Really That Simple

Not quite. Whilst the above division is physiologically accurate on a system level, there are a mix of cell types present in both gray and white matter.Gray matter also contains:

  • Neuropil a mix of dendrites, unmyelinated axons, and glia

White matter also contains:

  • Oligodendrocytes glial cells which produce myelin
  • Astrocytes

What Are White Spots

Figure 1 from Brain white matter lesions in migraine: whats the ...

Spots on a brain MRI are caused by changes in water content and fluid movement that occur in brain tissue when the brain cells are inflamed or damaged. These lesions are more easily seen on T2 weighted images, a term that describes the frequency of the radio impulses used during your scan.

White spots may be described in different ways on an MRI report:

  • “High signal intensity areas”
  • “White matter hyperintensities,” or lesions the appear bright white on certain sequences of MRI scans
  • “Leukoaraiosis,” a term that is used if the spots are thought to be caused by decreased blood flow
  • “Nonspecific white matter changes”

White spots are usually found in the brains white matter, typically near the ventricles, the four cavities located within the brain that contain cerebrospinal fluid . But they can be located anywhere in the brain.

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White Matter Plays An Integral Role In Brain Function

It enables executive behaviors, such as planning, organizing, and problem-solving, and allows us to learn, develop skills, and formulate memories.

When the white matter in our brain becomes damaged and diseased, it can disrupt cognitive function or result in other symptoms. While clinical examination and medical imaging can help detect abnormalities in the brain, accurately determining the cause can be difficult. Many conditions can cause abnormalities in white matter.

To better understand how white matter disease is identified and diagnosed, we spoke with Dr. Gaetano Pastena, a board-certified diagnostic radiologist and neuroradiology subspecialist.

DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from Dr. Pastena or one of our other neuroradiology subspecialists, you can learn more here.

What Are The Symptoms Of White Matter Disease

Signs and symptoms of white matter disease include:

These signs and symptoms may be worse in people who have more advanced white matter disease.

While people can experience many of these signs and symptoms as normal changes with aging and other medical conditions , a rather quick onset and progression of these symptoms may be cause for concern.

Sometimes white matter disease is detected when getting a brain MRI for other reasons. In some people, white matter disease may not cause symptoms . You should discuss with your healthcare provider whether your symptoms could be due to white matter disease or other causes.

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White Matter In The Brain And Spinal Cord

The white matter of your brain and spinal cord is composed of bundles of axons. These axons are coated with myelin, a mixture of proteins and lipids, that helps conduct nerve signals and protect the axons. White matter’s job is to conduct, process, and send nerve signals up and down the spinal cord. Damage to the white matter of your brain or spinal cord can affect your ability to move, use your sensory faculties, or react appropriately to external stimuli. Some people with damaged white matter suffer deficits in reflexive reactions.

What White Matter Consists Of


White matter consists of millions of bundles of axons, or nerve fibers. Axons are portions of the nerve cell that carries nerve impulses away from the cell body.

Axons are long slender-like structures that extend away from the cell body. The axons that make up the white matter are covered in a white substance called myelin sheath.

Myelin sheath is a sleeve of fatty tissue that insulates the axons and gives white matter its white appearance. Myelin works to insulate the axons of the nerve cells to ensure a higher speed of transmission of electrical signals.

Myelinated nerves can carry electrical impulses up to 100 times faster than non-myelinated nerves so if they were to be damaged, this can impact on sensory, motor, and cognitive functions.

Myelin sheath is made by the types of non-neuronal cells which are also present in the white matter, called oligodendrocytes. These types of cells are known as a glial cell, which are cells that provide support or protection to the neurons. Oligodendrocytes form the myelin and wrap this around the axons up to 150 times.

All the layers of myelin is tightly compressed around the axon to ensure it is protected. On the axon, there are gaps in the myelin sheath called nodes of Ranvier.

These unmyelinated gaps cause the impulses traveling along the length of the axon to leap from node to node. When it does this, the signal increases in velocity so it can reach its destination quicker than traveling down the axon without nodes.

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Why Is The Waxy Coat So Important

In short, we do not have the full answer to this question, but there are some compelling threads to pick at.

The synchrony of gray matter is important for neural development and learning. The saying goes, Neurons that fire together, wire together. In other words, neurons that fire in synchrony are more likely to become permanently connected nerves that fire together are considered important and will be strengthened and preserved.

Now, if two nerves that work together come from different distances and are identical, the signals will not arrive together to coordinate the firing, one of the axons needs to either be sped up or slowed down.

Millisecond precision is vital.

When we carry out a complex task such as playing an instrument, information is sent from a range of brain centers and flows back and forth. Synchrony is a must, and simply firing messages at the greatest possible speed would not be a viable solution.

As new discoveries mount up, it seems clear that myelin plays a key role in developing synchrony, and it can alter the conduction speed of tracts of white matter in a number of ways.

For example, myelin can physically change the diameter of the axon . Also, oligodendrocytes can alter how many sheets of myelin they lay down, which can be up to 150 sheets per fiber, again altering conduction velocity. Additionally, by altering the number or spacing of the nodes of Ranvier, speeds can be tweaked, with more nodes closer together slowing impulses down.

Grey Matter Vs White Matter In The Brain

About 276,000 people in the U.S. currently live with spinal cord injuries, with an additional 12,500 new cases every year. These injuries affect one of the most complicated and mysterious areas of the bodyan area that many injury survivors knew little about prior to their accident.

Knowing the basics of central nervous system anatomy can help you better understand the information your doctor provides, empowering you to be a better advocate for yourself or a loved one. A lot of confusion revolves around the distinction between gray and white matter in the brain, but the difference is actually a pretty simple one.

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Association With Stroke Severity And Post

Severity of leukoaraiosis has been linked to poor functional post-stroke outcome in both short- and long-term follow-up studies. In patients with acute ischemic stroke, severity of WMH is significantly associated with poor functional outcome at 3 months and beyond. When the topography of WML is considered, PVH burden, but not subcortical or deep WMH, appears to be linked to unfavorable clinical outcome in both short- and long-term studies. A study in patients with spontaneous ICH also showed that higher leukoaraiosis burden was an independent marker of worse functional outcome. [

Besides being a predictor of functional outcome after stroke, severity of leukoaraiosis was independently associated with larger infarct cores , greater infarct volume growth , and increased risk of hemorrhagic transformation and parenchymal hematoma following intra-arterial thrombectomy for treatment of acute ischemic stroke, especially leukoaraiosis in deep white matter region. [

What Are White Matter Lesions And When Are They A Problem

Changes in white matter as determinant of global functional decline in ...

White matter is found throughout the central nervous system, but much of it lies in the interior of the brain, between the cerebral cortex and deep gray matter structures such as the thalamus and basal ganglia. White matter is made up of tracts, or bundles, each of which contains millions of nerve fibers that connect gray matter regions throughout the central nervous system. The nerve fibers are composed of axons, which transmit electrical signals that help neurons communicate with one another. Axons are surrounded by a fatty material called myelin, which insulates them like a sheath and gives white matter its color.

Abnormalities in white matter, known as lesions, are most often seen as bright areas or spots on MRI scans of the brain. They can reflect normal aging white matter deteriorates as people age. Studies have found that white matter lesions appear in some degree on brain scans of most older adults but less often in younger people. White matter lesions are among the most common incidental findingswhich means the lesions have no clinical significanceon brain scans of people of any age.

They may also reflect a mixture of inflammation, swelling, and damage to the myelin. With other imaging techniques, a white matter lesion may appear as a black hole, which indicates damage to the axons.

There is increasing evidence that white matter lesions may be an early component of neurodegenerative conditions such as and stroke.

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Risk Of Stroke In High Risk Populations

Many prospective studies evaluated WMH and risk of stroke in high risk populations. A study in 89 Japanese participants who had clinical lacunar infarction and followed up for a mean of 51 months found that extensive WMH at baseline was a significant predictor of stroke risk A study in 121 American patients with lobar ICH showed that CT-based evidence of white matter damage nearly quadrupled the risk of recurrent ICH after 2.7 years of follow-up. A study of 81 Swedish patients with lacunar infarction found that severity of WML was a predictor of recurrent stroke , when followed long-term . Similarly, extensive WML was associated with recurrent stroke in a study of 228 Chinese patients with stroke . The Amsterdam Vascular Medicine Group in the Netherlands reported that patients with confirmed atherosclerotic disease including recent myocardial infarction , ischemic stroke , or peripheral arterial disease and evidence of PVH on neuroimaging have a higher recurrent ischemic stroke rate at 3.5 years compared to those without PVH . A study in 266 Japanese patients with ischemic stroke or ICH found that those patients with advanced WMH but no microbleeds developed had the highest recurrence rate of ischemic stroke among 3 other patient subgroups . [

What Is White Matter Disease

White matter disease is an umbrella term for changes and damage to your brains white matter the nerve fibers in your brain that connect different areas of your brain to each other and to your spinal cord like highways.

You can also get white matter disease, also called cerebral small vessel or microvascular disease, from aging and blood vessel changes in your brains white matter. It can be mild, moderate or severe.

When your white matter becomes damaged, it causes white matter lesions, which healthcare providers can see as bright spots on magnetic resonance imaging of your brain. Some white matter lesions may not cause noticeable symptoms and can be considered almost normal with aging. However, some of these lesions can damage important pathways within your brain and can cause problems with memory, balance and walking.

In general, people with more white matter lesions experience more symptoms.

White matter disease is strongly linked to cardiovascular disease risk factors, and researchers believe that white matter disease is a biomarker of the lifelong risk of stroke, dementia and disability.

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Assessment Of White Matter Changes

Severity of WMC was rated on axial T2- or FLAIR-weighted images from routine clinical MRIs using the Fazekas score in a modified version according to Prins and Scheltens , which is well established for defining different groups by severity of WMC . Absence of lesions in subcortical and periventricular regions was rated with a score of 0. Focal or punctuate lesions were rated with a 1 beginning confluent lesions were rated with a 2 and confluent lesions with a 3 . Rating of lesions was done by a single rater blinded to group status. Figure 1 shows examples of different WMC severity scores.

Figure 1. Presence and severity of white matter changes in MRI according to the Fazekas score, examples from the actual evaluation. Score 1 with focal or punctuate lesions score 2 with beginning confluent lesions score 3 with confluent lesions .

How Is White Matter Disease Diagnosed

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Brain magnetic resonance imaging is the main way healthcare providers diagnose white matter disease. An MRI scan is a painless test that produces very clear images of different parts of your body. MRI uses a large magnet, radio waves and a computer to produce these detailed images without any radiation .

Brain MRI scans allow healthcare providers to see the extent of white matter damage in your brain and to diagnose white matter disease.

White matter changes are visible on magnetic resonance imaging as lesions. An MRI report can call white matter changes a few different things, including:

  • Cerebral or subcortical white matter disease or lesions.
  • Microvascular disease.
  • Non-specific white matter changes.
  • T2 hyperintensities .

In some cases, your provider might see signs of white matter disease in your MRI results that you underwent for a different medical reason. In other cases, your provider may order an MRI if nothing else explains your symptoms, such as balance and memory issues.

While there are other types of imaging tests, such as CT scans, MRI has the best imaging quality and sensitivity for diagnosing white matter disease.

Your provider may also perform a neurological exam to assess your symptoms when diagnosing white matter disease.

Since white matter disease is associated with cardiovascular disease risk factors, your provider may also order the following blood tests to assess your risk:

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Gray Matter Vs White Matter

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The brain is an immensely complex structure, but there are ways we can divide up its anatomical structure into more discrete parts the left and right hemisphere, parietal, temporal, occipital and frontal lobes. Another common divider is to separate the brains gray and white matter. But what are these two structures? How different are they from each other? How significant, and physiologically relevant, is this divide? Read on to find out!

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