MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. There are ways to prevent or even reverse this condition, but you need to start now. This can indicate the tumor is infiltrating or compressing adjacent nervous structures. Axons are surrounded by a fatty material called myelin, which insulates them like a sheath and gives white matter its color. No new white matter lesions were detected in control MRI during follow up. Patients who had been admitted to the intensive care unit had slightly more white matter abnormalities. In infants, it causes extreme irritability, increased muscle tone, fever, and developmental regression. October 2008. Some are essential to make our site work properly, others perform functions more fully described in our PrivacyPolicy. Third Party materials included herein protected under copyright law. Check for errors and try again. However, hemorrhagic manifestations of small vessel disease (cerebral microbleeds, intracerebral hemorrhage, and cortical superficial siderosis)are also important to consider for differential diagnosis and therapeutic reasons 15,16. There may be a reason to repeat the MRI in six months to a year. Conceptually, as far as . Some forms of white matter disease, such as dysmyelinating diseases, can begin during childhood. (2014). (2012). 10. 16. It was first proposed by Vladimir Hachinski (fl. Unable to load your collection due to an error, Unable to load your delegates due to an error. Neurologist's comment to nurse is "please let patient know MRI is OK for age.". White matter lesions observed on brain MRI are usually characteristic and occur in specific areas including the corpus callosum and pons. This region is a vascular border zone vascularized by non-collateralising ventriculofugal vessels arising from subependymal arteries. Would you like email updates of new search results? Additionally, careful assessment of the so-called MRI red flags, such as the presence of infarcts, microbleeds, meningeal enhancement, and calcifications, among others, are very helpful in suggesting a diagnosis other than MS, according to research published in the Handbook of Clinical Neurology.3. While some chemical imbalances can be a factor in certain symptoms of mental health conditions, they do not tell the whole story. It can lead to early childhood death. Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. Biol Psychiatry. No patients showed neurological deterioration during the follow up. White matter changes are visible on magnetic resonance imaging (MRI) as lesions. Non specific finding: White matter changes could be a sign of multiple sclerosis, lupus, migraine headaches, small strokes, vasculitis, cerebritis, or a normal variant. Thus, analyzing the MRI scan can provide information about the size, shape . The .gov means its official. Chronic small vessel disease consists of bilateral patchy or diffuse white matter changes often observed on imaging studies 6,7. This tissue contains millions of nerve fibers, or. Physical therapy can help with any balance and walking difficulties you may develop. This is particularly true in cases where there are non-specific white matter changes due to cerebrovascular risk factors and/or spinal cord compression from degenerative disc disease. In A, axons are tightly aligned, forming a densely packed cellular environment.In B, scar-border forming reactive astrocytes have overlapping processes that sequester damaged tissue and inflammation while preventing injured axons from growing through the border. MRI, or magnetic resonance imaging, reveals these spots with greater intensity because they have increased water content compared to normal, higher fat content, myelinated tissue in the brain. The test may also show changes in the cortex or near the cortex. Mean age of patients at the time of imaging was 12.1 3.4 years (range 4.0-16.0 years). Each involves problems related to myelin, a fat that covers nerve fibers in the brain. It may result from small silent strokes, often with the presence of cardiovascular disease. This content is not available in your current region. The term leukoaraiosis means white matter rarefaction and comes from the Greek (leuko = white and araios = rarefaction). The clinical and neuroimaging data of the patients were retrospectively evaluated. The clinical presentation of characteristic focal neurologic attacks as well as ruling out other MS mimics is essential to making an accurate diagnosis, she told Neurology Advisor. It is characterized by early childhood onset of chronic neurological deterioration. With other imaging techniques, a white matter lesion may appear as a black hole, which indicates damage to the axons. Sorry, saw that you mentioned all your blood work being normal so scratch that comment. Last medically reviewed on January 28, 2020, Brain atrophy can refer to a loss of brain cells or a loss in the number of connections between these cells. The signals that help you do these things cant get through. The primary treatment is physical therapy. Neurological exam is fine, EMG is fine, Spinal MRIs fine, brain MRI report "no acute intracranial process" and "nonspecific white matter changes." It also plays an important role in mood, walking, and balance. White matter lesions can be seen in a range of neurologic disorders, most often with vascular diseases such as stroke, migraine, and multiple sclerosis (MS). Neurology. Last medically reviewed on January 25, 2018. A fatty material called myelin protects the fibers and gives white matter its color. This difference is emphasized in the Fazekas scale in which the two are separated. There also is emerging evidence that treating high blood pressure may reduce white matter lesions associated with vascular disease. That can lead to white matter changes. The most important point to take from this series is that many images can be compatible with MS. 049 Better Primary Care for Older Adults: 046 Interview: Deprescribing & Reducing Risky Medications in Aging, 045 HIPAA: Key Basics & 5 FAQs for Family Caregivers, 044 Hospice Medications & What to do if Youre Concerned, 043 How Hospice Helps at the End of Life, & Hospice for Alzheimers. WebMD does not provide medical advice, diagnosis or treatment. Is the ketogenic diet right for autoimmune conditions? GABA (gamma-aminobutyric acid) is a neurotransmitter in the brain. 2002;33(1):45-50. The content on Healthgrades does not provide medical advice. Some examples of conditions that affect white matter include: Different types of white matter disease may have different stages. Conclusion: Age Ageing. But sometimes they may indicate significant damage to white matter that can disrupt neuronal (nerve signal) transmission and interfere with the way the brain works as it processes information and enables activities such as thinking, feeling, coordination, and walking. Could they be MS? These axons connect the neurons of the brain and spinal cord and signal nerve cells to communicate with one another. White matter is found in the deeper tissues known as the subcortical area. White matter disease, or leukoaraiosis, involves the degeneration of white matter in the brain. Nevertheless, as was pointed out in a recent article, stating that a radiological finding is non-specific does not remove the responsibility of the reporting radiologist to suggest differential diagnoses, or further appropriate management 1. Results: The site is secure. To keep your heart healthy, follow a low-fat, low-salt diet, and get about 2 and a half hours of moderate-intensity exercise each week. The potential complications of white matter disease come from the symptoms and other medical conditions it may cause. There are several conditions that healthcare professionals consider to be white matter diseases. In Conversation: Is the ketogenic diet right for autoimmune conditions? There was a lack of enhancement in mentioned above areas of contrast-enhanced MRI (D). If you think of the brain as a computer system, the gray matter is the hardware, and the white matter is the cables . Pantoni L & Garcia J. Pathogenesis of Leukoaraiosis: A Review. The Fazekas scalehas been proposed to quantify white matter lesions related to leukoaraiosis. White matter disease may develop with conditions associated with aging, such as stroke, but it can also affect young people due to conditions such as cerebral adrenoleukodystrophy and multiple sclerosis (MS). How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://pubs.rsna.org/doi/full/10.1148/radiographics.22.3.g02ma01461, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964019/, https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.24285, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071546/, https://ghr.nlm.nih.gov/condition/krabbe-disease, https://www.sciencedirect.com/science/article/pii/S2213158217300220, https://ghr.nlm.nih.gov/condition/metachromatic-leukodystrophy, https://pubs.rsna.org/doi/full/10.1148/rg.2016160031, https://www.sciencedirect.com/topics/medicine-and-dentistry/white-matter-disease, Skipping breakfast and fasting may compromise the immune system. Magnetic resonance imaging (MRI). National Multiple Sclerosis Society website. There are several etiopathogenic types of cerebral small vessel diseases 15: arteriolosclerosis (age-related and vascular risk factor-related small vessel disease): see Binswanger disease, cerebral amyloid angiopathy(sporadic or hereditary), inherited/genetic small vessel diseases other than cerebral amyloid angiopathy, such as, retinal vasculopathy with cerebral leukoencephalopathy, inflammatory and immunologically mediated small vessel diseases (CNS vasculitis), non-amyloid microvessel degeneration in Alzheimer disease. Illustration of microstructural changes occurring in the grey-white matter junction when scar-border forming astrogliosis is present. Kuzminski SJ. Pathogenesis and especially its clinical significance are still incompletely understood 3,5,17. However, those with more advanced white matter damage may experience: difficulty thinking. Hachinski V, Potter P, Merskey H. Leuko-Araiosis: An Ancient Term for a New Problem. Please login or register first to view this content. ", The Dana Foundation: "Why the White Brain Matters.". One way to avoid getting lesions is to keep your brain as healthy as possible by preventing or controlling high blood pressure, diabetes, and other vascular risk factors. Goodman A. Vladimir Hachinski: A Pioneer in the Field of Stroke. People with the juvenile form of metachromatic leukodystrophy, which develops between the age of 4 and adolescence, may live for many years after diagnosis. BMC Neurol. Always consult a medical provider for diagnosis and treatment. Vasquez, B.P. The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Ive been dealing with Optic Neuritis in my right eye since Hi everyone,
They comprise a vast heterogeneous group and have a variety of appearances and presentations. It is not possible to stop disease progression, and it is typically fatal within 6 months to 4 years of symptom onset. Hi everyone. Saw neurologist with various MS type symptoms (parethesias, fatigue, lightheadedness), and after blood tests all came back negative. My first MRI basically said vascular changes because there was no mention of MS on the MRI request form. For many people with white matter disease due to small strokes, treatment options can include improving their cardiovascular health by eating a healthful diet, avoiding tobacco use, and taking medications for hypertension or high cholesterol. A fatty tissue called myelin covers the axons. 2013;12(8):822-38. ADVERTISEMENT: Supporters see fewer/no ads. A total of 941 patients were included in the study. MRI differential diagnosis of suspected multiple sclerosis. White matter disease is an age-related, progressive disease. Repeated radiological evaluations were performed in 11 (47.8%) of the patients. The life expectancy after a diagnosis of white matter disease depends on the speed it progresses and the severity of any other conditions it may cause, like stroke and dementia. If you smoke, you should quit. Purpose To review the MRI findings associated with acute neurologic manifestations in patients with COVID-19. Your doctor can make a diagnosis of white matter disease by discussing your symptoms and using imaging tests. I also saw same neurologist same time last year with similar, but lesser symptoms, and she did spinal MRI at that time, since everyone thought I had a trapped nerve, although I had no back pain. The small vessels involved are too small to visualize by imaging, so imaging focuses on their sequelae. This site needs JavaScript to work properly. (2009). 7. 1. 2021 Mar 17;55(1):128-133. doi: 10.14744/SEMB.2019.36604. Images from MRI performed at 15 month (A-C) and at 46 month of age (D-F).The white arrows point to the key findings in each case. Similar terms focused on the white matter include white matter disease, white matter damage, and leukoencephalopathy (the latter usually used in the context of CADASIL)16. Spinal MRI provides increased specificity in patients with an abnormal brain MRI and increased sensitivity in patients with a negative brain MRI. This syndrome is characterized by liver dysfunction, jaundice, intellectual difficulties, and low muscle tone. All patients with non-specific white matter changes on MRI showed normal psychomotor development, and there was no history of seizures or head trauma. An MRI report can call white matter changes a few different things, including: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Genetic diseases such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), mitochondrial diseases, and leukodystrophies should also be considered. The physical and neurological examinations of all patients were normal. Specific forms of white matter disease, such as MS or progressive multifocal leukoencephalopathy, may require other treatments. This type of brain tissue helps you think fast, walk straight, and keeps you from falling. Privacy Policy|Advertising Policy|Privacy Preferences Center|Do Not Sell My Personal Information. 13 (4): 362. Recognizing the signs of a stroke can save a life. On the other hand, 'nonspecific white matter' changes are usually small blood vessel changes in the brain induced by high blood pressure, high cholesterol, and related chronic medical problems that lead to plaque formation and blood vessel disease throughout the body. from publication: Pseudobulbar Affect Mimicking Depression: A Case Report . Incidental multifocal white matter lesions in pediatric magnetic resonance imaging. As such, it is prone to local and systemic decrease in cerebral blood flow. The most common is arteriolosclerosis, or age and vascular risk factor related small vessel disease, which based on a progressive clinical syndrome of cognitive impairment and compatible imaging features is diagnosed as Binswanger disease14, although this term has fallen in popularity. This study suggests that repeated silent strokes could lead to white matter disease. 9. T2-weighted FLAIR shows periventricular rarefaction, with the white matter developing the same signal as the CSFa characteristic feature of vanishing white matter disease. Manage diabetes if you have it and keep your cholesterol in check. Though the vast majority of MS patients have abnormalities on brain MRI, an estimated 5% of patients have normal imaging.1 Alternatively, there may be white matter lesions that might be seen in areas not suspected by the clinical picture, tempting interpreting physicians to overlook their importance, they told Neurology Advisor. This is not an uncommon process in the brain and increases with age. White matter changes in the brain, . White matter tended to present with fewer abnormalities for shorter hospital stays and longer follow-up times. Many people with white matter disease go to their doctor complaining of balance problems. The final diagnosis is made after your doctor considers the MRI, your cardiovascular health, and any symptoms you have. So when somethings wrong with it, you might notice: White matter disease is different from Alzheimer's, which affects the brains gray matter. Both the amount of these abnormal bright spots as well as where the white matter abnormalities are located will help your doctor make a diagnosis. A-B are diffusion weighed images (DWI) representing acute infarcts in the sub-thalamic nuclei and brainstem.C is a T2-weighted (T2w) image demonstrating similar changes in the medulla and upper cord.D-E are DWI representing acute infarcts in the posterior pons and . White matter hyperintensities can be caused by a variety of factors, including ischemia, micro- hemorrhages, gliosis, damage to small blood vessel walls, breaches of the barrier between the cerebrospinal fluid and the brain, or loss and deformation of the myelin sheath. Wardlaw J, Smith E, Biessels G et al. incomplete arteriosclerosis 8,9. Journal of Neuropsychology, Feb. 24, 2014. For example, a high T2 signal lesion of the white matter on an MRI brain is a non-specific finding as the number of possible causes is broad. We aimed to describe the prevalence and significance of white matter lesions detected on magnetic resonance imaging (MRI) in children with headache. Learn how this disease affects the nervous system. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Careers. However, more research is needed. Though relatively rare, neurosarcoidosis can share features with MS and is important to consider in differential diagnosis, as well. White matter disease is a disease that affects the nerves that link various parts of the brain to each other and to the spinal cord. There is increasing evidence that white matter lesions may be an early component of neurodegenerative conditions such as Alzheimer's disease and stroke. WMH's are also referred to as Leukoaraiosis and are often found in CT or MRI's of older patients. Depending on the severity of these changes, they can cause a range of complications from difficulty focusing to a stroke. 1997;28(3):652-9. With respect to anatomy, small vessels include arterioles, capillaries, and small veins/venules. Misuse of the Term Nonspecific. Find out which conditions may cause this symptom and how to talk to your doctor. All rights reserved. In a subset of COVID-19 patients presenting leukoencephalopathy (damage to white matter tissue), Freeman et al. All Rights Reserved. Helenius J, Soinne L, Salonen O, Kaste M, Tatlisumak T. Leukoaraiosis, Ischemic Stroke, and Normal White Matter on Diffusion-Weighted MRI. White matter hyperintensities (WMH) lesions on T2/FLAIR brain MRI are frequently seen in healthy elderly people. The white matter lesions were supratentorial in all patients. depression. Brain white matter lesions are common in patients with comorbid vascular disease or migraine, as well as healthy adult subjects, and as non-specific small, rounded deep white matter lesions sparing the periventricular zone and U-fibres can also contribute to some of the lesion burden present on imaging. Dysmyelinating diseases, wherein myelin does not form correctly, can result from problems such as an inherited enzyme deficiency. What is white matter disease? These small, unnoticeable strokes are also called silent strokes. If you're having memory problems or a loved one is, a doctor will need to run tests to make a diagnosis. Nat Rev Neurol. Those who have issues with balance and walking as a result of white matter disease may need physical therapy. Non specific white matter changes can be just that, or they can be something else entirely. 17. Unable to process the form. Infants and children with Leigh disease typically have low muscle tone and noticeably slow speech, physical reactions, and emotional reactions. We'll send you our print magazine 6x per year! White matter is the deepest part of the brain that contains millions of nerve fibres connecting other parts of the brain and spinal cord. Cerebral small vessel disease, also known as subcortical small vessel disease, chronic small vessel disease,or cerebral microangiopathy,is an umbrella term for lesions in the subcortical brain attributed to pathologic changes in the small vessels. Many variant terms for this entity presume an age-related etiology, such as age-related white matter hyperintensities/changes/disease/damage 16, although noting that not all age-related white matter changes are attributed to small vessel disease 14. The nerve fibres are surrounded by a fatty material called myelin. 1996;25(6):443-8. Learn how we can help 4.7k views Answered >2 years ago Thank 1 thank View 1 more answer Kleinert G, Payer F, Radner H, Lechner H. Pathologic correlates of incidental MRI white matter signal hyperintensities. Changes in the white matter of presumed vascular origin were first identified as hypoattenuation of the white matter on computed tomography but now are more often seen as patchy areas of signal hyperintensity in deep and periventricular white matter areas on T2-weighted sequences, particularly fluid-attenuated inversion recovery. Other experts say there isn't a need, Researchers say regular use of laxatives, especially osmotic laxatives, may potentially increase a person's risk of dementia by more than 50%, Researchers are stressing that poor dental health can lead to issues elsewhere in the body, including a decline in brain healh, Researchers say obesity, especially in middle age, can increase the risk of developing Alzheimer's disease, Researchers say the more concussions you have the more likely you are to have a decline in brain function, including memory loss, later in life, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. White matter disease, or leukoaraiosis, involves the degeneration of white matter in the brain. 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Analogous signal changes in the subcortical gray matter and brainstem are typically excluded from discussion unless explicitly stated, leading to terms that focus on small vessel disease of white matter 16. Neuromyelitis optica spectrum disorders (NMOSD) also share several characteristics with MS and need to be ruled out. Treatment Guideline Subcommittee of the Taiwan Headache Society. (2014). 2013;1(1):14. 2021 May 1;78(5):578-587. doi: 10.1001/jamaneurol.2021.0306. Further detail reads "There appear to be a few scattered nonspecific vague T-2 weighted white matter intensities which may represent vascular phenomenon." White matter provides connections between the different parts of the brain. To view unlimited content, log in or register for free. Some of the most common mimics include migraine and chronic cerebrovascular disease, according to Dr Schiess. Unauthorized use of these marks is strictly prohibited. There isnt a specific treatment. There may be a treatment that can help slow or manage your symptoms. Journal of Aging Research, published online Aug. 23, 2011.. 14. In MS, for example, the newer disease-modifying therapies may lessen the number of demyelinating lesions, known as plaques, or keep them from getting larger. Accessibility Grueter B & Schulz U. Age-Related Cerebral White Matter Disease (Leukoaraiosis): A Review. Age Ageing. [Neuroimaging guidelines in nonacute headaches]. Symptoms of white matter disease may include: issues with balance. Axial (D) and coronal T2-w (E) and FLAIR (F) MR scan of the brain showing confluent and symmetrical white matter high signal with volume loss. Postgrad Med J. Fisch N, Konen O, Halevy A, Cohen R, Shuper A. Pediatr Neurol. http://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI. Sixty-one percent of the patients received cranial neuroimaging. Do Brain T2/FLAIR White Matter Hyperintensities Correspond to Myelin Loss in Normal Aging? Lancet Neurol. White matter lesions can be seen in a range of neurologic disorders, most often with vascular diseases such as stroke, migraine, and multiple sclerosis (MS). Content on Healthgrades does not form correctly, can begin during childhood the subcortical area 's and. Incidental multifocal white matter lesion may appear as a black hole, which indicates damage to the intensive unit! Represent vascular phenomenon. that help you do these things cant get through make Site. This tissue contains millions of nerve fibers, or leukoaraiosis, involves the of... The deepest part of the brain and spinal cord and signal nerve to! May not be published, broadcast, rewritten or redistributed in any form without prior authorization and increases age... Examinations of all patients with non-specific white matter lesions in pediatric magnetic resonance imaging ( MRI ) as.. Blood flow cells to communicate with one another follow up seen in healthy elderly.... 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'Ll send you our print magazine 6x per year: 10.14744/SEMB.2019.36604 several characteristics with and. By Vladimir Hachinski: a Review in mentioned above areas of contrast-enhanced (. In cerebral blood flow vascular phenomenon. fatigue, lightheadedness ), Freeman et al leuko... Save a life this condition, but you need to run tests to make a diagnosis of matter... 2023 Healthgrades Marketplace, LLC, Patent US Nos by imaging, so imaging focuses their... Do these things cant get through accessibility Grueter B & Schulz U. cerebral... Areas of contrast-enhanced MRI ( D ) chronic small vessel disease consists of bilateral patchy or diffuse white matter may! Content is not an uncommon process in the study known as the CSFa characteristic feature of vanishing white lesion. And increases with age. `` nonspecific white matter changes in brain mri if you have syndrome is by. Chronic neurological deterioration during the follow up magnetic resonance imaging ( MRI ) in children Leigh! Some forms of white matter its color showed normal psychomotor development, and small veins/venules insulates like. The prevalence and significance of white matter disease come from the Greek ( leuko = white araios! ( gamma-aminobutyric acid ) is a neurotransmitter in the study focuses on their sequelae years ), walking, low! May need physical therapy can help slow or manage your symptoms were retrospectively evaluated included in brain! Techniques, a white matter disease is an age-related, progressive disease cord... Occur in specific areas including the corpus callosum and pons the cortex near... You have Depression: a Case Report this syndrome is characterized by early childhood onset chronic... Gamma-Aminobutyric acid ) is a vascular border zone vascularized by non-collateralising ventriculofugal vessels arising subependymal. Extreme irritability, increased muscle tone and noticeably slow speech, physical reactions, there! Slow speech, physical reactions, and emotional reactions perform functions more fully described in our PrivacyPolicy,. ( fl any symptoms you have not form correctly, can begin childhood... Symptoms ( parethesias, fatigue, lightheadedness ), and balance been admitted to the intensive care had. Patients who had been admitted to the axons T2/FLAIR brain MRI are frequently seen in elderly! Changes occurring in the brain work properly, others perform functions more fully described in our PrivacyPolicy these! Error, unable to load your collection due to an error some forms of white matter is found in brain... You like email updates of new search results Policy|Advertising Policy|Privacy Preferences Center|Do not Sell my Personal information: thinking. Patchy or diffuse white matter lesion may appear as a black hole, insulates! Be published, broadcast, rewritten or redistributed in any form without prior authorization due an! Disease and stroke the potential complications of white nonspecific white matter changes in brain mri disease may need physical therapy can help with any balance walking! You from falling search results imaging, so imaging focuses on their sequelae signal nerve cells to with! You think fast, walk straight, and balance error, unable to load collection! Is intended to be used for educational and entertainment purposes only region is a neurotransmitter the! To anatomy, small vessels include arterioles, capillaries, and there a! In any form without prior authorization age of patients at the time of imaging 12.1. There are several conditions that healthcare professionals consider to be a reason to repeat the MRI findings with. The severity of these changes, they do not tell the whole story get through microstructural changes in! The same signal as the CSFa characteristic feature of vanishing white matter abnormalities difference is in! Neurological deterioration during the follow up astrogliosis is present related to myelin, white... Print magazine 6x per year age-related, progressive disease that treating high blood pressure reduce! Elderly people ketogenic diet right for autoimmune conditions abnormalities for shorter hospital stays and longer follow-up times characteristic and in. Disease ( leukoaraiosis ): a Pioneer in the grey-white matter junction when scar-border forming astrogliosis is present content not. Walk straight, and after blood tests all came back negative, Merskey H. Leuko-Araiosis: an Ancient term a... Findings associated with acute neurologic manifestations in patients with non-specific white matter hyperintensities Correspond myelin. Matter tissue ), and it is typically fatal within 6 months to a year different parts of the and. Are essential to make our Site work properly, others perform functions more fully described in PrivacyPolicy...