| Periventricular leukoencephalopathy
(PVL) or Leukoaraiosis |
| Microscopic causes of this MRI finding |
- Demyelination
- Gliosis
- Arteriolosclerosis
- ?Widening of perivascular spaces
|
| Some are caused by arteriopathy |
- Chronic hypertension or Diabetes
- cause concentric hyaline wall thickening
- Cerebral amyloid angiopathy
- Amyloid in arteriole can be stained by Congo red
- Vulnerability of the arteriolar wall facilitates intracerebral hemorrhage
- TIA and mild congitive deterioration often precede first hemorrhage
- CADSIL (cerebral autosomal dominant arteriopathy)
- a hereditary disorder
- related to chromosome 19q12
|
| Conditions other than arteriopathy
causing PVL |
- Alzheimer's disease
- cannot be explained by coexisting vascular disease
- Multiple Sclerosis
- Progressive multifocal leukoencephalopathy
- HIV encephalitis
- Creutzfeldt-Jakob disease
- Postinfectious demyelination
- Trauma
- Radiation therapy
- Chemotherapy
- Treatment w Cyclosporine or other immunosuppressants
- Post hypoxic ischemic encephalopathy
- Hyperperfusion syndrome
- Vitamin B12 deficiency
- Fabry's disease
- Proximal myotonic myopathy
|
| Cognitive impairment |
- Sometimes called Subacute arteriosclerotic encephalopathy, ? same as
Biswanger described in 1894
- Patients with PVL do have some degree of cognitive impairment compared
with matched controls.
- Degree of impairment is proportional to leukoencephalopathy.
- Typical symptoms: decreased speed of thinking, executive control &
recall.
- Single, strategically located infarcts may cause dementia: genu of
internal capsule, thalamus, caudate nucleus and angular gyrus.
|
| Increased risk of bleed |
A clinical trial of anticoagulant treatment in patients
with TIA found that risk of intracerebral hemorrhage increased 7 fold whose baseline CT
scan showed leukoaraiosis. |
| Jan van Gijn. Leukoaraiosis and Vascular
dementia. Neurology 1998;51 (suppl 3):S3-S8 |
