White matter disease: what it is, symptoms and treatment (2023)


What is white matter disease?

White matter disease is a general term for changes and damage to the white matter of the brain: the nerve fibers of the brain.Brainwhich, like highways, connect different areas of your brain to each other and to your spinal cord.

You can also get white matter disease, also called small cerebral blood vessel disease or microvascular disease, from aging and aging.blood vesselChanges in the white matter of your brain. It can be easy, medium or difficult.

When your white matter is damaged, it causes white matter lesions that healthcare providers can "see" as bright spotsMagnetic Resonance Imaging (MRI)your brain. Some white matter lesions may not cause noticeable symptoms and can be considered almost "normal" with age. However, some of these injuries can damage important pathways (roads) in your brain and cause problems.Memory,balanceand on foot

Generally, people with more white matter lesions (more severe white matter disease) have more symptoms.

White matter disease is strongly associated withcardiovascular diseaseRisk factors, and researchers believe that white matter disease is a biomarker (medical sign) of lifetime riskcarrera,dementiaand disability

What is white matter?

White matter is made up of a large network of nerve fibers (axons) in the brain that allow information exchange and communication between different areas of the brain. It is called "white matter" because nerve fibers are covered with a protective coating called myelin, which gives the tissue its white color.

The superficial and deep areas of your brain contain gray matter, which gets its color from the cell bodies of neurons.

For your white matter to be healthy, it needs good blood flow and nutrients.

Decreased blood flow (ischemia) and nutrient supply to the white matter can cause damage to these nerve fibers (axons), including swelling, ruptures, and total loss. Just as your lawn may not look healthy without watering and nutrients (sunlight and fertilizer), your brain can be damaged by poor circulation and an unhealthy diet.

Who does white matter disease affect?

White matter disease can affect anyone, but it is most common in people age 60 and older and in people with cardiovascular disease.

(Video) White matter lesions—should all patients receive antihypertensive treatment?

While some white matter lesions in younger people with conditions such asmigraineGetting older and having more uncontrolled risk factors for cardiovascular disease increases the likelihood of having more white matter lesions.

In some people, genetic risk factors may increase the chance of white matter disease.

How common is white matter disease?

White matter disease is common. It is present in more than half of the population of people over 60 years of age.

symptoms and causes

What are the symptoms of white matter disease?

Signs and symptoms of white matter disease include:

  • memory problems
  • walk slow
  • Balance problems and frequent falls.
  • Difficulty performing two or more activities at the same time, e.g. B. walk and talk at the same time.
  • mood swings, likeDepression.
  • urinary incontinence.

These signs and symptoms may worsen in people with advanced (severe) white matter disease.

Although people consider many of these signs and symptoms to be normal changes with age and other medical conditions (such asArthritis,Diabetes-associated neuropathy,Alzheimer'sdementia and sleep disorders), the relatively rapid onset and progression of these symptoms may be cause for concern.

Sometimes white matter disease is found when an MRI of the brain is done for other reasons. In some people, white matter disorder may not cause symptoms (asymptomatic). You should consult with your doctor if your symptoms may be due to a white matter disease or other causes.

What causes white matter disease?

Researchers are still learning about white matter disease and its cause. So far, they believe it is caused by chronically reduced blood flow to nerve fibers in the white matter, which can lead to damage to the fibers.

As you get older, your arteries harden and have more trouble stretching (losing elasticity). This can cause less blood flow to the nerves in your brain, causing damage to your white matter.

White matter disease can also be caused byatherosclerosis, which is the thickening and hardening of artery walls that occurs over time as plaque builds up in the arteries. It can affect any artery in your body, including those in the brain.

(Video) The Basics: White Matter Disease | WebMD

Cardiovascular risk factors, such as high blood pressure, high blood sugar (due to diabetes), high dietary fat intake (high cholesterol), and smoking can increase the number of spots or lesions in the white matter of the brain.

Other causes of white matter lesions

Any process that changes the chemical composition of, damages, or decreases blood flow (ischemia) to myelinated fibers can appear as a white matter lesion on magnetic resonance imaging (MRI).

Although white matter disease involves multiple white matter lesions caused by blood vessel (vascular) problems, you may have small white matter lesions for other reasons. The lesions are common features of nonvascular conditions, including demyelinating inflammatory diseases such asMultiple sclerosisand genetic causes such asleucodistrofia.

Health care providers, such as neurologists and neuroradiologists, can often distinguish white matter lesions from other causes of lesions with MRI based on where they are in your brain. Additional tests are sometimes needed to determine the cause of white matter lesions on MRI.

diagnosis and tests

How is white matter disease diagnosed?

Magnetic resonance imaging (MRI) of the brain is the primary method used by health care providers to diagnose white matter disorders. An MRI is a painless test that provides very clear images of different parts of the body. MRI uses a large magnet, radio waves, and a computer to produce these detailed images without radiation (it does not use anyX-rays).

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

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

  • Diseases or lesions of the cerebral or subcortical white matter.
  • Microvascular disease.
  • Nonspecific white matter changes.
  • T2 hyperintensities (lesions).

In some cases, your doctor may see signs of white matter disease on your MRI results that you may have had for another medical reason. In other cases, your provider may order an MRI if nothing else explains your symptoms, such as: B. Balance and memory problems.

Although there are other types of diagnostic imaging tests, such asCT (computerized tomography)scans, MRI has the best image quality and sensitivity for diagnosing white matter disorders.

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

(Video) Severity of White Matter Hyperintensities & All-Cause Mortality

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

  • Comprehensive metabolic panel.
  • lipid panel.
  • Glycosylated hemoglobin test (HbA1c).

management and treatment

How is white matter disease treated?

When treating white matter disorders, health care providers focus on managing the symptoms and risk factors associated with cardiovascular disease.

Treating underlying health conditions, such as high blood pressure, diabetes, and high cholesterol, and stopping smoking can help prevent further white matter lesions from forming.

While there are no treatments to repair already damaged white matter, people with more out-of-control health problems generally experience more white matter damage and disability.

Treatment of symptoms of white matter disease

Physical therapy can help with balance and walking problems caused by white matter disease, including education and therapy to prevent falls.

Seeing a psychologist to discuss problems with depressed mood and seeing a psychiatrist for medications like antidepressants can help with symptoms of depression.

There are several treatments available to treat urinary incontinence, including medications, lifestyle changes, and procedures.

Management of risk factors for cardiovascular disease

Controlling risk factors associated with cardiovascular disease can help slow the progression of white matter disease and prevent life-threatening cardiovascular diseases such as stroke.

Treatments that can help control risk factors for cardiovascular disease include:

  • Medications and lifestyle changes to stay healthyblood pressure.
  • administration ofDiabetes(if you have diabetes).
  • administrationcholesterol levelswith medications and lifestyle changes.
  • Exercise regularly.
  • Avoidfrom smoking.
  • alcohol avoidance.
  • Antiplatelet drugs (a group of medicines that prevent blood cells from sticking together and forming a blood clot).
  • Statins (can help reduce inflammation of the blood vessels even if your cholesterol levels are normal).

What kind of doctor treats white matter disease?

Depending on your symptoms and situation, you may see any combination of the following health care providers to treat the symptoms of white matter disease and monitor its progression:

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  • neurologist.
  • primary care provider.
  • physiotherapist.
  • occupational therapist.
  • Physical medicine and rehabilitation provider (physiatrist).
  • cardiologist.
  • urologist.
  • psychologistmePsychiatrist.


Can white matter disease be prevented?

Studies show that people with risk factors for cardiovascular disease are also at increased risk of developing white matter disease.

Risk factors for cardiovascular disease include:

  • high blood pressure (hypertension).
  • High cholesterol(Hyperlipidemia, Dyslipidemia).
  • from smoking.
  • Poorly controlled diabetes.

There are steps you can take to try to slow its progression. Studies show that treating these risk factors through medication, lifestyle changes, and/or smoking cessation can help prevent further white matter lesions from forming.

Outlook / Forecast

What is the prognosis (outlook) of white matter disease?

White matter disease is a spectrum that can appear from mild to severe on MRI. Associated symptoms can range from absent to severe. Because of this, the prognosis (outlook) of white matter disease varies from person to person.

If you've been diagnosed with a white matter disorder, talk to your neurologist about what to expect.

to live with

When should I see my doctor for white matter disease?

If you've been diagnosed with a white matter disease, it's important to see your GP regularly to discuss how to control your risk factors. Depending on the type and severity of your white matter disease and your symptoms, you may need to see additional specialists.

A note from the Cleveland Clinic

If you have been diagnosed with a white matter disease, it is important to prioritize your cardiovascular health, e.g. B. take medicine and make lifestyle changes to control cholesterol and blood pressure. This can help prevent new white matter lesions and reduce the risk of stroke and dementia. If you have any questions about this condition or risk factors for cardiovascular disease, consult your doctor. Are you available.

(Video) Signs and Symptoms of Brain Disease | Webinar


Is there treatment for white matter disease? ›

White matter disease doesn't have a cure, but there are treatments that can help manage your symptoms. The primary treatment is physical therapy. Physical therapy can help with any balance and walking difficulties you may develop.

What happens when you have white matter disease? ›

White matter disease is the wearing away of tissue in the largest and deepest part of your brain that has a number of causes, including aging. This tissue contains millions of nerve fibers, or axons, that connect other parts of the brain and spinal cord and signal your nerves to talk to one another.

Can you live with white matter disease? ›

In general, the prognosis is grave, with the majority of patients dying after a few years. However, some die only after several months, and some manage to survive for several decades [6].

Can white matter disease cause pain? ›

In addition, white matter hyperintensities (WMH), for example in the spinothalamic tract, also referred to as the anterolateral pathway, may lead to an increase in pain experience; this type of pain is paraphrased as deafferentiation pain.

Can you recover from white matter damage? ›

White matter injuries are very serious, but, depending on the type and extent of the injury, extensive recovery may occur. As long as the neuron cell bodies remain healthy, axons can regrow and slowly repair themselves.

Is white matter in brain serious? ›

This is your brain on aging

But over the last decade, medical experts have come to understand that the presence of large areas of disease in the white matter of the brain are associated with cognitive decline and dementia in patients.

What type of doctor treats white matter disease? ›

A neuroradiologist is a doctor who is certified in general radiology and has also undergone specialty training, often with an added board certification in imaging of the brain, spine, and nerves. With this training, they're able to recognize both common and uncommon disorders that affect the nervous system.

Can you improve white matter in brain? ›

Increasing and Improving White Matter

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.

Can white matter in brain cause death? ›

It is not possible to stop disease progression, and it is typically fatal within 6 months to 4 years of symptom onset. People with the juvenile form of metachromatic leukodystrophy, which develops between the age of 4 and adolescence, may live for many years after diagnosis.

Is white matter a stroke? ›

White matter stroke is a prominent stroke subtype. White matter stroke is a leading cause of dementia (vascular dementia) and commonly co-occurs with Alzheimer's disease. Unlike multiple sclerosis, there is no cellular repair process in white matter stroke.

How common is white matter on the brain? ›

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 findings—which means the lesions have no clinical significance—on brain scans of people of any age.

At what age does white matter change? ›

Age-related changes in the brain -- the appearance, starting around age 60, of "white-matter lesions" among the brain's message-carrying axons -- significantly affect cognitive function in old age. White-matter lesions are small bright patches that show up on magnetic resonance imaging (MRI) of the brain.

Can stress cause white matter? ›

Increased exposures to stressful events are associated with a corresponding increase in the progression of white matter hyperintensities.

What improves white matter? ›

White matter, on the other hand, responds mainly to a steady diet of healthy fats, because brain matter is made up of fats. If you are out for dinner, dump dark green olive oil all over your meal. Or go for other sources of wonderful fats: cold water fish, organic nut butters, coconut and avocados.

Does exercise help white matter? ›

Our findings demonstrate that regular physical exercise significantly increases the integrity of white matter fiber tracts, especially those related to frontal function.

Does everyone have white matter in the brain? ›

“Gray matter” is only one of two types of brain tissue; the other “white matter” is rarely mentioned. Yet white matter makes up half the human brain and has not been thought to be important in cognition or learning outside the context of pathology.

Can white matter disease cause headaches? ›

Patients with extensive white matter hyperintensities are likely to have tension-type headaches or to have headaches develop during middle age, according to results published in Cephalagia. Currently, there are no established treatments or strategies for managing white matter hyperintensities.

Does white matter always mean dementia? ›

Comprising about half the brain, white matter is prominently or exclusively involved in well over 100 disorders, in each of which white matter dysfunction can potentially cause or contribute to dementia.

What does it mean when you have white matter on a brain MRI? ›

White matter lesions (WMLs) are areas of abnormal myelination in the brain. These lesions are best visualized as hyperintensities on T2 weighted and FLAIR (Fluid-attenuated inversion recovery) sequences of magnetic resonance imaging. They are considered a marker of small vessel disease.

Where is white matter located? ›

White matter is found in the deeper tissues of the brain (subcortical). It contains nerve fibers (axons), which are extensions of nerve cells (neurons). Many of these nerve fibers are surrounded by a type of sheath or covering called myelin.

Is white matter important? ›

White matter plays an essential role in communication within the brain and between the brain and spinal cord. As a result, damage to this tissue can lead to issues with: problem-solving. memory and focus.

Is white matter disease genetic? ›

White matter disease in midlife is heritable, related to hypertension, and shares some genetic influence with systolic blood pressure - PMC.

Do all elderly have white matter on the brain? ›

White matter lesions are often found on MR scans of elderly people, they are attributed to degenerative changes of long penetrating arteries. 1-6 Reported prevalence ranges from 5% to 90%, depending on study design, study population, and rating scales.

What is white matter in the brain responsible for? ›

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.

Why is it called white matter? ›

White matter is named for its relatively light appearance resulting from the lipid content of myelin. However, the tissue of the freshly cut brain appears pinkish-white to the naked eye because myelin is composed largely of lipid tissue veined with capillaries.

What are the types of white matter? ›

There are three main kinds of white matter tracts: projection, commissural, and association. The largest white matter structure of the brain is the corpus collosum, a form of commissural tract that connects the right and left hemispheres.

When does white matter disease usually start? ›

This is your brain on aging

By age 60, this degeneration, termed white matter disease, is present in more than half of the population. Originally, white matter disease was considered a normal, age-related change.

Should I be concerned about white matter in the brain? ›

The presence of white matter hyperintensities has been correlated with a higher risk of stroke, which can lead to vascular dementia. White matter hyperintensities are often referred to as white matter disease. Initially, white matter disease was thought to simply be related to aging.

Can a CT scan detect white matter disease? ›

Main Outcome Measure: The presence of abnormal neurological signs was examined at baseline and at a 12-month examination. Results: Periventricular white-matter lesions were observed with CT in 12 patients (44%) and with MRI in 21 patients (78%).

What autoimmune disease causes white matter disease? ›

Introduction. Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system, which leads to plaque like primary demyelination in the white and grey matter and focal as well as diffuse neurodegeneration [33].

What is another name for white matter disease? ›

Description. Leukoencephalopathy with vanishing white matter is a progressive disorder that mainly affects the brain and spinal cord (central nervous system). This disorder causes deterioration of the central nervous system's white matter, which consists of nerve fibers covered by myelin.

Does white matter mean stroke? ›

However, stroke also elicits profound white matter injury, a risk factor for higher stroke incidence and poor neurological outcomes. The majority of damage caused by stroke is located in subcortical regions and, remarkably, white matter occupies nearly half of the average infarct volume.

Does white matter disease cause headaches? ›

Patients with extensive white matter hyperintensities are likely to have tension-type headaches or to have headaches develop during middle age, according to results published in Cephalagia. Currently, there are no established treatments or strategies for managing white matter hyperintensities.

What disease destroys the white matter of the brain? ›

Alexander disease—a disorder characterized by the destruction of white matter and the formation of abnormal clumps of protein called Rosenthal fibers that accumulate in astrocytes in the brain. Alexander disease is caused by mutations in the GFAP gene.

What disease affects the white matter in the brain? ›

Leukodystrophies are a group of rare, genetic disorders that affect the white matter of the brain. The word leukodystrophy comes from leuko, which means white, and dystrophy, which means imperfect growth. Leukodystrophies are characterized by this abnormal growth of white matter in the brain.

Can white matter be caused by stress? ›

White matter dynamically changes in response to learning, stress, and social experiences. Several lines of evidence have reported white matter dysfunction in psychiatric conditions, including depression, stress- and anxiety-related disorders.


1. White Matter Disease
2. White Matter Disease CT and MRI
(Radiology Video - radiology made esay)
3. Silent Brain Infarcts and White Matter Disease
(Mayo Proceedings)
4. Clinical significance of white matter hyperintensities in mTBI
5. Heads UP - Episode 77: White Matter Lesions and Migraine Disease
(National Headache Foundation)
6. White matter disease associated with migraine headaches
(First Look MRI)


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