神经影像与临床.pptxVIP

imaging and clinical 10; Leukoaraiosis(脑白质疏松症) represents a heterogeneous diffuse anomaly of cerebral white matter localized predominantly periventricular, detected by CT scan (hypodensity) or MRI (hyperintensity on T2 weighted images or FLAIR). Leukoaraiosis affects approximately 7% of cases with ischemic stroke, 20% in those with lacunar infarcts, 30-40% of patients with dementia and 2/3 of patients with vascular dementia. Also in old people is in association with vascular risk factors like arterial hypertension . Pathophysiology: in region with leukoaraiosis, there are areas of demyelination, increased perivascular space, gliosis and axonal loss. Initially it was thought that demyelination was secondary to incomplete ischemia but PET scan revealed the los as totality of nervous fibers. ; The same images also appear in obstructive hydrocephalus, disseminated metastasis of white matter and lymphomas. Cerebral white matter is vascularised by penetrating arteries and arterioles which are branches of larger superficial cerebral arteries. Structural modification of these arteries are as follow: from concentric hyaline deposits of artery wall, to lipo-hyalinosis (it is referred to severe disorganisation of vascular bed with macrophage presence) and fibrinoid necrosis. In asymptomatic elders the lumen of these arteries are decreased significantly. Pathological studies suggest that leukoaraiosis is one of the manifestations of cerebral small vessels disease. From this point of view it can be explained the relation between leukoaraiosis and lacunar infarcts. ; Age and arterial hypertension are associated more frequently with ischemic leukoaraiosis, where hypercholesterolemia, diabetes mellitus, and myocardial infarction are associated more frequent with isolated lacunar infarcts. So suggested non-atheromatosis pathogenesis of cerebral small arteries implicated in ischemic leukoaraiosis . Staging of leukoaraiosis in grades according to lesion severity and their a