white matter lesions in 40 year old

Inaccurate MRI interpretation is the most common cause of incorrect diagnoses in patients with MS, underscoring the critical importance of the physicians familiarity with MS mimics.2 Taking a thorough medical history focused on questioning the patient about prior neurological episodes that might have been overlooked or dismissed by the patient remains crucial in any assessment for MS, said Nicoline Schiess MD, MPH, an assistant professor of neurology at Johns Hopkins University Multiple Sclerosis Center. February 27, 2023 alexandra bonefas scott No Comments . White spots on a brain MRI are not always a reason to worry. Secondary analyses using the four sub-indexes of adult IQ showed that larger WMH volume was associated with lower scores on processing speed ( = 0.14, 95% CI = 0.20 to 0.07; P<0.001), verbal comprehension ( = 0.14, 95% CI = 0.21 to 0.07; P<0.001) and perceptual reasoning ( = 0.13, 95% CI = 0.19 to 0.06; P<0.001). People who have mild forms of microvascular ischemic brain disease may have no symptoms. Studies have found that white matter lesions appear in some degree on brain scans of most older adults but less often in younger people. 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. S Before Furthermore, he serves on the North West National Institute for Health Research (NIHR) advisory panel for the Research for Patient Benefit (RfPB) scheme and is a chief investigator and a research supervisor on a range of NIHR portfolio studies in stroke and neurological disorders. Thus, white matter hyperintensities may be a useful surrogate biomarker for identifying individuals in midlife at risk for future accelerated cognitive decline and selecting participants for dementia prevention trials. , Shibata DK, Windham BG, Mosley TH, West NA, Knopman DS. Wu M, Rosano C, Butters M, Whyte E, Nable M, Crooks R, Meltzer CC, Reynolds CF 3rd, Aizenstein HJ. Neuroimage Clin. A Diffeomorphic Anatomical Registration through Exponentiated Lie template of 55years or younger was used to best approximate the age of our cohort (Ashburner, 2007), and a grey matter mask was applied to decrease the chance of false positives. Hello,I am a 24 year old male, and 2 years ago an MRI scan showed up to 20 deep white . MS lesions, known as plaques, may form in CNS white matter in any location;. Research shows that white matter hyperintensities (WMHs) are one such surrogate biomarker of cognitive decline and ADRD that can be measured in the brains of older adults (Cees De Groot et al., 2000; Lee et al., 2016). White matter lesions are among the most common incidental findingswhich means the lesions have no clinical significanceon brain scans of people of any age. High blood pressure (hypertension ) is a very common cause. HHS Vulnerability Disclosure, Help We used measurements from 23 of the 32 subjects for age-matched statistical . Professor Hedley Emsley (a consultant neurologist) explains what white matter lesions are, the range of potential causes, if they can cause problems and more. Top Magn Reson Imaging. Subcortical vascular disease was determined by white matter hyperintensities (WMH) volume and presence of subcortical lacunes. We'll send you our print magazine 6x per year! , Belsky DW, Danese A, Poulton R, Caspi A. Moffitt R multiple sclerosis, ADEM. However, in this case, there were no additional abnormalities. First visit: 150. Correspondence to: Dr. Ahmad R. Hariri, PhD Department of Psychology & Neuroscience Laboratory of NeuroGenetics Cognition and Cognitive Neuroscience, Training Program Duke University Durham, NC 27708, USA E-mail: A fast diffeomorphic image registration algorithm, Cerebral white matter lesions and cognitive function: the Rotterdam scan study, Neuroimaging findings in midlife and risk of late-life dementia over 20 years of follow-up, Looking for system integrity in cognitive epidemiology, The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis, White matter hyperintensities and imaging patterns of brain ageing in the general population, UBO Detectora cluster-based, fully automated pipeline for extracting white matter hyperintensities, White matter hyperintensities are a core feature of Alzheimers disease: evidence from the dominantly inherited Alzheimer network, Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: the cardiovascular health study, Coevolution of white matter hyperintensities and cognition in the elderly, The longitudinal study of aging in human young adults: knowledge gaps and research agenda. On an imaging basis alone, MS could not be diagnosed but remained part . This region is a vascular border zone vascularized by non-collateralising ventriculofugal vessels arising from subependymal arteries. Rhrig L, Sperber C, Bonilha L, Rorden C, Karnath HO. They are associated with subtle functional impairment and higher prevalence of neuropsychiatric disorders. Epub 2022 Sep 28. Liu Y, Liu D, Liu M, Li K, Shi Q, Wang C, Pan Z, Zhou L. Neurol Sci. Background: Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. The CSF fraction increased significantly with age, consistent with previous reports. White matter lesions are one of the most common incidental findings on brain scans. Longitudinal studies have shown that WMHs tend to grow and expand from existing lesions and that higher baseline volumes predict faster accumulation of WMHs and more rapid cognitive decline in older adults (Maillard et al., 2012; Prins and Scheltens, 2015). , De Leeuw F-E, Oudkerk M, Van Gijn J, Hofman A, Jolles J, et al. Y The initial symptoms in particular such as numbness, tingling, and blurred vision, for example may be highly nonspecific. Doctors used to consider white spots on a brain MRI a normal and benign sign of aging, like wrinkles or gray hair. 25-year-old female patient, not known to have any chronic illness, presented with migraine without aura for 6-year duration of grade II severity, not responding to medical treatment. A subcortical white matter hyperintensity similar to slide 1. Please choose an alternative time. Background White matter hyperintensities (WMHs) are frequently detected in migraine patients. Associations between abdominal adipose tissue, reproductive span, and brain characteristics in post-menopausal women. As the brain ages, it begins to accrue small microbleeds and lesions in white matter that are detectable as WMHs using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) (Iadecola, 2013). 2009 Sep;35(4):386-93. doi: 10.1016/j.encep.2008.06.008. ND Signs and symptoms of white matter disease include: Memory problems. Only gold members can continue . (/?<0.002) was detected in the 51-70-year-old group with WMLs (Table 1). Dr Lange is the chief neurologist at HSS and a professor of neurology at Weill Medical College of Cornell University, and Dr Melisaratos is a board-certified radiologist at HSS who specializes in neuroradiology. The cohort is primarily white (93%), which matches the demographics of the South Island (Poulton et al., 2015). Genetic factors, alone or in interaction with environmental factors, appear to be important. montana frost depth map; Hola mundo! oldpatientwithKrabbedisease. One solution is to assess WMHs in midlife, a time when the brain may be more responsive to interventions and has yet to be affected by decades of age-related organ decline. Cognitive ability in childhood was assessed using the Wechsler Intelligence Scale for Children Revised (score range, 40160) at ages 7, 9 and 11 with the mean for these three assessments used in analyses (Wechsler, 1974; Moffitt et al., 1993). MRI brain shows a few non-specific white matter lesions scattered in the brain. 3, 7, 11 Geissler et al 6 observed white-matter hyperintensities on brain MRI in almost half of the patients with IBD who were free of . Summary: Ops! While there is robust evidence that WMHs are related to cognitive decline in older adults (Debette and Markus, 2010; Prins and Scheltens, 2015), our study provides initial evidence that this relationship begins by midlife. 2007 Jan 16;68(3):214-22. doi: 10.1212/01.wnl.0000251302.55202.73. eCollection 2020. The Dunedin Multidisciplinary Health and Development Study is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation, and Employment. 1995 Jul 15;38(2):86-91. doi: 10.1016/0006-3223(94)00248-2. To view unlimited content, log in or register for free. FOIA New imaging techniques present an opportunity to examine white matter pathology in great detail in younger populations. Abstract We evaluated brain tissue compartments in 72 healthy volunteers between the ages of 18 and 81 years with quantitative MRI. sharing sensitive information, make sure youre on a federal (C) Association between WMH volume and cognitive decline. AJR:151,August1988 MAOFWHITE MATTER DISEASE 363 Fig.6.-A, MRimage2500/80 shows diffuse confluent highsignalthroughout whitematter in 4-year-old boywithmetachromatic leukodystro- The lesion, detected during a routine medical examination, was a . Epub 2005 Oct 25. 2004 May;22(1):144-54. doi: 10.1016/j.neuroimage.2003.12.027. A sensitivity analysis using a difference score (adult IQ childhood IQ) as a measure of change in IQ rather than a residualized change score did not change the results. Vasculitic autoimmune diseases such as systemic lupus erythematosus(SLE) and Sjgrens syndrome can also result in white matter abnormalities on MRI. damage and/or destruction of previously normally myelinated structures. The pathogenesis of many white matter diseases remains poorly understood. White matter is tissue that includes nerve fibers (axons), which connect nerve cells. White matter hyperintensities on T2-weighted magnetic resonance imaging are frequent incidental findings in the brains of elderly individuals. First, descriptive statistics was generated for the sample as a whole (Table1). Do you want to book the appointment in any case? This is important because even sub-clinical cognitive decline impacts daily functioning and psychological well-being (Tucker-Drob, 2011). official website and that any information you provide is encrypted The relevant ethics committees approved each phase of the study, and informed consent was obtained from all participants. What's more, these two predictors of cognitive performance in old age were independent; they didn't consistently affect scores in the same way. Methods Paired LUS and chest CT scan were prospectively performed and compared when in diagnosing five pathologies including region with alveolar-interstitial pattern (RAIP), alveolar-interstitial syndrome (AIS), lung . The possibility of . WMHs were common in the cohort, with an average volume of 953.50 mm3 (25th75th quartile = 425.251,142.44 mm3, median = 681.75; Fig. The second possibility is that low IQ is an indicator of lower overall brain integrity that was present early in life (Deary, 2012). Deterioration of the white matter happens with ageing and can be seen on brain scans as white matter lesions (abnormal areas). This difference was exacerbated in adulthood; larger WMH volume was associated with lower IQ ( = 0.15, 95% CI = 0.22 to 0.09; P<0.001; Fig. It is sensible to make sure conditions such as diabetes mellitus and high cholesterol are under control. Very often, white matter lesions are non-specific and their appearance doesnt suggest any particular underlying cause. https://doi.org/10.1093/braincomms/fcz041, https://sites.google.com/site/dunedineriskconceptpapers/documents, http://creativecommons.org/licenses/by/4.0/, Receive exclusive offers and updates from Oxford Academic. The first possibility is that children with lower IQs tend to be born into or seek out environments that lead to higher rates of neurodegeneration (e.g. The nerve fibres are surrounded by a fatty material called myelin. Habes Other factors such as genetics are likely to play a role. As such, our findings point to the need to investigate these possible mechanistic pathways in future studies with child-to-adult imaging data. The mean age of the study population was 63.3 years (range, 45.7 to 96.7), and 1049 of the subjects (52.4%) were women. HHS Vulnerability Disclosure, Help A 59-year-old male visiting from Michigan presented to a hospital in Florida with an ischemic stroke with aphasia and acute confusion for two days. The site is secure. However, there are numerous non-vascular causes, as well. Distribution of WMHs in 45-year-old participants from the Dunedin Study. Background: White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. The 60-year-old father of the main resident of the home got into a confrontation with the four suspects outside around 4:40 a.m. As the confrontation escalated, the suspects shot the man in the head. White matter disease, or leukoaraiosis, involves the degeneration of white matter in the brain. White matter lesions (WMLs) or leukoaraiosis indicate small vessel vascular brain disease as well as degenerative or inflammatory processes. One hundred and thirty-seven cognitively unimpaired . The .gov means its official. All error bars display the standard error of the mean. Very often, white matter lesions dont cause any noticeable problemsfor the individual. However, in many cases, the white matter lesions as isolated observations are nonspecific and could be due to MS or another cause, explained Drs Lange and Melisaratos. Please enable it to take advantage of the complete set of features! Intervention efforts targeting WMHs as a surrogate biomarker in older adults have had mixed results (Prins and Scheltens, 2015). White matter hyperintensities are of presumed vascular origin and are frequently observed in older adults as well as in patients with AD (Brickman, Muraskin, & Zimmerman, 2009; Dadar et al., 2015). He then completed a PhD on inflammation and cytokine regulation in stroke and undertook specialist training as a clinical lecturer in neurology at the Walton Centre for Neurology & Neurosurgery in Liverpool. Armstrong NJ, Mather KA, Sargurupremraj M, Knol MJ, Malik R, Satizabal CL, Yanek LR, Wen W, Gudnason VG, Dueker ND, Elliott LT, Hofer E, Bis J, Jahanshad N, Li S, Logue MA, Luciano M, Scholz M, Smith AV, Trompet S, Vojinovic D, Xia R, Alfaro-Almagro F, Ames D, Amin N, Amouyel P, Beiser AS, Brodaty H, Deary IJ, Fennema-Notestine C, Gampawar PG, Gottesman R, Griffanti L, Jack CR Jr, Jenkinson M, Jiang J, Kral BG, Kwok JB, Lampe L, C M Liewald D, Maillard P, Marchini J, Bastin ME, Mazoyer B, Pirpamer L, Rafael Romero J, Roshchupkin GV, Schofield PR, Schroeter ML, Stott DJ, Thalamuthu A, Trollor J, Tzourio C, van der Grond J, Vernooij MW, Witte VA, Wright MJ, Yang Q, Morris Z, Siggurdsson S, Psaty B, Villringer A, Schmidt H, Haberg AK, van Duijn CM, Jukema JW, Dichgans M, Sacco RL, Wright CB, Kremen WS, Becker LC, Thompson PM, Mosley TH, Wardlaw JM, Ikram MA, Adams HHH, Seshadri S, Sachdev PS, Smith SM, Launer L, Longstreth W, DeCarli C, Schmidt R, Fornage M, Debette S, Nyquist PA. Stroke. areas such as the septum that appear similar to WMHs on FLAIR images). A 52-year-old woman with intellectual disability was admitted to the hospital due to pneumonia. He had imaging that noted a subacute infarct in the left parietal lobe along with multiple areas of white matter signal abnormalities and Cees De Groot TE Measures of change in IQ were estimated by calculating residualized change scores. Debette 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. While WMHs are uncommon in adults before age 30 (Habes et al., 2016), they are detectable in <90% of individuals by age 65 (Longstreth et al., 1996). Find the best specialist in Neurology in your location: White matter lesions explained by a neurologist, Professor Emsley was appointed Consultant Neurologist with special interest in Stroke Neurology at Lancashire Teaching Hospitals NHS Foundation Trust in 2008, and in. what is a t2 hyperintense liver lesion. Risk factors of white matter hyperintensities in migraine patients. 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. Non-specific white matter lesions are sometimes seen in people withmigraine. Recent studies have reported that they may also be common in middle-aged individuals, and their systematic evaluation in younger populations is necessary. Epub 2022 Nov 11. A stroke, for example, is a type of brain lesion. In this case the most likely diagnosis is migraine headaches. "However, in many cases, the white matter. Methods: Sixty volunteers from a tertiary headache center were . In the Dunedin Study, a population-representative cohort followed since birth, we measured white matter hyperintensities in 843 45-year-old participants using T2-weighted magnetic resonance imaging and we assessed cognitive decline from childhood to midlife. this complication is seen in up to 40 % of patients receiving intrathecal methotrexate [29, 30]. leukodystrophies (note, however, that many . , Booth T, Murray C, Gow AJ, Penke L, Morris Z, et al. "Black holes" on T1 weighted imaging are not usually seen in the spinal cord but gadolinium enhancement of acute cord lesions does occur. The two main types of lesions found in migraineurs include: White matter hyperintensities (WMH): These lesions appear bright white on certain sequences of MRI scans. Fourth, the association between volume and change in IQ was tested using ordinary least squares multiple regression. The average number of WMH clusters (occurrences) per brain was 1.37 (0.94 for DWMH and 0.43 for pathological PVWMH) and the mean WMH tissue volume was 0.278 ml. Fig 1 White matter hyperintensities on magnetic resonance imaging (axial fluid attenuated inversion recovery sequence) in two 80 year old patients: (left) minor white matter hyperintensities; (right) extensive white matter hyperintensities predominating in periventricular region. 3A); individuals with the highest volume (>1.5 SDs above the mean) had childhood IQs that were 4.80 points lower on average than individuals with the lowest volume (<1.5 SDs below the mean). A 2013 study found that moderate or severe cerebral SVD was associated with a decline in. Hum Brain Mapp. Dr Schiess added that ancillary testing, including blood work, CSF findings, optical coherence tomography (OCT), and evoked potentials can also facilitate diagnosis. White matter lesions are much more common in older or elderly people. Epub 2008 Sep 23. Neuroimage. White matter disease can be broadly grouped into: demyelinating disorders. Christidi F, Tsiptsios D, Sousanidou A, Karamanidis S, Kitmeridou S, Karatzetzou S, Aitsidou S, Tsamakis K, Psatha EA, Karavasilis E, Kokkotis C, Aggelousis N, Vadikolias K. Neurol Int. At baseline, the majority of lesions were found in the supratentorial brain. The Clinical Utility of Leukoaraiosis as a Prognostic Indicator in Ischemic Stroke Patients. With the wide use of brain MRI, white matter hyperintensity (WMH) is frequently observed in clinical patients. National Library of Medicine http://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI. All statistical analyses were done using R (v.3.4.5). This refers tohow many white matter lesions there are and whether they are becoming joined up, or confluent. eCollection 2021 Oct. Endres D, Matysik M, Feige B, Venhoff N, Schweizer T, Michel M, Meixensberger S, Runge K, Maier SJ, Nickel K, Bechter K, Urbach H, Domschke K, Tebartz van Elst L. Diagnostics (Basel). A total of 843 participants were included in the final analysis after eight participants were removed for excessive UBO false positives, four participants were excluded because they had incidental findings that interfered with the UBO algorithm, three participants were removed for having multiple sclerosis and nine participants were excluded for missing IQ data in childhood or adulthood. After receiving a brain scan result showing white matter lesions, youll likely have lots of questions. However, an accurate diagnosis can be made only after thorough review of images obtained from the entire brain and by understanding the clinical context, Drs Lange and Melisaratos concluded. Purpose of review: . As can been seen in these images, WMHs were most common around the anterior and posterior horns of the lateral ventricles as expected. Zhang Cognitive decline is depicted here as the change from group mean childhood IQ score to group mean adult IQ score, for groups defined based on the level of white matter hyperintensities. WMHs were most common around the anterior and posterior horns of the lateral ventricles (e.g. age-matched groups (51-70 years old) with and without white matter lesions with respect to carotid ultrasonography, cerebral blood flow (xenon-133 injection), and cerebrovascular risk . Standardized methods to examine such pathology and its determinants will help inform strategies for their prevention, which is an important component of a healthy ageing agenda. White matter is the deepest part of the brain that contains millions of nerve fibres connecting other parts of the brain and spinal cord. Maillard Successful surrogate biomarkers would allow clinicians to assess risk, monitor sub-clinical disease progression and intervene before clinically significant dementia symptoms manifest. Neurologists order brain scanswhich might show white matter lesionsfor a wide variety of motor symptoms (such as weakness, incoordination, and gait disorder), sensory symptoms (such as numbness, tingling, and visual loss), and neurobehavioral problems (such as memory loss, language impairment, and personality changes). It is indicated that ENKL should be recognized as one of the rare causes of RPD and early testing for EBVDNA in cerebrospinal fluid and imaging of cauda equina would be useful diagnostic tools. Support for these hypotheses would provide novel evidence that WMHs could be a surrogate biomarker of risk in the general population as early as midlife, allowing for earlierand potentially more effectiveinterventions for cognitive decline and ADRD. Coker , Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, et al. Want to view more content from Neurology Advisor? New imaging techniques present an opportunity to examine white matter pathology in great detail in younger populations. White matter lesions (WMLs) are areas of abnormal myelination in the brain. Epub 2006 Nov 13. National Library of Medicine Ontario Neurodegenerative Disease Research Initiative (ONDRI): Structural MRI Methods and Outcome Measures. The Dunedin Multidisciplinary Health and Development Study: overview of the first 40 years, with an eye to the future, White matter hyperintensities, cognitive impairment and dementia: an update, The evolution of preclinical Alzheimers disease: implications for prevention trials, Neurocognitive functions and everyday functions change together in old age, Brain white matter damage in aging and cognitive ability in youth and older age, Wechsler Intelligence Scale for Children-Revised (WISC-R), Wechsler Adult Intelligence ScaleFourth Edition, Segmentation of brain MR images through a hidden Markov random field model and the expectation-maximization algorithm. rletal lobes In12-month-old boywithbiopsy- patientwithcamitlne deficiency. White matter hyperintensities (WMH): These lesions appear bright white on certain sequences of MRI scans. 2020 Jul;51(7):2111-2121. doi: 10.1161/STROKEAHA.119.027544. A 44-year-old man with a 30-pack-year history of smoking presented with 2 months of headaches. Accessibility 1, 2 The underlying pathology of these lesions mostly reflects demyelination and axonal. 2020 Aug 11;11:847. doi: 10.3389/fneur.2020.00847. Subscribe to our Newsletter to stay up to date on the latest news, TOP DOCTORS | 85 Tottenham Court Road, London, W1T 4TQ. However, those with more advanced white matter damage may experience: difficulty thinking. For example, brain scans are sometimes done because a patient is seeking reassurance that there is no sinister cause for their headache. Preparation for kNN classification feature, Preparation for kNN classification feature space: ( a ) A candidate WMH cluster, Some kNN classification results. Also, this site uses cookies. , Viqar F, Zimmerman ME, Narkhede A, Tosto G, Benzinger TLS, et al. body mass index, smoking, primary-care visits) and the NZ census on educational attainment. A 69-year-old, male, with a left frontal meningioma, . By continuing to use our site, you agree to the Termsof Use and acknowledge that youve read our PrivacyPolicy. These lesions are best visualized as hyperintensities on T2 weighted and FLAIR (Fluid-attenuated inversion recovery) sequences of magnetic resonance imaging. Common Genetic Variation Indicates Separate Causes for Periventricular and Deep White Matter Hyperintensities. 2020 Sep 14;10(9):691. doi: 10.3390/diagnostics10090691. White matter hyperintensities are lesions in the brain that can be detected by T2-weighted MRI on which these lesions show up with increased brightness. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Given that prevention of damage is often more efficacious than reversal of damage (Sperling et al., 2014; Moffitt et al., 2017), particularly in the brain, our results suggest that lifestyle and pharmaceutical interventions aimed at slowing the progression of WMHs in midlife may be promising complements to interventions in older adults. Analyses reported here were checked for reproducibility by an independent data-analyst, who recreated the code by working from the manuscript and applied it to a fresh dataset. The authors declare no competing interests. In the below slideshow, Drs Lange, Melisaratos, and Schiess shared a collection of MRI findings from their clinical practice to illustrate a selection of MS mimics. WMLs appear as hyperintense periventricular or subcortical patchy or confluent areas on T2 or fluid-attenuated inversion recovery MRI sequence. She had presented at age 40 with clumsiness of the right hand, and over the next 10 years had become increasingly unsteady, with subjective cognitive decline and bladder urgency. Some of the most common mimics include migraine and chronic cerebrovascular disease, according to Dr Schiess. Our results further show that accumulation of WMHs in midlife already indicates mild cognitive decline. Cureus. White matter hyperintensities (WMHs) are frequently seen on MRI scans of the brain in older people. Overall assessment of their patients The new computer algorithm was validated and compared with the scores of visual rating, and the correspondence between the two methods was high. Abnormalities in white matter, known as lesions, are most often seen as bright areas or spots on MRI scans of the brain. 6, 7, 11, 18 A few case reports describe focal lesions in the white matter in IBD patients who developed neurological symptoms. Our results demonstrate that a link between white matter hyperintensities and early signs of cognitive decline is detectable decades before clinical symptoms of dementia emerge. MRI differential diagnosis of suspected multiple sclerosis. 2013;34(11):2972-2985. doi:10.1002/hbm.22119 . P The only way to tell is to determine if there are co-existing abnormalities in other parts of the brain and this must be incorporated within the context of the clinical condition, they said. , Caspi A, Harkness AR, Silva PA. Poulton Genetic and Environmental Effects on the Development of White Matter Hyperintensities in a Middle Age Twin Population.

Funny Nicknames For Zodiac Signs, Dayton Refrigeration Vacuum Pump Model 4z577 Manual, Articles W