What is white matter and what happens to it
White matter consists of processes of nerve cells covered with myelin, through which signals are transmitted between different areas of the brain. It is fed by small arteries that have almost no bypass routes of blood supply. With prolonged high blood pressure and diabetes, the walls of these vessels thicken, the lumen narrows, and the tissue receives less oxygen. Myelin is gradually damaged, and connections between areas of the brain are disrupted. In the pictures it looks like areas of altered signal around the ventricles and deep in the hemispheres. Hence the main symptoms - slowness, problems with gait and attention.
- White matter - brain pathways
- Feeds on small arteries without alternate routes
- Myelin damage disrupts signal transmission
- Changes visible on MRI around the ventricles
- Speed of thinking and gait suffer
Main reasons
In the first place is the vascular nature: long-term high blood pressure, diabetes mellitus, atherosclerosis, smoking. Such changes are very often found in people over sixty years of age, and their severity depends on the control of risk factors. Other causes are less common: autoimmune diseases such as multiple sclerosis, toxic effects of certain substances and drugs, effects of radiation therapy and chemotherapy, carbon monoxide poisoning. Separately, progressive multifocal leukoencephalopathy is distinguished - viral brain damage in people with severely weakened immunity, as well as hereditary leukodystrophies.
- Arterial hypertension and atherosclerosis
- Diabetes mellitus
- Smoking and high cholesterol
- Multiple sclerosis and autoimmune diseases
- Toxic lesions and consequences of tumor treatment
- Viral infection in immunodeficiency
- Hereditary leukodystrophies
Symptoms
The vascular form develops slowly over years. The first thing that usually suffers is not the memory for events, but the speed and flexibility of thinking: a person takes longer to think, has a harder time switching, loses initiative, and becomes absent-minded. The gait changes early - steps become shorter, instability appears, and falls become more frequent. Frequent urination and loss of urinary control, as well as emotional changes: apathy, tearfulness, and decreased mood are often associated. For other causes, symptoms may worsen over weeks and include weakness in the limbs, speech and vision problems.
- Slowness of thinking and absent-mindedness
- Decreased initiative and apathy
- Unsteady gait, short stride, falls
- Impaired urinary control
- Memory loss
- Emotional instability
Diagnostics
The main method is magnetic resonance imaging of the brain, if necessary with contrast: it shows the location, extent and nature of the changes, which helps to suggest the cause. Next, vascular risk factors are assessed: pressure is measured over time, lipid profile, glucose and glycated hemoglobin are examined, ECG and ultrasound examination of neck vessels is performed. The neurologist conducts tests for memory, attention and speed of thinking. If inflammatory, infectious or hereditary causes are suspected, additional tests and consultations are prescribed.
- MRI of the brain, with contrast if necessary
- 24-hour blood pressure monitoring
- Lipid profile, glucose, glycated hemoglobin
- Ultrasound of neck vessels and ECG
- Neuropsychological testing
- Additional tests if rare causes are suspected
Treatment and prevention
There is no special drug that restores white matter, but it is possible to slow down the progression of the vascular form. The main thing is consistently normal blood pressure, control of sugar and cholesterol, complete cessation of smoking, regular physical activity, weight loss and treatment of sleep apnea. Mental stimulation, socializing, and treating depression have also been shown to benefit thinking. For gait disorders, rehabilitation, balance training, and measures against falls at home are important. For other reasons, the underlying disease is treated under the supervision of a specialized specialist.
- Stable blood pressure control
- Treatment of diabetes and correction of cholesterol
- Complete smoking cessation
- Regular walking and exercise
- Balance training and fall prevention
- Mental and social activity
- Treatment of the underlying cause in non-vascular forms