Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Spatial Heterogeneity of White Matter Lesions

Neurology; ePub 2018 Aug 3; Habes, et al

Results of a recent study support the hypothesis that the appearance of white matter lesions or hyperintensities (WMH) follows age and disease-dependent regional distribution patterns, potentially influenced by differential underlying pathophysiologic mechanisms, and possibly with a differential link to vascular and neurodegenerative changes. MRI scans of 1,836 participants (median age 52.2 ± 13.16 years) from a cross-sectional German study were included. Scans of 307 participants (median age 73.8 ± 10.2 years, with 747 observations) from the Baltimore Longitudinal Study of Aging were also included to examine differences in longitudinal progression of these components. Researchers found:

  • WMH were found to occur nonuniformly, with higher frequency within spatially heterogeneous patterns encoded by 4 components, which were consistent with common categorizations of deep and periventricular WMH, while further dividing the latter into posterior, frontal, and dorsal components.
  • Temporal trends of the components differed both cross-sectionally and longitudinally.
  • Frontal periventricular WMH were most distinctive as they appeared in the fifth decade of life, whereas the other components appeared later in life during the sixth decade.
  • Furthermore, frontal WMH were associated with systolic blood pressure and with pronounced atrophy, including Alzheimer disease-related regions.


Habes M, Sotiras A, Erus G, et al. White matter lesions. Spatial heterogeneity, links to risk factors, cognition, genetics, and atrophy. [Published online ahead of print August 3, 2018]. Neurology. doi:10.1212/WNL.0000000000006116.

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