Leukoaraiosis and Lacunes – A Very Brief Overview

As people age, it is common for their brain white matter to change. These changes often appear as bright white spots on T2-weighted MR scans. These areas or spots of hyperintensity (i.e., white matter hyperintensities {WMH}) are also called leukoaraiosis (LA). Researchers are still investigating the exact nature and pathology of these abnormalities but our understanding of them is increasing. They most often seem to start around the lateral ventricles and spread from there, although it is possible to have punctate WMH throughout the brain white matter (i.e., WMH that are not connected to other regions). WMH on brain MRIs represent rarefaction of the white matter, including swelling, demyelination, and damage, although the exact nature and combination of the white matter changes is not known. These WMH can interfere with normal cognitive functioning, including processing speed, attention, inhibition, as well as global executive functioning (although these claims are still being investigated).

Other damage to white matter includes lacunes, which are little holes in the brain, much like the holes in Swiss cheese. They are caused by mini infarcts, or strokes, or other processes. Most of the time they are due to “silent strokes”, or strokes that are small enough that the person does not have any noticeable stroke symptoms. These lacunes can have similar impact on cognition as WMH. Both WMH and lacunes are related to vascular risk factors, such as hyper- or hypo-tension, diabetes, etc.

Dealing with TBIs from the Iraq War

I read a good article on CNN that details some of the problems that veterans and health professionals face when dealing with TBIs acquired during military action. The article provides a good perspective of the “human side” of TBI.

Link to the story

I’ve posted about this topic before but felt that we should revisit it because so many veterans are affected by TBIs (as well as mental health issues). I don’t know the exact number of veterans affected by TBIs but studies have shown that >30% of soldiers and Marines have some sort of psychological issue related to their service in Iraq and/or Afghanistan. The military and the government are realizing how salient this problem is and will be.

“Congress included $900 million in the DoD’s supplemental budget fir fuscal years 2007 and 2008 to fund more mental health services, as well as more research on the effects of traumatic brain injuries (TBI) and treatments for TBI and post-traumatic stress disorder (PTSD)” (Monitor on Psychology, Sep. 2007, pp. 38-39).