Leukoaraiosis
Case example
Old brains can shine too
A 15 year-old Jack Russel Terrier was presented with seizures of 3 weeks duration, deafness and anisocoria.
MRI findings
Generalized atrophy of the forebrain with deep sulci and small gyri is appreciated. The ventricular system is distended without evidence of obstruction. The height of the interthalamic adhesion is decreased at 2 mm (normally above 5 mm) (image 1). Multiple periventricular and bilaterally symmetric T2 und FLAIR hyperintense areas (“white matter hyperintensities”, image 2) are seen. These are T1 isointense and show no contrast enhancement.
Conclusions
- Marked generalized brain atrophy with hydrocephalus ex vacuo and bilaterally symmetric leukoaraiosis
Learning points
- Leukoaraiosis has been shown to represent an age-related brain pathology, suggesting an incomplete form of infarction and clinical signs can range from compulsive behavior to ataxia.
- Advanced imaging techniques: diffusion weighted and diffusion tensor imaging show hyperintensities on ADC due to increased water molecular diffusion and marked loss of fractional anisotropy, respectively. These imaging techniques aid in early detection of leukoaraiosis and provide a more reliable image of the extent of white matter changes.
- MRI differential diagnoses can include periventricular oedema and inflammatory-infectious diseases. However, periventricular oedema is most commonly associated with an obstructive hydrocephalus and infectious-inflammatory changes are characterized by asymmetrical T2/T2 FLAIR hyperintensities, but often show variable T1 intensities and contrast enhancement with vasogenic oedema.
More information
- »Magnetic resonance imaging features of leukoaraiosis in elderly dogs«
— Vet Radiol Ultrasound 2017; 58(4): 389-398. - »Pathological correlated of white matter hyperintensities on magnetic resonance imaging«
— Geriatr Cogn Disord 2015;39(1-2):92-104.
Images courtesy of the Anicura Tierklinik Hollabrunn, Austria.
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