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White matter hyperintensities (WMH) lesions on T2/FLAIR brain MRI are frequently seen in healthy elderly people. The pathophysiology and long-term consequences of these lesions are unknown. width: "100%", 10.1136/jnnp.2009.204685, Yamamoto Y, Ihara M, Tham C, Low RW, Slade JY, Moss T: Neuropathological correlates of temporal pole white matter hyperintensities in CADASIL. As already indicated in this early report, the severity of periventricular and deep WMdemyelination closely correlates with its extent (Figure1). more frequent falls. The author declares that they have no competing interests. This is the most common cause of hyperintensity on T2 images and is associated with aging. The risk is high in people with a history of stroke and depression. White matter changes were defined as "ill-defined hyperintensities >= 5 mm. The prevailing view is that these intensities are a marker of small-vessel vascular disease and in clinical practice, are indicative of cognitive and emotional dysfunction, particularly in the ageing population. The multifocal periventricular and posterior fossa white matter lesions have an appearance typical of demyelinating disease. 10.1212/01.wnl.0000249119.95747.1f, Krishnan MS, O'Brien JT, Firbank MJ, Pantoni L, Carlucci G, Erkinjuntti T: Relationship between periventricular and deep white matter lesions and depressive symptoms in older people. Whether these radiological lesions correspond to irreversible histological changes is still a matter of debate. 10.1212/WNL.43.9.1683, Grafton ST, Sumi SM, Stimac GK, Alvord ECJ, Shaw CM, Nochlin D: Comparison of postmortem magnetic resonance imaging and neuropathologic findings in the cerebral white matter. T1 Scans with Contrast. Dr. Sanil Rege is a Consultant Psychiatrist and founder of Psych Scene and Vita Healthcare. However, the hyperintensity area appears a little lighter comparatively. https://doi.org/10.1186/2051-5960-1-14, DOI: https://doi.org/10.1186/2051-5960-1-14. White matter lesions (WMLs) are areas of abnormal myelination in the brain. Normal vascular flow voids identified at the skull base. Overall, its a non-invasive and painless method that provides a detailed and cross-sectional illustration of the internal organs., MRI scan is different from other diagnostic imaging techniques. It was amazing and challenging growing up in two different worlds and learning to navigate and merging two different cultures into my life, but I must say the world is my playground and I have fun on Mother Earth. In medicine, MRI hyperintensity is available in three forms according to its location on the brain. Lesions are not the only water-dense areas of the central nervous system, however. WMHs may, therefore, be a marker for diffuse vascular involvement including peripheral and coronary arteries increasing the risk of cardiovascular mortality. Finally, this study focused on demyelination as main histopathologic lesion. In the absence of T2w lesions slices (n=3) at the level of the lateral geniculate nucleus were examined. Welcome to Iggy Garcia, The Naked Shaman Podcast, where amazing things happen. They can pose serious diagnostic problems which is reflected by their English name and abbreviation - UBOs (Unidentified Bright Objects). WebAnswer (1 of 8): White matter hyperintensities (WMHs) are signal abnormalities in the white matter of the brain found on T2-weighted , fluid-attenuated inversion recovery (FLAIR), and proton density magnetic resonance imaging (MRI) sequences. While these findings are non specific they are commonly seen with chronic microvascular ischemic change. 10.2307/2529310, Pantoni L, Garcia JH: Pathogenesis of leukoaraiosis: a review. Round Earth and Much More, Iggy Garcia LIVE Episode 175 | Open Forum, Iggy Garcia LIVE Episode 174 | Divine Appointments, Iggy Garcia LIVE Episode 173 | Friendships, Relationships, Partnerships and Grief, Iggy Garcia LIVE Episode 172 | Free Will Vs Preordained, Iggy Garcia LIVE Episode 171 | An appointment with destiny, Iggy Garcia Live Episode 170 | The Half Way Point of 2022. Usually this is due to an increased water content of the tissue. The corresponding Luxol-van Gieson (LVG)-stained histological slides were analyzed by both pathologists assessing the degree of demyelination around the perivascular spaces. 10.1136/jnnp.2009.172072, Fazekas F, Kleinert R, Offenbacher H, Schmidt R, Kleinert G, Payer F: Pathologic correlates of incidental MRI white matter signal hyperintensities. He currently practices on the Mornington Peninsula. Among these lesions, degeneration of myelin is the most frequently encountered in old age and may take place long before the emergence of cognitive or affective symptoms [14]. MRI said few tiny discrete foci of high signal on FLAIR sequences in the deep white matter in the cerebellum, possibly part of chronic small vessel disease. Neuro patients going in for head and cervical MRI should ask to see if they are being imaged on a 3.0 Tesla MRI using an MS imaging protocol. WebParaphrasing W.B. Three trained neuroradiologists evaluated brain T2w and FLAIR MRI of all 59 cases blind to the neuropathologic data. unable to do more than one thing at a time, like talking while walking. Top Magn Reson Imaging 2004, 15: 365367. The MRI imaging presents a range of sequences. 10.1161/STROKEAHA.107.489112, Service neuro-diagnostique et neuro-interventionnel DISIM, University Hospitals of Geneva, rue Gabrielle Perret-Gentil 4, Geneva 14, 1211, Switzerland, Sven Haller,Victor Cuvinciuc,Ann-Marie Tomm&Karl-Olof Lovblad, Department of Mental Health and Psychiatry, Geneva, Switzerland, Enik Kvari,Panteleimon Giannakopoulos&Constantin Bouras, Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland, Department of Readaptation and Palliative Medicine, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, Geneva, Switzerland, You can also search for this author in Focal hyperintensities in the subcortical white matter demonstrated by T2-weighted or FLAIR images are a common incidental finding in patients undergoing brain MRI for indications other than stroke. These white matter hyperintensities are an indication of chronic cerebrovascular disease. In old age, WMHs were mainly associated with myelin pallor, tissue rarefaction including loss of myelin and axons, and mild gliosis [3, 23, 2628]. Treatment typically involves reducing or managing risk factors, such as high blood pressure, cholesterol level, diabetes and smoking. We used to call them UBOs; Unidentified bright objects. WebFluid-attenuated inversion recovery (FLAIR) is an MRI sequence with an inversion recovery set to null fluids. It has significantly revolutionized medicine. They are non-specific. 1 The situation is WebThe most important scans are T1 scans with contrast and T2/FLAIR scans. J Comput Assist Tomogr 1991, 15: 923929. There is strong evidence that WMH are clinically important markers of increased risk of stroke, dementia, death, depression, impaired gait, and mobility, in cross-sectional and in longitudinal studies. PubMed Normal brain structures without white matter hyperintensity. The deep white matter is even deeper than that, going towards the center Lesions are not the only water-dense areas of the central nervous system, however. 10.1002/mrm.1910100113, Murray ME, Senjem ML, Petersen RC, Hollman JH, Preboske GM, Weigand SD: Functional impact of white matter hyperintensities in cognitively normal elderly subjects. California Privacy Statement, Khalaf, A., Edelman, K., Tudorascu, D., Andreescu, C., Reynolds, C. F., & Aizenstein, H. (2015). Only in one case, they underestimated the underlying pathology (exact McNemar p<0.001). Microvascular ischemic disease is a brain condition that commonly affects older people. It is a common finding on brain MRI and a wide range of differentials should The present study revealed that brain T2/FLAIR sequence-identified WMHs overestimated demyelination in the periventricular and perivascular regions but underestimated it in the deep WM during normal brain aging. They can be seen for no good reason, perhaps more often with a history of migraines, more likely with a history of hypertension and other risk factors for atherosclerosis. Foci of T2 Hyperintensity, therefore, means "focal points, or concise areas, of very bright spots." 10.1212/WNL.59.3.321, Topakian R, Barrick TR, Howe FA, Markus HS: Bloodbrain barrier permeability is increased in normal-appearing white matter in patients with lacunar stroke and leucoaraiosis. Lacunes were defined as well-defined areas > 2 mm, with the same signal characteristics on MRI as spinal fluid. 10.1016/S0140-6736(00)02604-0, Article We will be traveling to Peru: Ancient Land of Mystery.Click Here for info about our trip to Machu Picchu & The Jungle. depression. Glial cell responses include astrogliosis and clasmatodendrosis as well as loss of oligodendrocytes and distinct microglial responses (for review see [13]). For example, it affects the handing out speed and executive functions., According to health practitioners, there is a strong connection between death and MRI hyperintensity. An exception could be the rare cases of pure vascular dementia, where diffuse white matter hyperintensities could be important also at later stages of cognitive decline and conversion. MRI said few tiny discrete foci of high signal on FLAIR sequences in the deep white matter in the cerebellum, possibly part of chronic small vessel disease. What does scattered small foci of t2 hyperintensity in the subcortical white matter means. This article is published under license to BioMed Central Ltd. Again, all tests were repeated with a subsample of 33 cases with delay between MRI and autopsy less than 5 years. The ventricles and basilar cisterns are symmetric in size and configuration. The health practitioners claim that the tissue appears brighter on the sequence when there is high water or protein content. I have some pins and needles in hands and legs. ); Debette et al., The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis, BMJ 2010; 341: c3666. This article requires a subscription to view the full text. Im an entrepreneur, writer, radio host and an optimist dedicated to helping others to find their passion on their path in life. Completing a GP Mental Health Treatment Plan in Treatment-Resistant Depression (TRD)-Part 1, Shared Decision Making in Generalised Anxiety Disorder A Practical Approach, Attention Deficit Hyperactivity Disorder (ADHD)- All You Need to Know. Appointments & Locations. The only radio-pathological study with pre-mortem MRI included only 23 unselected cases and reported that vascular integrity was the only parameter that correlated with total WMH [29]. Consistent with the very old age of our cohort [16], three cases showed Braak stages 5 for neurofibrillary tangles [17] and 8 cases had at least one cortical Lewy body [18]. Discordant pairs were analyzed with exact Mc Nemar significance probability. Since its invention, researchers and health practitioners are constantly refining MRI imaging techniques. Pathological tissue usually has more water than normal brain so this is a good type to scan to pick this up. All of the cases included in the present series presented with high MMSE scores compatible with normal cognitive functioning and absence of major depression. WebWhite matter hyperintensities are common in MRIs of asymptomatic individuals, and their prevalence increases with age from approximately 10% to 20% in those approximately 60 years old to close to 100% in those older than 90 years. The presence of white matter hyperintensities may increase the risk that an individual will develop mild cognitive impairment or have declining performances on cognitive tests but may not be enough to facilitate progression from mild cognitive impairment to dementia, the latter being overwhelmingly driven by neurodegenerative lesions. How often have you read, There are small scattered foci of signal abnormalities (T2 hyperintensities or increased FLAIR signal) in the cerebral white matter Other risk factors for white spots include getting older, race/ethnicity, genetics, obesity, diabetes, hypertension, and high cholesterol. These small regions of high intensity are observed on T2 weighted MRI images (typically created using 3D FLAIR) WebAnswer (1 of 8): White matter hyperintensities (WMHs) are signal abnormalities in the white matter of the brain found on T2-weighted , fluid-attenuated inversion recovery (FLAIR), and proton density magnetic resonance imaging (MRI) sequences. These areas are hyperintense on T2-weighted (T2) and fluid-attenuated inversion recovery (FLAIR) MRI sequences, and by consensus are now referred to as white matter hyperintensities (WMH), or subcortical hyperintensities where deep gray matter is also involved. WMHs have a high association with Vascular dementia but their role in Alzheimers dementia is unclear. 1 The situation is Citation, DOI & article data. For neuropathologists (2 raters) we used standard Cohens kappa testing. To this end, the T1- and T2-weighted, as well as the T2-weighted FLAIR, magnetic resonance imaging (MRI) data obtained from migraine patients were analyzed to describe the imaging characteristics of WMHs. WHAT IS THE CLINICAL SIGNIFICANCE OF WMH'S? This article requires a subscription to view the full text. Non-specific white matter changes. The MRI found: "Discrete foci T2/ FLAIR hyperintensity in the supratentorial white matter, non specific" When I saw this I about died.. This Vascular depression is regarded as a subtype of late-life depression characterised by a distinct clinical presentation and an association with cerebrovascular damage. WebParaphrasing W.B. These lesions are best visualized as hyperintensities on T2 weighted and FLAIR (Fluid-attenuated inversion recovery) sequences of magnetic resonance imaging. 10.1001/archpsyc.57.11.1071, Schmidt R, Petrovic K, Ropele S, Enzinger C, Fazekas F: Progression of leukoaraiosis and cognition. These values are then illustrated in 2 x 2 tables (see Table1). walking slow. Arch Neurol 1991, 48: 293298. They are more common in individuals with a history of cognitive impairment, dementia, or cerebrovascular disease. Originally just called "FLAIR", this technique was developed in the early 1990's by the Hammersmith research team led by Graeme Bydder, Joseph Hajnal, and Ian Young. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. A morphometric correlation with arteriolosclerosis and dilated perivascular spaces. They are indicative of chronic microvascular disease. The association is particularly strong with cardiovascular mortality. None are seen within the cerebell= um or brainstem. These also involve different imaging patterns that highlight the different kinds of tissues. Correspondence to Google Scholar, Douek P, Turner R, Pekar J, Le Patronas N, Bihan D: MR color mapping of myelin fiber orientation. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience These are: age-related changes, common incidental findings usually of little or no clinical significance. WebFluid-attenuated inversion recovery (FLAIR) is an MRI sequence with an inversion recovery set to null fluids. There are seve= ral (approximately eight) punctate foci of T2 and FLAIR hyperintensit= y within the cerebral white matter. There are several different causes of hyperintensity on T2 images. 10.1001/archgenpsychiatry.2009.5, de Groot JC, de Leeuw FE, Oudkerk M, Hofman A, Jolles J, Breteler MM: Cerebral white matter lesions and depressive symptoms in elderly adults. What it means Signal area hyperintense on T2 and FLAIR in the white matter anterior to the left nucleus-capsular region, which may represent an area of encephalomalacia.. Deep WMHs were scored as follows: 0, absent; 1, punctate; 2, coalescing; and 3, confluent. Part of It is a common finding on brain MRI and a wide range of differentials should J Clin Neurosci 2011, 18: 11011106. In the United States, you can find a network of imaging centers that facilitate patients. Specifically, WMHs can impact on memory, vigilance and executive functioning, depending on its localisation and severity. Normal brain structures without white matter hyperintensity. Citation, DOI & article data. It produces images of the structures and tissues within the body. Come and explore the metaphysical and holistic worlds through Urban Suburban Shamanism/Medicine Man Series.For more information, please visit:IggyGarcia.com & WithInsightsRadio.com. Histological slides were independently evaluated by two trained neuropathologists without previous knowledge of the MRI data. 2023 BioMed Central Ltd unless otherwise stated. Representative examples of the concordance between brain MRI WMHs and demyelination. Both the wide bore and open MRI scan methods help radiologists in narrowing the diagnosis. The wide space makes it easier to conduct brain MRI and other body parts as required., The open MRI involves an open machine that uses magnets to take inside images from all four sides., As compared to ultrasound and CT scans, MRI has more advantages. 10.1161/STROKEAHA.112.662593, Kim JH, Hwang KJ, Kim JH, Lee YH, Rhee HY, Park KC: Regional white matter hyperintensities in normal aging, single domain amnestic mild cognitive impairment, and mild Alzheimer's disease. They can be seen for no good reason, perhaps more often with a history of migraines, more likely with a history of hypertension and other risk factors for atherosclerosis. I dropped them off at the neurologist this morning but he isn't in until Tuesday. The LADIS Study. WebWhite matter changes are visible on magnetic resonance imaging (MRI) as lesions. In the same line, another cohort study supported the clinical relevance of deep WMHs that were correlated with cardiac arrhythmia, brain atrophy, and silent infarcts [2]. In contrast, radiologists showed moderate agreement for periventricular WMHs (kappa of 0.42 (95% CI: 0.31-0.55; p<0.0001)) and only fair agreement for deep WMHs (kappa of 0.34, 95% CI: 0.22-0.48; p<0.0001)). 10.1001/archneur.1991.00530150061019, van Swieten JC, van den Hout JH, van Ketel BA, Hijdra A, van Wokke JH, Gijn J: Periventricular lesions in the white matter on magnetic resonance imaging in the elderly. Among cardiovascular risk factors hypertension was present in 33 (55.9%), hypotension in 11 (18.6), dyslipidemia in 10 (17.2) and diabetes in 12 (20.3%) subjects of the sample. WebT2-FLAIR stands for T2-weighted- F luid- A ttenuated I nversion R ecovery. For more information, please visit: IggyGarcia.com & WithInsightsRadio.com, For more information, please visit: MRI showed some peripheral hyperintense foci in white matter. All authors participated in the data interpretation. Only two cases showed severe amyloid angiopathy. To this end, the T1- and T2-weighted, as well as the T2-weighted FLAIR, magnetic resonance imaging (MRI) data obtained from migraine patients were analyzed to describe the imaging characteristics of WMHs. WebHyperintensities are often not visible on other types of scans, such as CT or FLAIR. There are really three important sections of the brain when it comes to hyperintensities: the periventricular white matter, the deep white matter, and the subcortical white matter. Although more They can be seen for no good reason, perhaps more often with a history of migraines, more likely with a history of hypertension and other risk factors for atherosclerosis. Springer Nature. Landis and Koch's interpretations of kappa were used as follows [22]:< 0.0 Poor, 0.00 0.20 Slight, 0.21 0.40 Fair, 0.41 0.60 Moderate, 0.61 0.80 Substantial, 0.81 1.00 Almost perfect. What is non specific foci? A recent review of post-mortem MRI in patients with small vessel disease pointed to the marked heterogeneity of the pathologic correlates of WMHs [13]. Please add some widgets by going to. Radiology 1990, 176: 439445. WebAnswer (1 of 2): Exactly that. Moseley ME, Cohen Y, Kucharczyk J, Mintorovitch J, Asgari HS, Wendland MF: Diffusion-weighted MR imaging of anisotropic water diffusion in cat central nervous system. Foci of T2 Hyperintensity, therefore, means "focal points, or concise areas, of very bright spots." Appointments & Locations. There are many possible causes, including vitamin deficiencies, infections, migraines, and strokes. WebThe most important scans are T1 scans with contrast and T2/FLAIR scans. All statistics were performed with Stata release 12.1, Stata Corp., College Station, TX, USA 2012 (FRH 21 years of experience). Be sure to check your spelling. White matter changes were defined as "ill-defined hyperintensities >= 5 mm. The agreement between neuropathologists was substantial both for periventricular (kappa of 0.71 (95% CI: 0.53 - 0.87; p<0.0001)) and deep WM demyelination (kappa of 0.79 (95% CI: 0.65 - 0.93; p<0.0001)). No evidence of midline shift or mass effect. And I The MRI found: "Discrete foci T2/ FLAIR hyperintensity in the supratentorial white matter, non specific" When I saw this I about died.. Impression: There are scattered foci of T2/FLAIR hyperintensity within the periventricular, deep and subcortical white matter. Symptoms of white matter disease may include: issues with balance. They are indicative of chronic microvascular disease. Inter-rater reliability was substantial-almost perfect between neuropathologists (kappa 0.71 - 0.79) and fair-moderate between radiologists (kappa 0.34 - 0.42). Major imaged intracranial flow = voids appear normally preserved. While these findings are non specific they are commonly seen with chronic microvascular ischemic change. Copyright 2000-2022 IGNACIO GARCIA, LLC.All rights reserved Web master Iggy Garciamandriotti@yahoo.com Columbus, Ohio Last modified May, 2021 Hosted by GVO, USC TITLE 42 CHAPTER 21B 2000BB1 USC TITLE 42 CHAPTER 21C 2000CC IRS PUBLICATION 517, Welcome to Iggy Garcia, The Naked Shaman Podcast, where amazing things happen. Radiologic convention, right hemisphere on left hand side. Mainly located in the periventricular white matter (WM) and perivascular spaces, they can also be detected in deep WM. Below are the links to the authors original submitted files for images. WebMicrovascular Ischemic Disease. Initially described in patients with cardiovascular risk factors and symptomatic cerebrovascular disease [4], WMHs are thought to have a deleterious effect on cognition and affect in old age (for review see [57]). WebAbstract. The deep white matter is even deeper than that, going towards the center As it is not superficial, possibly previous bleeding (stroke or trauma). Herrmann LL, Le Masurier M, Ebmeier KP: White matter hyperintensities in late life depression: a systematic review. No evidence of midline shift or mass effect. WebA 3 Tesla MRI catches about 30% more lesions than a 1.5 Tesla MRI. 10.1002/gps.1596. WebAnswer (1 of 2): Exactly that. Come and explore the metaphysical and holistic worlds through Urban Suburban Shamanism/Medicine Man Series. WebAbstract. There are many possible causes, including vitamin deficiencies, infections, migraines, and strokes. [Taylor W et al., 2003], WMH accumulation occurs over significantly shorter intervals (ie 12 weeks) than has been previously shown. Two recent studies in healthy controls indicated that WMHs are associated with subtle executive dysfunctions and reduced speed of information processing [35, 36]. The ventricles and basilar cisterns are symmetric in size and configuration. However, there are numerous non-vascular 10.1097/01.rmr.0000168216.98338.8d, Article Matthews about dizziness, there can be few physicians so dedicated to their art that they do not experience a slight decline in spirits when they learn that a patients brain MRI shows nonspecific white matter T2-hyperintense lesions compatible with microvascular disease, demyelination, migraine, or other causes. We report the radiologic-histopathologic concordance between T2/FLAIR WMHs and neuropathologically confirmed demyelination in the periventricular, perivascular and deep white matter (WM) areas. Cite this article. Overall, the MRI scans are highly beneficial in detecting health disorders, allowing proactive designing of the treatment plans. The presence of nonspecific white matter hyperintensities may cause uncertainty for physicians and anxiety for patients. These include: Leukoaraiosis. She has been in ministry over 30 years; and along with her husband is a Senior Pastor of New Genesis Christian Center, Inc. Brooklyn, NY. MRI brain: T1 with contrast scan. Originally just called "FLAIR", this technique was developed in the early 1990's by the Hammersmith research team led by Graeme Bydder, Joseph Hajnal, and Ian Young. They are considered a marker of small vessel disease. A radiologic-neuropathologic correlation study, http://creativecommons.org/licenses/by/2.0. (See Section 12.5, Differential Diagnosis of White Matter Lesions.) 12.3.2 Additional Imaging Recommended Postcontrast MRI of the brain should be obtained if gadolinium was not administered for the initial brain MRI. T2-FLAIR. J Alzheimers Dis 2011,26(Suppl 3):389394. They are indicative of chronic microvascular disease. The main strength of the present study is the unusually large autopsy series of very old healthy controls with MRI documentation. MRI indicates a few scattered foci of T2/FLAIR hyperintensities in the pons, periventricular and subcortical white matter. Neurology 2006, 67: 21922198. Microvascular disease. This file may have been moved or deleted. However, it is commonly associated with the following vascular risk factors: The white MRI hyperintensity is often a reflection of small vessel disease. White spots on a brain MRI are not always a reason to worry. All cases were drawn from the brain collection of the Geriatric Hospitals of Geneva County. Scattered T2 and FLAIR hyperintense foci identified in subcortical and periventricular white matter which are nonspecific. Usually this is due to an increased water content of the tissue. White matter hyperintensity accumulation during treatment of late-life depression. It makes it easier for the doctors to assess the lesion, its cause, and its impact on the individuals health., The MRI hyperintensity is a common imaging feature in T2 MRI imaging reports. Therefore, it is identified as MRI hyperintensity. She is also the author of several books, including Seven Keys to Living in Victory, I am My Beloveds and The Cup Bearer. WebThe T2 MRI hyperintensity is often a sign of demyelinating illnesses. As a result, it has become increasingly valuable in diagnosing health issues. BMJ 2010, 341: c3666. WebT2-FLAIR stands for T2-weighted- F luid- A ttenuated I nversion R ecovery. Although WMH do become more common with advancing age, their prevalence is highly variable. White matter lesions (WMLs) are areas of abnormal myelination in the brain. On the contrary, hypointensity would be blacker in color., The MRI hyperintensity reflects the existence of lesions in the brain. The subcortical white matter is just a little bit deeper than the gray matter of the cerebral cortex. Probable area of injury. Scattered T2 and FLAIR hyperintense foci identified in subcortical and periventricular white matter which are nonspecific. Normal vascular flow voids identified at the skull base. a focus of T2 hyperINTENSITY means that the signal from that area has different tissue characteristics compared to normal brian tissue. more frequent falls. MRI showed some peripheral hyperintense foci in white matter. acta neuropathol commun 1, 14 (2013). We tested the hypothesis that periventricular WMHs might overestimate demyelination given the relatively high local concentration of water in this brain area.