White matter degeneration

Introduction The white matter of the brain is the place where the nerve fibers gather inside the brain. Because its area is lighter than the surface layer of the brain where the cells are concentrated, it is called white matter. For example, myelin damage of central nervous cells in the white matter of the brain causes leukoencephalopathy. White matter disease is a structural change of the brain. It is mainly characterized by myelin damage of central nervous cells. The lesions involve white matter bundles that play a role in advanced brain function. Its clinical manifestations range from lack of concentration, forgetfulness and personality changes to dementia, coma, and even death. When human beings are about twenty years old, white matter will gradually develop completely in different brain regions, and the timing and maturity of its growth will affect learning, self-control and mental illness, such as schizophrenia, autism and morbid lying. One of the reasons for the youth's "small and frivolous" is also because the white matter is not fully developed.

Cause

White matter leukoencephalopathy is a group of central nervous system demyelinating diseases whose specific causes are still unclear. It can be a secondary manifestation of neurological diseases such as infection, poisoning, degeneration, post-traumatic injury, and lack of infarction. The main causes of inference include:

1. Genetic factors: HLA-A3, -B7 and -DW2 antigens are more common in white and white multiple sclerosis patients in Europe and America; and patients with metachromatic leukodystrophy are an autosomal recessive hereditary disease.

2, human geography factors: such as multiple sclerosis in the cold temperate zone, tropical less. The incidence of Europeans is high, while the prevalence of the East and Africa is low.

3. Infectious factors: suspected measles virus, herpes virus and HIV virus are associated with multiple sclerosis. JC virus and SV-40 (Simian Virus monkey virus) of the P. sylvestris family have been shown to be progressive multifocal leukoencephalopathy. The pathogen, the medical community recognized that subacute sclerosing panencephalitis is caused by the measles virus.

4, poisoning: white matter caused by a variety of toxic factors including brain irradiation, drug treatment, such as certain anti-tumor drugs, antibiotics and immune preparations, drugs of abuse, such as toluene, ethanol, heroin, etc., as well as environmental toxins, etc. .

5, vascular disease: is the most common in adults (especially the elderly), clinical history of hypertension, arteriosclerosis, and repeated multiple infarction and brain atrophy.

6, adrenal white matter malnutrition: the most common in children, adults more common in men aged 20 to 30 years, with adrenal insufficiency, decreased sexual function, cerebellar ataxia and mental decline.

an examination

Related inspection

Brain CT examination brain MRI examination EEG examination brain pool imaging

Symptoms and clinical indexing: The most prominent clinical manifestation of leukoencephalopathy is a change in mental state, that is, at least one of attention, memory, visual spatial skills, executive function, and emotional state without aphasia. Mild cases manifest as chronic ambiguity, with inattention, memory loss, and affective dysfunction; more severe cases produce severe sequelae such as dementia, loss of consciousness, stupor, and coma. The gray matter is the opposite, mainly involving language, behavior or sensory function. If focal necrosis occurs in the white matter of the brain, changes in mental status are more prominent than general signs such as hemiplegia, sensory disturbance, and loss of vision. The distribution of lesions in toxic leukoencephalopathy is usually diffuse, and its clinical index is generally parallel to the severity of white matter damage.

Laboratory examinations: preliminary mental state examinations, including evaluation of inattention tests, three-word delayed recall test to identify memory impairment, clock painting to evaluate visual dysfunction, and alternating motion sequences to evaluate brain function. If the mental state check results are suspicious, neuropsychiatric tests can be further performed. If the first two types of tests for the initial mental state examination did not find any defects, then no detectable brain damage could be determined. If the first two types of tests find abnormalities, brain neuroimaging can be performed. Magnetic resonance imaging is the first choice for examination and is an important means to identify early or mild leukoencephalopathy and mental illness, while CT can only show severe white matter damage.

Differential diagnosis

Differential diagnosis

Less white matter in the brain: Less white matter is a manifestation of malnutrition of the white matter.

Lean body white matter: white matter sparse hair occurs in people over 50 years old, common in dementia and cerebrovascular patients. CT features manifested as bilateral white matter symmetry low density lesions, or complicated with cerebral infarction, cerebral hemorrhage and brain atrophy.

White matter atrophy: MRI shows that white matter atrophy is a symptom of clinical diagnosis of hereditary multiple cerebral infarction dementia.

Demyelination of the white matter: Normal myelin, which is already mature, is destroyed, namely: demyelination of the white matter. It mainly includes: multiple sclerosis, progressive multifocal leukoencephalopathy, acute sporadic encephalomyelitis, subacute sclerosing panencephalitis, central pontine myelinolysis, corpus callosum degeneration, subcortical arteriosclerotic encephalopathy and concentricity Round hardening, etc.

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