Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations

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Stroke. 1986;17:1090-1097

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Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations

IA Awad, PC Johnson, RF Spetzler and JA Hodak

The pathological correlates of subcortical lesions noted on magnetic resonance imaging (MRI) in the elderly are not known. Postmortem in vitro proton MRI was performed on the brains of seven consecutive elderly patients dying of nonneurologic causes. Scans were done in the fresh and fixed states with the specimen immersed in saline and formaldehyde respectively. A 1.5 Tesla superconductive system was used with a multiple spin-echo protocol generating T2 weighted images. Subcortical MRI lesions were localized in three dimensions and identified at brain cutting. In addition, pathological correlations were obtained from an eighth patient who underwent MRI eleven days before death. Histological examinations were performed in a blinded fashion, including control areas from the same brains. Subcortical MRI lesions were found to be associated with arteriosclerosis, dilated perivascular spaces, and vascular ectasia (p less than 0.05). These histological changes were characteristic of "etat crible" which, like subcortical MRI lesions, is associated with age and hypertension. Shrinkage (or atrophy) of the brain parenchyma around ectatic blood vessels would result in an extensive network of tunnels filled with extracellular water. The proton MRI signal from such areas of the brain would be increased. Gliosis and small areas of infarction occasionally coexisted with "etat crible," but these were not present in all areas with MRI lesions and could not be distinguished by MRI signal alone. In conclusion, clinical and pathological correlations lend support to the uniform hypothesis that MRI provides a nonspecific index of brain parenchymal alterations caused by aging and chronic cerebrovascular disease.

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				D. K. Jones, M. Catani, C. Pierpaoli, S. J. Reeves, S. S. Shergill, M. O'Sullivan, P. Maguire, M. A. Horsfield, A. Simmons, S. C.R. Williams, et al. A Diffusion Tensor Magnetic Resonance Imaging Study of Frontal Cortex Connections in Very-Late-Onset Schizophrenia-Like Psychosis Am J Geriatr Psychiatry, December 1, 2005; 13(12): 1092 - 1099. [Abstract] [Full Text] [PDF]

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				M. Shibata, R. Ohtani, M. Ihara, and H. Tomimoto White Matter Lesions and Glial Activation in a Novel Mouse Model of Chronic Cerebral Hypoperfusion Stroke, November 1, 2004; 35(11): 2598 - 2603. [Abstract] [Full Text] [PDF]

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				A. Hassan, B. J. Hunt, M. O'Sullivan, R. Bell, R. D'Souza, S. Jeffery, J. M. Bamford, and H. S. Markus Homocysteine is a risk factor for cerebral small vessel disease, acting via endothelial dysfunction Brain, January 1, 2004; 127(1): 212 - 219. [Abstract] [Full Text] [PDF]

				A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]

				K. L. Davis, D. G. Stewart, J. I. Friedman, M. Buchsbaum, P. D. Harvey, P. R. Hof, J. Buxbaum, and V. Haroutunian White Matter Changes in Schizophrenia: Evidence for Myelin-Related Dysfunction Arch Gen Psychiatry, May 1, 2003; 60(5): 443 - 456. [Abstract] [Full Text] [PDF]

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				M. D. Miller, E. J. Lenze, M. A. Dew, E. Whyte, E. Weber, A. E. Begley, and C. F. Reynolds III Effect of Cerebrovascular Risk Factors on Depression Treatment Outcome in Later Life Am J Geriatr Psychiatry, October 1, 2002; 10(5): 592 - 598. [Abstract] [Full Text] [PDF]

				Y. Ge, R. I. Grossman, J. S. Babb, M. L. Rabin, L. J. Mannon, and D. L. Kolson Age-Related Total Gray Matter and White Matter Changes in Normal Adult Brain. Part I: Volumetric MR Imaging Analysis AJNR Am. J. Neuroradiol., September 1, 2002; 23(8): 1327 - 1333. [Abstract] [Full Text] [PDF]

				A. J. Thomas, J. T. O'Brien, S. Davis, C. Ballard, R. Barber, R. N. Kalaria, and R. H. Perry Ischemic Basis for Deep White Matter Hyperintensities in Major Depression: A Neuropathological Study Arch Gen Psychiatry, September 1, 2002; 59(9): 785 - 792. [Abstract] [Full Text] [PDF]

				P. J. Harrison The neuropathology of primary mood disorder Brain, July 1, 2002; 125(7): 1428 - 1449. [Abstract] [Full Text] [PDF]

				D.-E. Kim, H.-J. Bae, S.-H. Lee, H. Kim, B.-W. Yoon, and J.-K. Roh Gradient Echo Magnetic Resonance Imaging in the Prediction of Hemorrhagic vs Ischemic Stroke: A Need for the Consideration of the Extent of Leukoariosis Arch Neurol, March 1, 2002; 59(3): 425 - 429. [Abstract] [Full Text] [PDF]

				S. J. Teipel, W. Bayer, G. E. Alexander, Y. Zebuhr, D. Teichberg, L. Kulic, M. B. Schapiro, H.-J. Moller, S. I. Rapoport, and H. Hampel Progression of Corpus Callosum Atrophy in Alzheimer Disease Arch Neurol, February 1, 2002; 59(2): 243 - 248. [Abstract] [Full Text] [PDF]

				M. O'Sullivan, P. E. Summers, D. K. Jones, J. M. Jarosz, S. C.R. Williams, and H. S. Markus Normal-appearing white matter in ischemic leukoaraiosis: A diffusion tensor MRI study Neurology, December 26, 2001; 57(12): 2307 - 2310. [Abstract] [Full Text] [PDF]

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				L. O. Wahlund, F. Barkhof, F. Fazekas, L. Bronge, M. Augustin, M. Sjogren, A. Wallin, H. Ader, D. Leys, L. Pantoni, et al. A New Rating Scale for Age-Related White Matter Changes Applicable to MRI and CT Stroke, June 1, 2001; 32(6): 1318 - 1322. [Abstract] [Full Text] [PDF]

				A J Thomas, I N Ferrier, R N Kalaria, R H Perry, A Brown, and J T O'Brien A neuropathological study of vascular factors in late-life depression J. Neurol. Neurosurg. Psychiatry, January 1, 2001; 70(1): 83 - 87. [Abstract] [Full Text] [PDF]