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(Stroke. 1998;29:543.)
© 1998 American Heart Association, Inc.

Letters to the Editor

New Clinical Relevance of Leukoaraiosis

For the European Task Force on Age-Related White Matter Changes¹; Leonardo Pantoni, MD; Domenico Inzitari, MD

Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy

To the Editor:

Changes in the cerebral white matter are detected with high frequency by CT and MRI in aged individuals.¹ The descriptive term leukoaraiosis, meaning rarefaction of the white matter, was proposed some 10 years ago to describe these radiological changes.² Although the mechanism of leukoaraiosis in different clinical conditions such as Alzheimer's disease or stroke remains undefined, vascular mechanisms probably underlie a reasonably large part of these alterations.³ Leukoaraiosis has been inconsistently associated with cognitive impairment, assorted motor dysfunctions, and gait disturbances, but its contribution to Alzheimer's disease and vascular dementia is controversial.¹ Part of these discrepancies stem from different sensitivities of rating scales for white matter changes, small sample sizes of patients, and use of disparate neuropsychological tests.¹

Recently, new evidence has suggested that leukoaraiosis may be clinically important. First, patients with leukoaraiosis have a poor prognosis in terms of death, stroke, and myocardial infarction. This has been documented both in patients with motor impairment and extensive leukoaraiosis on CT⁴ and in clinically heterogeneous patients with any degree of leukoaraiosis.⁵ Second, the results of prospective studies indicate that leukoaraiosis may be an independent and strong predictor of dementia in stroke patients.^{6 7} Among 300 patients with TIA, cerebral infarction, or intracerebral hemorrhage, those with poststroke dementia showed leukoaraiosis on their entry CT scan three times more frequently than nondemented patients.⁷ Third, and most recent, the presence of leukoaraiosis increases the risk of intracranial bleeding in patients with cerebrovascular diseases treated with anticoagulants.⁸ The SPIRIT (Stroke Prevention In Reversible . . . [Full Text of this Article]

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