South Western Sydney Clinical School, University of New South Wales (UNSW), Liverpool, New South Wales, Australia.
Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.
Eur J Neurosci. 2021 Aug;54(4):5531-5559. doi: 10.1111/ejn.15379. Epub 2021 Jul 26.
White matter lesions have been implicated in the setting of stroke, dementia, intracerebral haemorrhage, several other cerebrovascular conditions, migraine, various neuroimmunological diseases like multiple sclerosis, disorders of metabolism, mitochondrial diseases and others. While much is understood vis a vis neuroimmunological conditions, our knowledge of the pathophysiology of these lesions, and their role in, and implications to, management of cerebrovascular diseases or stroke, especially in the elderly, are limited. Several clinical assessment tools are available for delineating white matter lesions in clinical practice. However, their incorporation into clinical decision-making and specifically prognosis and management of patients is suboptimal for use in standards of care. This article sought to provide an overview of the current knowledge and recent advances on pathophysiology, as well as clinical and radiological assessment, of white matter lesions with a focus on its development, progression and clinical implications in cerebrovascular diseases. Key indications for clinical practice and recommendations on future areas of research are also discussed. Finally, a conceptual proposal on putative mechanisms underlying pathogenesis of white matter lesions in cerebrovascular disease has been presented. Understanding of pathophysiology of white matter lesions and how they mediate outcomes is important to develop therapeutic strategies.
脑白质病变与中风、痴呆、脑出血、其他几种脑血管疾病、偏头痛、多发性硬化等多种神经免疫性疾病、代谢紊乱、线粒体疾病等有关。尽管我们对神经免疫性疾病有了很多了解，但我们对这些病变的病理生理学及其在脑血管疾病或中风管理中的作用和影响，特别是在老年人中的作用和影响的了解仍然有限。有几种临床评估工具可用于在临床实践中描绘脑白质病变。然而，它们在临床决策中的应用，特别是在预后和患者管理方面，还不能达到护理标准的要求。本文旨在概述脑白质病变的病理生理学、临床和影像学评估的最新进展，重点介绍其在脑血管疾病中的发展、进展和临床意义。还讨论了临床实践的关键指征和未来研究领域的建议。最后，提出了一个关于脑血管疾病中脑白质病变发病机制潜在机制的概念性建议。了解脑白质病变的病理生理学以及它们如何影响结果对于制定治疗策略非常重要。
