Cerebral Leukoaraiosis: Symptoms, Treatment, and Lifestyle Tips

Cerebral hemispheric ischemic lesions

Hello Dr.
Jiang,
About three years ago, I started experiencing occasional headaches that are so severe I can't concentrate and feel very uncomfortable.
Sometimes, these headaches are accompanied by nosebleeds.
I have a history of severe nasal allergies, which cause my nose to itch and feel uncomfortable, especially during seasonal or climatic changes, leading to tearing and significant discomfort.
For my nasal discomfort, I visit a clinic to get allergy medications for relief.
As for the headaches, they can be intense enough to make me feel nauseous.
Fortunately, taking extra-strength acetaminophen usually provides relief after a few minutes.
However, my headaches occur either once a week or once every one to two months, so I decided to get a thorough check-up.
In January of this year, I went to a large hospital for a self-paid health examination (which showed slightly low blood pressure) and underwent an MRI of the brain.
The report stated:
"MR imaging of the brain on a 1.5 Tesla scanner utilizing axial and sagittal T1WI, axial T2WI, axial FLAIR, axial T2* GRE, and axial DWI and ADC map shows scattered hyperintensity in the periventricular and deep white matter with mild juxtacortical involvement.
The ventricles and sulci are normal in size and configuration.
There is no acute infarct or intracerebral hemorrhage.
No extra-axial blood or fluid collection is present.
No intracranial mass is identified.
The brainstem, posterior fossa, and cervical medullary junction are preserved.
Normal intracranial intravascular flow voids are seen.
The orbits, periorbital, and paracavernous spaces are normal.
No abnormality of the skull base or calvarium is identified.
Impression: Cerebral leukoaraiosis.
Suspected ischemic lesions in both cerebral hemispheres."
1.
I would like to ask the doctor what the phrase (the last sentence of the report: Impression: Cerebral leukoaraiosis.
Suspected ischemic lesions in both cerebral hemispheres) means.
2.
Do I need further treatment, or can I maintain good daily habits (diet, exercise, etc.)?
3.
Additionally, I have been using a nasal spray for my nosebleeds.
I wonder if the nasal spray could be causing side effects or if it could be related to the "suspected ischemic lesions in both cerebral hemispheres" indicated in the MRI.
Thank you, doctor, for your help and clarification.
I greatly appreciate it!

Ni Ni, 30~39 year old female. Ask Date: 2023/04/27

Dr. Jiang Junyi reply Neurology

Dear Ms.
Ni,
Your report mentions "scattered hyperintensity in the periventricular and deep white matter with mild juxtacortical involvement." These lesions are commonly referred to as white matter lesions, indicating that the cells along the brain's conduction pathways have previously experienced inflammation.
"Normal intracranial intravascular flow voids" suggest that the major blood vessels within the brain are patent.
Clinically, it is essential to rule out autoimmune diseases, severe migraines, small vessel disease, and other related issues.
I recommend that you consult a neurologist for further discussion and treatment.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2023/04/27

More Info

Cerebral leukoaraiosis is a term used to describe changes in the brain's white matter, which can be detected through MRI scans. These changes are often characterized by areas of hyperintensity in the periventricular and deep white matter, indicating that there may have been some ischemic damage or reduced blood flow to these areas. The report you received suggests that there are no acute infarcts or hemorrhages, which is a positive sign, but the presence of leukoaraiosis can be associated with various neurological symptoms and conditions.

Understanding Cerebral Leukoaraiosis
1. What Does It Mean?
The term "cerebral leukoaraiosis" refers to the presence of white matter changes in the brain, often associated with small vessel disease. This condition is commonly seen in older adults and can be linked to risk factors such as hypertension, diabetes, and hyperlipidemia. The hyperintensities observed in your MRI indicate that there has been some form of chronic ischemia, which can lead to cognitive decline, gait disturbances, and other neurological symptoms over time.

2. Symptoms and Impact
Symptoms of cerebral leukoaraiosis can vary widely. Some individuals may experience no symptoms at all, while others may have issues such as:
- Cognitive impairment or memory problems
- Difficulty with balance and coordination
- Mood changes or depression
- Headaches, which you have reported experiencing
- Other neurological deficits depending on the areas affected
3. Treatment and Management
Treatment for cerebral leukoaraiosis primarily focuses on managing the underlying risk factors. This includes:
- Lifestyle Modifications: Adopting a heart-healthy diet, engaging in regular physical activity, and maintaining a healthy weight can significantly impact your overall vascular health. Foods rich in omega-3 fatty acids, antioxidants, and fiber are beneficial.

- Medical Management: If you have conditions such as hypertension, diabetes, or high cholesterol, it is crucial to manage these effectively with medications and regular check-ups.

- Regular Monitoring: Follow-up MRI scans may be recommended to monitor the progression of leukoaraiosis and any associated symptoms.

4. Lifestyle Tips
- Diet: Focus on a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Limit salt, sugar, and saturated fats.

- Exercise: Regular physical activity can improve blood flow and overall brain health. Aim for at least 150 minutes of moderate aerobic activity each week, along with strength training exercises.

- Cognitive Engagement: Engage in activities that stimulate your brain, such as puzzles, reading, or learning new skills.

- Stress Management: Practice stress-reducing techniques such as mindfulness, yoga, or meditation.

5. Nasal Bleeding and Headaches
Regarding your nasal bleeding and headaches, it is essential to consider that nasal sprays, especially those containing steroids, can sometimes lead to nasal dryness and bleeding. However, the connection between your nasal symptoms and the leukoaraiosis is not direct. It is advisable to discuss your nasal symptoms with an ENT specialist to determine if your allergies or the nasal spray could be contributing to your issues.

Conclusion
In summary, cerebral leukoaraiosis indicates changes in the brain's white matter due to chronic ischemia, often linked to vascular risk factors. While immediate treatment may not be necessary, managing your overall health through lifestyle changes and regular medical follow-ups is crucial. If you experience worsening symptoms or have concerns about your condition, consulting with a neurologist for a tailored treatment plan is recommended.

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