• In general, what is the prognosis for white matter disease?

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    According to WebMD, White Matter Disease can be reversed if you can reverse the underlying cause.

    In reality, the underlying cause is usually age plus diabetes, or heart disease, or hypertension, or all three and more, which, coupled with age, are all nearly impossible to reverse.

    White Matter Disease is progressive. It is a type of dementia, but does not follow any specific path, as Alzheimer’s types do, and while death waits at the end of any dementing disease’s path, White Matter Disease most often ends when the person strokes or the kidneys or heart fails.

    What Is White Matter Disease?

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    Slow deterioration if a treatable cause cannot be identified.

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    The answer to your question varies and dependent on the cause it can vary quite a bit. When I think of the average person, say 65 or so then many in this group would show signs of white matter disease on a cat scan. That being said and advancing case would make some one to loose cognitive abilities, muscle tone and cord.

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    White matter hyperintensities (WMHs) are signal abnormalities in the white matter of the brain found on T2-weighted , fluid-attenuated inversion recovery (FLAIR), and proton density magnetic resonance imaging (MRI) sequences. They are usually seen in older people and considered part of the spectrum of brain injury due to cerebrovascular diseases. WMHs should not be confused with multiple sclerosis and other diseases resulting in inflammatory and demyelinating lesions of the brain.

    WMHs on MRI (FLAIR sequence) in two 80 year old patients: (left) minor WMHs; (right) extensive WMHs predominating in periventricular region. WMHs are considered present if hyperintense on T2-weighted, FLAIR, and proton density images, without prominent hypointensity on T1-weighted images. Source: The clinical importance of white matter hyperintensities on brain MRI: systematic review and meta-analysis.

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    Pathological studies of brain regions with WMHs revealed loss of myelin and axons and mild gliosis (brain scarring). The lesions are usually found in the deep white matter with sparing of subcortical U-fibers. An important feature of these lesions is the presence of small vessel disease. Presumably, narrowing of small arteries due to lipohyalinosis (somewhat akin to atherosclerosis of large arteries) leads to chronic hypoperfusion (lack of blood supply) of the white matter. This results in disruption of the blood-brain barrier and leakage of plasma into the white matter. Since water has a long T2 value (see: Why do body tissues other than the brain have low T2 values for MRI?), the lesions will be bright on FLAIR, T2-weighted, and proton density MRI sequences.

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    WMHs as an incidental finding is common since brain MRI is now widely utilized. The prevalence of WMHs in the general population is 10-20% in people who are in their 60s but can be as high as 90% for those in their 80s. Here’s an excellent layman-friendly source: Should You Worry About Spots on Your MRI? Understanding a Common Finding. By Peter Pressman, MD. Neurology Expert.

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    WMHs are consistently associated with age, hypertension, and other cardiovascular risk factors. Those with extensive WMHs are at increased risk for future stroke. An association between cognitive impairment and WMHs has also been detected in the elderly with Alzheimer’s dementia (AD) or mild cognitive impairment (MCI) and in the elderly who does not meet the criteria for AD or MCI, although the findings are somewhat controversial. If you want more info, check out these open-source review articles:

    Current concepts of analysis of cerebral white matter hyperintensities on MRI.

    The clinical importance of white matter hyperintensities on brain MRI: systematic review and meta-analysis.

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    White matter are the bundles of nerve fibers in the brain. The nerve cell bodies are what is called grey matter. These nerve fibers have layers and layers of membranes wrapped around them, called myelin, which serve a protective function and facilitate faster nerve conduction. A good analogy is wiring – white matter are the wires between start and endpoints.

    There are several causes for “white matter disease’ which is usually loss of the sheaths that protect the nerves. Inflammation is one of the key features, and one product of inflammation is excess production of nitric oxide (I discovered this back in the ‘90’s and it is due to the activation of dormant gene). It is useful for fighting off infections and cancer but when activated inappropriately there can be havoc. One of the reasons that my research outlined is the subsequence conversion of nitric oxide (NO) to the same gases as smog (NO2, N2O3) through their reaction with oxygen. This is accelerated within the sheaths (myelin) around nerve fibers (the white matter) about 360 fold. These gases disrupt many reactions and biochemical havoc. Regular smog is linked to brain damage and cognitive decline for the same reasons. This matches the data that shows that if you live near traffic you have a far greater incidence of cognitive issues.

    Related to these events are other drivers – immune activation is one. But one of the better accepted drivers is ischemia or loss of blood perfusion. This may arise from vascular disease (hypertension, diabetes) as well as sleep apnea where the blood oxygen levels drop during sleep because of poor oxygenation.

    In many circumstances all of the mechanisms can act together or in sequence depending on the individual.

    What to do about it? I would focus on what are the causes and address them. Anti-inflammatory supplements should be considered – examples would be cat’s claw, curcumin, Boswellia as well as omega-3 fatty acids. NSAIDS will not be effective.

    I would also strongly urge free radical scavengers that work in membranes (the sheath) – the very best is astaxanthin (the carotenoid that makes salmon pink) as it the most potent free radical scavenger known and fits perfectly in membranes. Make sure its is natural – synthetic forms are twisted and not as effective.

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    White matter disease is the wearing away of tissue in the largest and deepest part of your brain due to aging. This tissue contains millions of nerve fibers, or axons, that connect other parts of the brain and spinal cord and signal your nerves to talk to one another. A fatty material called myelinprotects the fibers and gives white matter its color.

    This type of brain tissue helps you think fast, walk straight, and keeps you from falling. When it becomes diseased, the myelin breaks down. The signals that help you do these things can’t get through. Your body stops working like it should, much like a kink in a garden hose makes the water that comes out go awry. White matter disease happens in older or elderly people. There are ways to prevent or even reverse this condition, but you need to start now.

    Prevent :- Age-related white matter disease is progressive, meaning it can get worse. But you can take steps to stop it from spreading. Scientists think you might even be able to repair the damage, if you catch it early.

    Keep your blood pressure and blood sugar in check. That can lead to white matter changes. To keep your heart healthy, follow a low-fat, low-salt diet, and get about 2 and a half hours of moderate-intensity exercise each week. Manage diabetes if you have it and keep your cholesterol in check. If you smoke, stop now.

    Treatment :- There isn’t a specific treatment. The goal is to treat the cause of the damage and stop the disease from getting worse. Your doctor may prescribe medicines to lower your blood pressure or cholesterol.

    White matter disease of the brain ranges from part of normal ageing with no adverse sequelae, through lifelong severe disability, to progressive lethal disease.

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    While I could be wrong, it sounds to me like someone you know, perhaps YOU, have undergone a CT or MRI of the brain and mention was made of white matter (WM) disease. While you, the OP, could easily employ an internet search engine to first obtain a list of WM disorders followed by looking symptoms for each condition, here’s the best answer: instruct the person who underwent this scan to contact the Physician who actually ordered it so that you may ask what the clinical significance is of the WM findings.

    This answer is not a substitute for professional medical advice.…

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    I would say it is a possibility. Depression can be a part of White Matter disease so it might be that the sleepiness stems from the depression caused by the effects of the White matter disease. Also sleep disordered breathing and sleep apnea can contribute to daytime sleeping. White Matter Disease is a progressive disorder which interferes connections in the brain and to the spinal cord (Academy of Neurologic PT). Symptoms include difficulties in problem solving, urinary troubles, balance issues, poor ambulation, depression and more.

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    Many different diseases, injuries, and toxins can cause changes in your white matter. Doctors point to the same blood vessel problems that lead to heart trouble or strokes, such as long term high blood pressure, ongoing blood vessel inflammation and smoking. You may also be more likely to get it if you have diabetes, Parkinson’s disease or high cholesterol. Genetics may also play a role.

    The treatment depends upon the cause. To stop the disease from getting worse, your doctor may prescribe medicines to lower your blood pressure or cholesterol. To keep your heart healthy, follow a low-fat, low-salt diet, and get about 2 and a half hours of moderate-intensity exercise each week. Manage diabetes if you have it and keep your cholesterol in check. If you smoke, stop now.

    Source: What Is White Matter Disease?

    You asked, OP: Is white matter disease the same as MS?

    Now I could be wrong, OP, but based on the way you phrased your question, I wager that either you (or a loved one but let’s assume assume for the sake of this discussion that it is you,) recently received an imaging report concerning the brain, more likely an MRI than CT, and within this report you saw the three words, white matter disease. AND somewhere in your mind, since the report did not mention Multiple Sclerosis (commonly abbreviated as MS, but please, whenever you “play the alphabet soup game” with us Physicians, let alone laymen, you should spell out the first time what such abbreviations stand for explicitly,) you’re wondering whether you have MS.

    Wow! Unless that’s what your Physician has already informed you of such, that kind of reasoning would certainly be anxiety-provoking! But it would also be reckless extrapolation. As a Radiologist, I can tell you that sometimes there are recognizable patterns of WM disease, but not always. I can also attest that i, or any Neuroradiologist (or Neurologist, for that matter,) would be a fool to believe that just because you didn’t provide other findings on this report or other pertinent reports or your medical history or findings on neurological examination, does not mean you don’t have any, and if so, they may have nothing to do with MS.

    So it’s quite likely, if my wager is correct, that the Radiologist interpreting the study gave, at best, a short Differential Diagnosis (DDx) or perhaps none at all. While the list that Michael Soso, MD, gave in his answer is impressive, it is certainly not complete (nor, frankly, could I do any better.) Thus, if I am correct as to what motivated you to post this question, the best thing you can do until you see or hear from the Physician who ordered this study is to not let your imagination get the better of you.

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