Hyperintensity
High intensity on MRI brain scans
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Hyperintensities are commonly divided into 3 types depending on the region of the brain where they are found. Deep white matter hyperintensities occur deep within white matter, periventricular white matter hyperintensities occur adjacent to the lateral ventricles and subcortical hyperintensities occur in the basal ganglia.
Hyperintensities are often seen in auto immune diseases that have effects on the brain.
Postmortem studies combined with MRI suggest that hyperintensities are dilated perivascular spaces, or demyelination caused by reduced local blood flow.
Causes
White matter hyperintensities can be caused by a variety of factors including ischemia, micro-hemorrhages, gliosis, damage to small blood vessel walls, breaches of the barrier between the cerebrospinal fluid and the brain, or loss and deformation of the myelin sheath. People with a peripheral diastolic blood pressure (ie. as measured in a peripheral artery, most commonly the brachial artery) that is consistently below 60 mmHg may be at higher risk of white matter lesions due to a decrease in cerebral perfusion (blood flow). Over half of cerebral perfusion occurs during diastole.
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Cognitive effects
In most elderly people, presence of severe WMH and medial temporal lobe atrophy (MTA) was linked with an increase in frequency of mild cognitive deficits. Studies suggest that a combination of MTA and severe WMH showed more than a fourfold increase in the frequency of mild cognitive deficits. Severe WMH is consistently shown to be associated with gait disorders, impaired balance and cognitive disturbances. Certain features of gait pattern associated with WMH are: slight widening of the base, slowing and shortening of stride length and turning en bloc. Speed of cognitive processes and frontal skills may also be impaired in people with WMH. Pathological signs of oligodendritic apoptosis and damage to axonal projections have been evident. Sufficient damage to the axons that course through WMH can cause adequate interference with normal neuronal functions.
It is also thought that WMH have a negative impact on cognition in people with Alzheimer's disease. In people with Alzheimer's, higher WMH are associated with higher amyloid beta deposits, possibly associated with small vessel disease and reduced amyloid beta clearance.

