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Review
. 2023 Sep 18;219(6):278-284.
doi: 10.5694/mja2.52079. Epub 2023 Aug 21.

Consensus statement for the management of incidentally found brain white matter hyperintensities in general medical practice

Thomas P Ottavi  1 , Elizabeth Pepper  1 , Grant Bateman  1 , Mark Fiorentino  1 , Amy Brodtmann  2
Affiliations
Review

Consensus statement for the management of incidentally found brain white matter hyperintensities in general medical practice

Thomas P Ottavi et al. Med J Aust. .

Abstract

Introduction: There is a paradigm shift in our understanding of white matter hyperintensities (WMH) found on brain imaging. They were once thought to be a normal phenomenon of ageing and, therefore, warranted no further investigation. However, evidence now suggests these lesions are markers of poor brain and cardiovascular health, portending an increased risk of stroke, cognitive decline, depression and death. Nevertheless, no specific guidelines exist for the management of incidentally found WMH for general medical practitioners and other clinicians ordering brain magnetic resonance imaging scans for diverse clinical indications. Informed by a literature review and expert opinion gleaned from stroke neurologists, medical and imaging specialists, and general practitioners, we present our consensus statement to guide the management of incidentally found WMH in adults.

Main recommendations: When incidental WMH are found on brain imaging: Perform a detailed history and examination to screen for neurological events. Investigate for potential undiagnosed or undertreated cardiovascular risk factors, especially hypertension and diabetes mellitus. Commence intensive and individualised cardiovascular risk management when risk factors are uncovered. Treat underlying risk factors via accepted guidelines but note that antiplatelet and anticoagulant medications should not be prescribed for incidental WMH in the absence of an alternative indication.

Changes to management as a result of this consensus statement: A brain health opportunity. We consider the discovery of incidental WMH on brain imaging to represent an opportunity to investigate for common cardiovascular risk factors and to optimise brain health. This can be commenced and monitored by the general practitioner or physician without delay in waiting for an outpatient neurology review.

Keywords: Cerebrovascular disorders; Dementia; Preventive medicine; Stroke.

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References

    1. Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12: 822-838.
    1. Wen W, Sachdev PS, Li JJ, et al. White matter hyperintensities in the forties: their prevalence and topography in an epidemiological sample aged 44-48. Hum Brain Mapp 2009; 30: 1155-1167.
    1. de Leeuw FE, de Groot JC, Achten E, et al. Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study. J Neurol Neurosurg Psychiatry 2001; 70: 9-14.
    1. Debette S, Schilling S, Duperron MG, et al. Clinical significance of magnetic resonance imaging markers of vascular brain injury: a systematic review and meta-analysis. JAMA Neurol 2019; 76: 81-94.
    1. Hu HY, Ou YN, Shen XN, et al. White matter hyperintensities and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 36 prospective studies. Neurosci Biobehav Rev 2021; 120: 16-27.

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