Dynamic Changes in White Matter Hyperintensities in Reversible Cerebral Vasoconstriction Syndrome

Area of Science:

• Neurology
• Neuroimaging
• Vascular Neurology

Background:

• White matter hyperintensities (WMHs) are common in reversible cerebral vasoconstriction syndrome (RCVS).
• The characteristics and causes of WMHs in RCVS are not well understood.

Purpose of the Study:

• To investigate the spatiotemporal distribution of WMHs in RCVS patients.
• To explore the underlying pathomechanisms of WMHs in RCVS.

Main Methods:

• Prospective study of 65 RCVS patients over 3 years.
• Serial 3-T MRI with 3D FLAIR sequence and color-coded sonography.
• Automated WMH segmentation and classification into anatomical locations.

Main Results:

• WMH load peaked in the third week post-onset and decreased by the fourth week.
• WMHs were predominantly frontal and periventricular.
• WMH load correlated with Lindegaard index, pulsatility index, and resistance index.

Conclusions:

• WMHs in RCVS exhibit dynamic temporal changes linked to disease severity.
• Partially reversible WMHs in RCVS warrant clinical attention.
• WMHs may result from regional hypoperfusion and impaired pulsatile flow dampening.