white matter lesions in 40 year old

WASHINGTON -- Age-related changes in the brain -- the appearance, starting around age 60, of "white-matter lesions" among the brain's message-carrying axons -- significantly affect cognitive. Scanned participants did not differ from other living participants on childhood social economic status (SES) or childhood intelligent quotient (IQ) (see attrition analysis in the Supplementary material). White matter hyperintensities (WMHs) are a frequent finding on T2-weighted MRI of the brain in elderly individuals, but their prevalence and severity in younger asymptomatic populations is less well studied. White matter lesions might be referred to as age-related, wear-and-tear changes. However, in many cases, the white matter lesions as isolated observations are nonspecific and could be due to MS or another cause, explained Drs Lange and Melisaratos. High blood pressure (hypertension ) is a very common cause. "Black holes" on T1 weighted imaging are not usually seen in the spinal cord but gadolinium enhancement of acute cord lesions does occur. Purpose of review: 2009 Jul 28;73(4):266-72. doi: 10.1212/WNL.0b013e3181aa52ea. In the Dunedin Study, a population-representative cohort followed since birth, we measured white matter hyperintensities in 843 45-year-old participants using T2-weighted magnetic resonance imaging and we assessed cognitive decline from childhood to midlife. We report the topography of WMHs on T2-weighted fluid inversion recovery (FLAIR) MRI in 428 . White matter lesions around the cerebral ventricles are common and can cause unsteadiness . 150. which makes diagnosis difficult. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Epub 2009 Mar 5. Top Magn Reson Imaging. , Moffitt TE, Silva PA. Prins abnormal structure and function of myelin, usually secondary to a hereditary disorder. The relevant ethics committees approved each phase of the study, and informed consent was obtained from all participants. 2007 Jan 16;68(3):214-22. doi: 10.1212/01.wnl.0000251302.55202.73. There was also a trending association between larger volume and decreased working memory ability ( = 0.06, 95% CI = 0.13 to 0.00; P=0.06). Al-Hashel JY, Alroughani R, Gad K, Al-Sarraf L, Ahmed SF. Deterioration of the white matter happens with ageing and can be seen on brain scans as white matter lesions (abnormal areas). A sensitivity analysis using a difference score (adult IQ childhood IQ) as a measure of change in IQ rather than a residualized change score did not change the results. eCollection 2020. 11 junio, 2020. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r = 0.331, p = 0.001) and the duration since migraine onset (r = 0.264, p = 0.012). Correspondence to: Dr. Ahmad R. Hariri, PhD Department of Psychology & Neuroscience Laboratory of NeuroGenetics Cognition and Cognitive Neuroscience, Training Program Duke University Durham, NC 27708, USA E-mail: A fast diffeomorphic image registration algorithm, Cerebral white matter lesions and cognitive function: the Rotterdam scan study, Neuroimaging findings in midlife and risk of late-life dementia over 20 years of follow-up, Looking for system integrity in cognitive epidemiology, The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis, White matter hyperintensities and imaging patterns of brain ageing in the general population, UBO Detectora cluster-based, fully automated pipeline for extracting white matter hyperintensities, White matter hyperintensities are a core feature of Alzheimers disease: evidence from the dominantly inherited Alzheimer network, Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: the cardiovascular health study, Coevolution of white matter hyperintensities and cognition in the elderly, The longitudinal study of aging in human young adults: knowledge gaps and research agenda. Secondary analyses using the four sub-indexes of adult IQ showed that larger WMH volume was associated with lower scores on processing speed ( = 0.14, 95% CI = 0.20 to 0.07; P<0.001), verbal comprehension ( = 0.14, 95% CI = 0.21 to 0.07; P<0.001) and perceptual reasoning ( = 0.13, 95% CI = 0.19 to 0.06; P<0.001). This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, Reduced coupling between offline neural replay events and default mode network activation in schizophrenia, Cognitive correlates of antisaccade behaviour across multiple neurodegenerative diseases, Uncovering spatiotemporal patterns of atrophy in progressive supranuclear palsy using unsupervised machine learning, Brain-derived neurotrophic factor released from blood platelets prevents dendritic atrophy of lesioned adult central nervous system neurons. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. 2013;34(11):2972-2985. doi:10.1002/hbm.22119 . Interestingly, our results also showed a modest association between low childhood IQ and WMHs in midlife. As such, our findings point to the need to investigate these possible mechanistic pathways in future studies with child-to-adult imaging data. WMLs appear as hyperintense periventricular or subcortical patchy or confluent areas on T2 or fluid-attenuated inversion recovery MRI sequence. Published by Oxford University Press on behalf of the Guarantors of Brain. Third, the associations between WMH volume (measured in cubic millimetres) and adult IQ and between volume and childhood IQ were tested using ordinary least squares multiple regression. White matter lesions observed on brain MRI are usually characteristic and occur in specific areas including the corpus callosum and pons. 25-year-old female patient, not known to have any chronic illness, presented with migraine without aura for 6-year duration of grade II severity, not responding to medical treatment. Abnormalities in white matter, known as lesions, are most often seen as bright areas or spots on MRI scans of the brain. 2022 Apr 29;22(1):159. doi: 10.1186/s12883-022-02680-8. While there is robust evidence that WMHs are related to cognitive decline in older adults (Debette and Markus, 2010; Prins and Scheltens, 2015), our study provides initial evidence that this relationship begins by midlife. J CONCLUSIONS: Even in relatively healthy 43- to 56-year-old subjects with small white matter lesion burden, structural and functional MR imaging in penumbral tissue reveals significant signal abnormalities versus white matter lesions and other normal WM. PMC Number of white matter hyperintensity lesions (N# WMH) is reported as 1+log (N# WMH). Background: White matter hyperintensities of presumed vascular origin (WMH) are a common finding in elderly people and a growing social malady in the aging western societies. The Dunedin Multidisciplinary Health and Development Study is supported by the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation, and Employment. e.g. Mood changes, such as depression. "Most clinically stable MS patients get one surveillance MRI per year," says Dr. Miller. After providing informed consent, 40 adults aged 62 to 82 years (n = 17 MCI) were included in this study. He undertook several junior doctor posts in the North West of England and at the National Hospital On an imaging basis alone, MS could not be diagnosed but remained part . The authors suggested that these abnormalities might be of ischaemic origin, secondary to atherosclerosis or vasculitis. MRI was performed on 77 cognitively normal (CN) subjects, 50 AD and 13 mixed dementia patients. This is because the nerve signals cant get through as normal. Demographic characteristics for the 843 participants from the Dunedin Study included in the current analyses. 6, 7, 11, 18 A few case reports describe focal lesions in the white matter in IBD patients who developed neurological symptoms. These tests are ideal for measuring child-to-adult cognitive decline because both tests are matched for content coverage and format, both were individually administered by trained psychometrists and both yield summary scores that are reliable at 95. The nerve fibres are surrounded by a fatty material called myelin. Neuroimage Clin. (A) Mean childhood IQ (average from measurements at ages 7, 9 and 11) for each of the WMH volume groups. The repeatability of R 1 dispersion imaging parameters measured on a 26-year-old healthy female are reported in Supplementary Table S2. The intracranial fraction of white matter was significantly lower in the age categories above 59 years. We used measurements from 23 of the 32 subjects for age-matched statistical . Summary: Using K-nearest neighbours algorithms, clusters in the MRI images are classified as WMHs or non-WMHs (i.e. official website and that any information you provide is encrypted These are findings on a brain scan that are unrelated to the reason the scan has been requested. As the brain ages, it begins to accrue small microbleeds and lesions in white matter that are detectable as WMHs using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) (Iadecola, 2013). A 59-year-old male visiting from Michigan presented to a hospital in Florida with an ischemic stroke with aphasia and acute confusion for two days. Search for other works by this author on: Department of Medicine, University of Otago, Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Social, Genetic, & Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, & Neuroscience, Kings College London, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Center for Genomic and Computational Biology, Duke University. Christidi F, Tsiptsios D, Sousanidou A, Karamanidis S, Kitmeridou S, Karatzetzou S, Aitsidou S, Tsamakis K, Psatha EA, Karavasilis E, Kokkotis C, Aggelousis N, Vadikolias K. Neurol Int. Gray matter reduction is correlated with white matter hyperintensity volume: a voxel-based morphometric study in a large epidemiological sample. Background: Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. Genetic and Environmental Effects on the Development of White Matter Hyperintensities in a Middle Age Twin Population. TE It is known that WMHs predict cognitive decline and risk for ADRD in older adults (Valds Hernndez et al., 2013), but it is not known when WMHs accumulate sufficiently to be associated with early cognitive decline. Lastly, participants with larger WMH volume experienced more cognitive decline by midlife ( = 0.09, 95% CI = 0.13 to 0.02; P<0.001; Fig. The most important point to take from this series is that many images can be compatible with MS. Objectives To compare the performances of lung ultrasonography (LUS) versus chest CT for assessing peripheric pulmonary lesions in hemorrhagic fever with renal syndrome (HFRS). Second, WMH volume was log-transformed for normality. Very often, white matter lesions dont cause any noticeable problemsfor the individual. Professor Emsley graduated with an MBChB in 1996 from the University of Manchester. White matter lesions have been repeatedly associated with gait disturbances and mobility difficulties. White matter lesions are among the most common incidental findingswhich means the lesions have no clinical significanceon brain scans of people of any age. official website and that any information you provide is encrypted Abstract We evaluated brain tissue compartments in 72 healthy volunteers between the ages of 18 and 81 years with quantitative MRI. Among the many potential etiologies for rapidly progressive dementia (RPD), primary central nervous system extranodal NK/Tcell lymphoma, nasaltype (ENKL) is a rare entity. Disclaimer. Medicina (Kaunas). Note that UBO labelling in septal regions was removed from the estimation of WMH volume using an exclusion mask. Schindler LS, Subramaniapillai S, Barth C, van der Meer D, Pedersen ML, Kaufmann T, Maximov II, Linge J, Leinhard OD, Beck D, Gurholt TP, Voldsbekk I, Suri S, Ebmeier KP, Draganski B, Andreassen OA, Westlye LT, de Lange AG. 2020 Jul;51(7):2111-2121. doi: 10.1161/STROKEAHA.119.027544. White matter hyperintensities (WMHs) are a frequent finding on T2-weighted MRI of the brain in elderly individuals, but their prevalence and severity in younger asymptomatic populations is less well studied. White matter lesions observed on brain MRI are usually characteristic and occur in specific areas including the corpus callosum and pons. . The first description of neonatal white matter injury comes from Parrot, in which he described pale infarcts seen as yellowish or chalky plaques in the lateral corners of the periventricular white matter; softening of the plaques formed cavities, which did not communicate with the ventricles (40).Fifty years later, Schwartz re-described these lesions, but it . How much? J Traumatic brain injury (TBI) is a leading cause of death and disability in the U.S., contributing to about 30 percent of all injury deaths, according to the CDC. Epub 2008 Sep 23. Some are essential to make our site work properly, others perform functions more fully described in our PrivacyPolicy. Although some WMH is associated with specific causes, such as lacunar infarction, traumatic brain injury, and demyelinating disease [ 1 - 3 ], some WMH has no specific cause, especially in young patients. Slow walking. I had a followed up lumbar punction which was negative for MS. At the time I experience paresthesia on my right thigh, which are gone now. Overall assessment of their patients There was no significant sex difference in the severity and distribution of WMHs. In older adults, WMHs are associated with multiple dementia risk factors, including increasing age, hypertension, stroke, brain atrophy and cognitive ability (Prins and Scheltens, 2015). 2023 Jan;44(1):171-180. doi: 10.1007/s10072-022-06408-x. Prevalence, incidence, and risk factors of lacunar infarcts in a community sample. White spots on a brain MRI are not always a reason to worry. A 2013 study found that moderate or severe cerebral SVD was associated with a decline in. , Manolio TA, Arnold A, Burke GL, Bryan N, Jungreis CA, et al. Diagnosing Organic Causes of Schizophrenia Spectrum Disorders: Findings from a One-Year Cohort of the Freiburg Diagnostic Protocol in Psychosis (FDPP). The https:// ensures that you are connecting to the . A brain MRI showed multiple supratentorial and infratentorial masses at the gray/white matter junction with surrounding vasogenic edema (Figure 8A-C). White matter lesions are an example of an incidental finding on a brain scan. 3, 7, 11 Geissler et al 6 observed white-matter hyperintensities on brain MRI in almost half of the patients with IBD who were free of . However, these trials have produced mixed results (Prins and Scheltens, 2015). White matter lesions affect the white matter . Damage to the very small blood vessels in the brain can cause white matter lesions. A limitation of our study is the lack of childhood neuroimaging to assess the development of WMHs across the lifespan, although it should be noted that no sample with WMH measures in midlife would have childhood WMH measures, because cohorts of non-patient children did not have MRI imaging 40years ago. Cognitive ability in adulthood was assessed using the Wechsler Adult Intelligence ScaleIV (IQ score range, 40160) at age 45years (Weschler, 2008). This further suggests a need for interventions that increase brain resiliency and boost tissue regeneration in those at highest risk (e.g. The second possibility is that low IQ is an indicator of lower overall brain integrity that was present early in life (Deary, 2012). NCI CPTC Antibody Characterization Program. His areas of expertise include vascular neurology, stroke, cerebrovascular disease, late-onset epilepsy, migraine and neurological disorders. A total of 875 (93% of age-45 participants) also completed MRI scanning. https://doi.org/10.1093/braincomms/fcz041, https://sites.google.com/site/dunedineriskconceptpapers/documents, http://creativecommons.org/licenses/by/4.0/, Receive exclusive offers and updates from Oxford Academic. Sometimes, white matter disease, particularly when it is severe, caninterfere with the way the brain works and the processes that it controls, including thinking and walking. White matter is tissue that includes nerve fibers (axons), which connect nerve cells. coined the term leuko-araiosis (white matter rarefaction) to describe and define it. , Erus G, Toledo JB, Zhang T, Bryan N, Launer LJ, et al. Copyright 2023 Haymarket Media, Inc. All Rights Reserved. The MS Lesion Checklist provides brief definitions for 10 types of lesions that are best appreciated on axial or sagittal T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) sequences. The cohort represents the full range of socioeconomic status in the general population of South Island, New Zealand (Poulton et al., 2015). Despite VDC33 and VDC66, VFLAIR remained a significant predictor on overall performance over the follow-up period in VADAS and executive functions. This site needs JavaScript to work properly. Periventricular white matter lesions Periventricular white matter changes (3-13 mm from the ventricular surface) are thought to be haemodynamically determined rather than only related to small vessel disease 8. Subscribe to our Newsletter to stay up to date on the latest news, TOP DOCTORS | 85 Tottenham Court Road, London, W1T 4TQ. Genetic diseases such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), mitochondrial diseases, and leukodystrophies should also be considered. Additionally, careful assessment of the so-called MRI red flags, such as the presence of infarcts, microbleeds, meningeal enhancement, and calcifications, among others, are very helpful in suggesting a diagnosis other than MS, according to research published in the Handbook of Clinical Neurology.3. By continuing to use our site, you agree to the Termsof Use and acknowledge that youve read our PrivacyPolicy. WMHs, also known as leukoaraiosis, are frequently identified in CT or MRI scans of elderly people. Department of Psychology & Neuroscience, Duke University. results of a one-year exercise intervention. As such, white matter hyperintensities have been targeted as a surrogate biomarker in intervention trials with older adults. Maillard Larger WMH volume was associated with lower IQ in childhood ( = 0.08, 95% CI = 0.15 to 0.02; P=0.013; Fig. This difference was exacerbated in adulthood; larger WMH volume was associated with lower IQ ( = 0.15, 95% CI = 0.22 to 0.09; P<0.001; Fig. Our research aims to study the correlation of migraine type, attack frequency, and other clinical variables with the presence, volume and localization of white matter lesions (WML), in a controlled study. The resulting WMH probability maps were thresholded at 0.7, which is the suggested standard (Jiang et al., 2018). A subcortical white matter hyperintensity similar to slide 1. NSF DGE-1644868). this complication is seen in up to 40 % of patients receiving intrathecal methotrexate [29, 30]. Register now at no charge to access unlimited clinical news with personalized daily picks for you, full-length features, case studies, conference coverage, and more. Various conditions can cause these lesions. However, for additional quality assurance, every participants UBO-generated WMH map was visually inspected to check for false positives (e.g. However, the success of this investment hinges on developing surrogate biomarkersbiological measures that are part of the putative disease pathway and are measurable before the onset of clinical symptomsso that prevention can target at-risk individuals before cerebral decline has taken hold. BMI = body mass index. Of the 875 scanned participants who had at least one MRI scan, 867 had both a T1 image and an FLAIR image that are required to extract WMHs with UBO. Please enable it to take advantage of the complete set of features! Though relatively rare, neurosarcoidosis can share features with MS and is important to consider in differential diagnosis, as well. Right hemispheric white matter hyperintensities improve the prediction of spatial neglect severity in acute stroke. First visit: Clipboard, Search History, and several other advanced features are temporarily unavailable. Please choose an alternative time. 146 of the 218 (34.1% of whole sample population of 428) subjects had deep white matter hyperintensities (DWMHs). Armstrong NJ, Mather KA, Sargurupremraj M, Knol MJ, Malik R, Satizabal CL, Yanek LR, Wen W, Gudnason VG, Dueker ND, Elliott LT, Hofer E, Bis J, Jahanshad N, Li S, Logue MA, Luciano M, Scholz M, Smith AV, Trompet S, Vojinovic D, Xia R, Alfaro-Almagro F, Ames D, Amin N, Amouyel P, Beiser AS, Brodaty H, Deary IJ, Fennema-Notestine C, Gampawar PG, Gottesman R, Griffanti L, Jack CR Jr, Jenkinson M, Jiang J, Kral BG, Kwok JB, Lampe L, C M Liewald D, Maillard P, Marchini J, Bastin ME, Mazoyer B, Pirpamer L, Rafael Romero J, Roshchupkin GV, Schofield PR, Schroeter ML, Stott DJ, Thalamuthu A, Trollor J, Tzourio C, van der Grond J, Vernooij MW, Witte VA, Wright MJ, Yang Q, Morris Z, Siggurdsson S, Psaty B, Villringer A, Schmidt H, Haberg AK, van Duijn CM, Jukema JW, Dichgans M, Sacco RL, Wright CB, Kremen WS, Becker LC, Thompson PM, Mosley TH, Wardlaw JM, Ikram MA, Adams HHH, Seshadri S, Sachdev PS, Smith SM, Launer L, Longstreth W, DeCarli C, Schmidt R, Fornage M, Debette S, Nyquist PA. Stroke. In this case the most likely diagnosis is migraine headaches. HHS Vulnerability Disclosure, Help In a mouse study, scientists at the University of Southern California (USC) in Los Angeles reveal how damage to cells called pericytes can trigger white matter disease, which is associated with. Tracy dArbeloff, Maxwell L Elliott, Annchen R Knodt, Tracy R Melzer, Ross Keenan, David Ireland, Sandhya Ramrakha, Richie Poulton, Tim Anderson, Avshalom Caspi, Terrie E Moffitt, Ahmad R Hariri, White matter hyperintensities are common in midlife and already associated with cognitive decline, Brain Communications, Volume 1, Issue 1, 2019, fcz041, https://doi.org/10.1093/braincomms/fcz041. Unable to load your collection due to an error, Unable to load your delegates due to an error, Preparation for kNN classification feature space: (, Some kNN classification results. Participants were members of the Dunedin Multidisciplinary Health and Development Study, a longitudinal investigation of health and behaviour in a population representative birth cohort. By continuing to use our site, you consent to the use of these cookies. Magnetic resonance imaging (MRI). Accessibility took up his post as Professor of Clinical Neuroscience at Lancaster University in 2017 alongside his NHS role. sharing sensitive information, make sure youre on a federal This is important because even sub-clinical cognitive decline impacts daily functioning and psychological well-being (Tucker-Drob, 2011). Studies have found that white matter lesions appear in some degree on brain scans of most older adults but less often in younger people. As can been seen in these images, WMHs were most common around the anterior and posterior horns of the lateral ventricles as expected. The only way to tell is to determine if there are co-existing abnormalities in other parts of the brain and this must be incorporated within the context of the clinical condition, they said. Brain lesions and cerebral functional impairment in migraine patients. S Getting lost easily could be an early sign of Alzheimers - a expert neurologist reveals, Innovations in the treatment of multiple sclerosis (MS), Gamma knife Vs. Cyberknife: radiosurgery to treat cancer and other diseases, (Let us know you are a Top Doctors patient), By using the telephone number provided by TOP DOCTORS, you automatically agree to let us use your phone number for statistical and commercial purposes. With other imaging techniques, a white matter lesion may appear as a black hole, which indicates damage to the axons. LH TE However, their significance and correlation to migraine disease burden remain unclear. He has published over 100 publications in peer-reviewed medical journals and regularly engages in peer-review and editorial work. Methods: Sixty volunteers from a tertiary headache center were . Epub 2005 Oct 25. Neuromyelitis optica spectrum disorders (NMOSD) also share several characteristics with MS and need to be ruled out. What's more, these two predictors of cognitive performance in old age were independent; they didn't consistently affect scores in the same way. The risk of dementia is expressed as age- and sex-adjusted hazard ratios. The lesion, detected during a routine medical examination, was a . , Mormino E, Johnson K. Valds Hernndez This tissue contains millions of nerve fibers, or. Additional support was provided by the Jacobs Foundation. grey matter or cerebral spinal fluid) based on anatomical location, intensity and cluster size features. Signs and symptoms of white matter disease include: Memory problems. However, it is unclear at what stage of aging white matter hyperintensities begin to relate to cognition and if they may be a viable target for early prevention. MRI brain shows a few non-specific white matter lesions scattered in the brain. S There is confluence (merging together) so that there is a cloud surrounding the upper ventricles. The .gov means its official. The site is secure. This perspective suggests that the association between low childhood IQ and midlife WMH is driven by a higher vulnerability to tissue damage and faster neurodegeneration in low-IQ children, given the same lifetime exposures. Cognitive ability in childhood was assessed using the Wechsler Intelligence Scale for Children Revised (score range, 40160) at ages 7, 9 and 11 with the mean for these three assessments used in analyses (Wechsler, 1974; Moffitt et al., 1993). White matter lesions (WMLs) or leukoaraiosis indicate small vessel vascular brain disease as well as degenerative or inflammatory processes. Recommended investigations in white matter disorders Case 1 A 50-year-old woman was referred with a possible leukodystrophy. Should we standardize PhD training in neuroscience? Recent studies have reported that they may also be common in middle-aged individuals, and their systematic evaluation in younger populations is necessary. Epub 2022 Nov 11. WT Risk factors of white matter hyperintensities in migraine patients. 2). This research was supported by National Institute on Aging (Grant Nos. There are many possible causes, including vitamin deficiencies, infections, migraines, and strokes. Methods A total of 69 migraineurs underwent MRI scans to evaluate WMHs . White matter lesions (WMLs) or leukoaraiosis indicate small vessel vascular brain disease as well as degenerative or inflammatory processes. eCollection 2021 Oct. Endres D, Matysik M, Feige B, Venhoff N, Schweizer T, Michel M, Meixensberger S, Runge K, Maier SJ, Nickel K, Bechter K, Urbach H, Domschke K, Tebartz van Elst L. Diagnostics (Basel). Before Careers. Published by on 30 junio, 2022 Difficulty performing two or more activities at once, such as walking and talking at the same time. All variables were z-transformed so that the resulting betas () were standardized, allowing direct comparisons of effect sizes across regressions. One solution is to assess WMHs in midlife, a time when the brain may be more responsive to interventions and has yet to be affected by decades of age-related organ decline. Ontario Neurodegenerative Disease Research Initiative (ONDRI): Structural MRI Methods and Outcome Measures. Case 4 A 32-year-old woman born of consanguineous parents gave a 3-year history of slowly progressive gait distur-bance, headaches and subcortical cognitive dysfunc-tion.

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