White matter hyperintensities are bright spots on T2 and FLAIR MRI sequences in the brain's white matter, often related to small vessel disease but with many other possible causes.
Many small hyperintensities cause no symptoms. More extensive changes can be associated with cognitive decline, balance problems, or stroke-like episodes.
Imaging shows the pattern, distribution, and burden of the changes — useful for separating typical age-related findings from demyelinating disease, vasculitis, or other specific conditions.
MRI of the brain is the standard test; the pattern and clinical context determine the next steps.
Management focuses on the underlying cause — vascular risk factor control (blood pressure, diabetes, cholesterol, smoking), specific treatment for demyelinating or inflammatory conditions, and lifestyle changes.
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