White Matter Hyperintensities: How Much (and What Shape) Is Too Much?

The management of white matter hyperintensities (WMH) of presumed vascular origin is a common challenge in neurologic clinical practice. Such lesions may be identified incidentally during workup for common neurologic complaints such as headaches. In addition, they may be observed on imaging performed as part of stroke assessment and management or as part of the investigation of cognitive complaints. Whatever the context, the identification of these lesions often leads to complex and uncertain discussions with patients regarding their potential significance (particularly relative to the patient’s age) and implications for the individual’s risk for stroke, dementia, or other adverse health outcomes.1

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