= ENCEPHALOPATHIA SUBCORTICALIS PROGRESSIVA = LEUKOARIAOSIS = SUBCORTICAL ARTERIOSCLEROTIC ENCEPHALOPATHY (SAE)

Cause: arteriosclerosis affecting the poorly collateralized distal penetrating arteries (perforating medullary arteries, thalamoperforators, lenticulostriates, pontine perforators); positive correlation with hypertension + aging

Path: ischemic demyelination / infarction

Age:>60 years

• psychiatric changes, intellectual impairment, slowly progressive dementia, transient neurologic deficits
• seizures, spasticity, syncope

Location: periventricular white matter, centrum semiovale, basal ganglia; sparing of subcortical white matter “U” fibers + corpus callosum

• multifocal hypodense lesions (periventricular, centrum semiovale) with sparing of U fibers
• lacunar infarcts in basal ganglia
• sulcal enlargement + dilated lateral ventricles (brain atrophy)

MR:

• focal areas of increased signal intensity on T2WI (= “unidentified bright objects”)

DDx: leukodystrophy, progressive multifocal leukoencephalopathy, multiple sclerosis