Consensus statement for the management of incidentally found brain white matter hyperintensities in general medical practice

Med J Aust. 2023 Aug 21. doi: 10.5694/mja2.52079. Online ahead of print.ABSTRACTINTRODUCTION: There is a paradigm shift in our understanding of white matter hyperintensities (WMH) found on brain imaging. They were once thought to be a normal phenomenon of ageing and, therefore, warranted no further investigation. However, evidence now suggests these lesions are markers of poor brain and cardiovascular health, portending an increased risk of stroke, cognitive decline, depression and death. Nevertheless, no specific guidelines exist for the management of incidentally found WMH for general medical practitioners and other clinicians ordering brain magnetic resonance imaging scans for diverse clinical indications. Informed by a literature review and expert opinion gleaned from stroke neurologists, medical and imaging specialists, and general practitioners, we present our consensus statement to guide the management of incidentally found WMH in adults.MAIN RECOMMENDATIONS: When incidental WMH are found on brain imaging: Perform a detailed history and examination to screen for neurological events. Investigate for potential undiagnosed or undertreated cardiovascular risk factors, especially hypertension and diabetes mellitus. Commence intensive and individualised cardiovascular risk management when risk factors are uncovered. Treat underlying risk factors via accepted guidelines but note that antiplatelet and anticoagulant medications should not be prescribed for incidental WMH in the...
Source: Medical Journal of Australia - Category: General Medicine Authors: Source Type: research