lacunar infarct vs subcortical leukencephalopathy

[michaelrack]

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what is the difference between the 2? They were described as separate entities during a psych MOC review course I recently took.

 

[Thama]

A lacunar infarct is a small stroke. Leukencephalopathy is a vast category of disease including genetic, metabolic, and infectious etiologies.

 

[neglect]

A lacunar infarct is a small stroke. Leukencephalopathy is a vast category of disease including genetic, metabolic, and infectious etiologies.

Would just clarify the above definition of PVWM changes to be more pediatric/young adult. Past the 4th decade of life, "subcortical leukencephalopathy" is a wastebasket radiology term of periventricular white matter changes of no known significance. There is rarefaction of the white matter tracks, accelerated by vascular risk factors but NOT clearly strokes, and also seen in migraine, autoimmune disease (non-CNS), and increasing age. When robust, it can appear demyelinating.

My take is that it is pretty much meaningless. It is seen on CT and MRI, so radiologists are forced to comment on it, but there is no such thing as "PVWM disease." There is no disease here. There is a signal change and loss of white matter around the ventricles, likely in relationship to vascular changes (without clear or clinically significant ischemia), inflammation, migainous vasospasm (?), and even amyloid via CAA.

As mentioned, a lacune is just a small vessel stroke.