Parts of the Brain Affected by White Matter Lesions
White matter lesions are often concentrated in specific regions of the brain. Notably, the frontal lobe tends to show more lesions, which affects memory. Conditions such as intracranial hypertension also impact the frontal lobes, further contributing to cognitive decline.
- Impact on Postural Control and Gait – White matter lesions can occur in regions of the brain responsible for postural control and gait. These areas are responsible for balance and walking.
- Effect on Memory and Problem Solving – Lesions are also found in parts of the brain associated with memory and problem-solving abilities. Individuals may experience memory loss and handling complex tasks.
- Influence on Personality – White matter lesions can affect the areas of the brain that contribute to personality.
Hi, my name is Dr. Ross Hauser. Welcome to the Hauser Neck Center here in Fort Myers, Florida. Today’s discussion addresses The Significance of White Matter Lesions. I will review some research and discuss the causes of brain degeneration. The main point is that white matter lesions on an MRI signal that brain cells are starting to die. While it is expected that some brain cells die with aging, the presence of white matter lesions is an indication that this process is advanced and abnormal.
White matter consists of tracks or bundles of nerve fibers connecting gray matter regions. Damage to the axons (the long slender communication lines of the neuron) and their myelin sheaths results in white matter lesions, which appear as bright spots on MRI scans. These lesions can result from a variety of disorders, including genetic conditions, stroke, migraine, multiple sclerosis, inflammatory conditions, trauma, and Alzheimer’s disease. Studies indicate that the prevalence of white matter lesions increases with age, and these lesions are more common and severe in women. Structural differences, such as increased ligament and joint laxity in women, may play a role. This suggests that structural, not just chemical, factors should be considered in dementia and cognitive decline.
Studies have shown that the severity of white matter lesions is directly linked to the seriousness of dementia. In cases where mild white matter lesions were present, only a small percentage of individuals exhibited mild dementia. For example, severe white matter lesions were observed in 22% of people with mild dementia, whereas moderate dementia was present in almost 40% of cases. This demonstrates a clear correlation between the extent of white matter lesions and the level of cognitive impairment. (1,2)
White Matter Lesions in Younger Populations
During my medical training at the University of Illinois in Chicago and my residency at Heinz VA Medical Center (affiliated with Loyola Medical Center), I cared for many veterans. It was striking how often white matter lesions appeared on their MRIs. Radiology reports often attributed these lesions to small vessel disease.
We are now seeing white matter lesions in people as young as their 30s, whereas previously this was typical only in people in their 70s or 80s. There was even a recent case of a 19-year-old diagnosed with Alzheimer’s disease. (3) Without addressing the causes of brain disease, we may see more teenagers and young adults developing white matter lesions, indicating progressive brain destruction.
What is the cause of white matter lesions in people as young as their 30s?
I believe that cell phone addiction and changes in neck curvature are contributing to this issue. When the natural neck curve is altered—often due to prolonged electronic device usage—it can block the jugular veins, increasing brain pressure. Elevated brain pressure can occlude small blood vessels, leading to white matter lesions, as seen on MRI reports. Lesions around the ventricles are termed periventricular white matter disease, while those in the cortex or subcortical regions are called subcortical white matter lesions. Both indicate some degree of brain damage.
In clinical practice, heart rate variability is sometimes tested to assess vagal tone. For example, one patient with high vagal tone nevertheless experienced significant anxiety and depression, despite having previously been calm and focused. Both he and his partner, who also suffered from severe brain fog and fatigue, found their cognitive abilities diminished. Tasks that previously required eight hours became overwhelming, and personality changes were evident. These symptoms suggest that elevated brain pressure or impaired waste clearance may be at play, often linked to cervical instability.
Small Vessel Disease
The prevailing theory is that small vessel disease damages the brain where the smallest blood vessels, the capillaries, are affected. Oxygenated blood is delivered to tissues by capillaries, which also carry waste products away. When capillaries are blocked, tissues—including the brain—cannot get the nutrients they need and begin to degenerate. This results in white matter lesions. High brain pressure, often due to impaired venous drainage from cervical spine issues, can further damage these small vessels.
Venous insufficiency – Chronic Cerebrospinal Venous Insufficiency and neurologic-like problems
Nerve cell anatomy and injury
Most medical conditions, including nerve injury, are progressive. If a person experiences minor damage to the myelin sheath—the outside of the nerve cell—and the underlying issues like pressure or microvascular disease are not resolved, nerve injury may continue to worsen and eventually lead to nerve cell death. The axon is a key part of the nerve cell, which connects directly to the cell body. This cell body is the main component of the brain’s nerve cells. The portion of the nerve cell that often sustains damage is the myelin sheath, which is located on the outside of the nerve cell. The primary causes of nerve injury include a lack of nutrients reaching these tissues and increased pressure. Both situations can lead to damage in nerve cells. In the office, non-invasive tests are used to check for brain pressure, especially in individuals who have white matter lesions.
Patients experiencing brain fatigue or brain fog often show elevated markers for increased brain pressure. When interventions such as increasing the neck curve and stabilizing the neck with Prolotherapy are implemented, these markers decrease. This reduction in brain pressure is typically accompanied by improved energy levels, better brain function, and enhanced problem-solving ability.
Heart rate variable
A high heart rate variability reflects your body’s resilience in managing “fight-or-flight” responses to danger, stress, and anxiety, as well as its capacity to return to a state of calm. Conversely, low heart rate variability is generally viewed as an indicator of existing or potential health issues, as it suggests that the body is less adaptable and has difficulty responding to changing conditions.
Brain Metabolism and the electronic device lifestyle
Today’s constant digital engagement increases brain metabolism, producing far more waste products than in previous generations. If jugular veins are blocked due to poor posture, the brain’s ability to clear these waste products decreases, increasing the risk of brain damage from both toxicity and pressure.
Most internal jugular vein and vagus nerve compressions occur at the atlas, the top vertebra. When the jugular veins are obstructed, fluid accumulates and pressure increases in the frontal lobes—areas critical for memory and problem-solving. Damage to these regions can result in cognitive decline. Upper cervical instability may cause jugular vein compression, breakdown of the blood-brain barrier, and accumulation of toxins, leading to inflammation and brain cell damage. Any blockage in the venous system can cause intracranial hypertension and various brain issues, including arterial vasospasm and damage from accumulated toxins.
Flushing out neuron waste. The brain contains one billion neurons or nerve cells. For these nerve cells to be healthy, fluid has to flow into and out of the brain appropriately.
Brain Inflammation, Cervical Instability, and Systemic Effects
Increased intracranial pressure can result from decreased venous drainage of the brain, often due to a breakdown of the cervical curve and ligamentous cervical instability.
The Blood-Brain Barrier and Cognitive Decline
The blood-brain barrier is designed to selectively allow substances into the brain and prevent unwanted elements from entering. When the blood-brain barrier breaks down, inflammatory substances, cytokines, immune cells, and proteins can enter the brain, leading to neural inflammation. When the blood-brain barrier breaks down, inflammatory substances, cytokines, immune cells, and proteins can enter the brain, leading to neural inflammation. This inflammation may cause mental illness, cognitive decline, psychiatric disorders, brain fog, fatigue, and dissociative disorders.
Arterial blood entering the brain is red, while cerebral spinal fluid remains clear. In dementia and Alzheimer’s disease, proteins such as tau and amyloid accumulate, indicating the brain’s inability to clear waste products and toxins. This accumulation contributes to cognitive decline and, ultimately, dementia. Medications are being developed to enhance the brain’s capacity to detoxify. However, if waste removal issues stem from jugular vein compression caused by changes in the neck curve, restoring the neck curve may be a more effective treatment. Simple postural adjustments, like raising your computer screen to eye level, can help. For ligamentous joint instability, Prolotherapy may be used to strengthen the ligaments.
Systemic toxic inflammation can lead to symptoms such as brain fog. Often, the underlying cause is cervical destruction or a breakdown of the neck curve, which may injure the vagus nerve. This combination can produce symptoms that appear to be neck-related. Many people undergo brain MRIs due to memory issues or other symptoms, and the occurrence of white matter lesions requires investigation into both the lesions and accompanying symptoms, such as temperature dysregulation, chronic fatigue, brain fog, allergies, autoimmunity, and dysautonomia.
These issues can be traced back to breakdowns in the neck curve and cervical ligament instability. While aging, heart disease, diabetes, and poor diet can cause certain symptoms, cognitive decline, brain fog, and chronic fatigue are often linked to ligamentous cervical instability. Brain inflammation can lead to a range of outcomes, including dementia and anxiety.
Personality and Cognitive Changes
Over the years we have seen a significant number of patients who are experiencing anxiety, depression, and dissociation. Some have been diagnosed with personality disorders, some with bipolar disorder. These difficulties can be a manifestation of cervical spine and craniocervical instability causing nerve, vein, and arterial compression due to the unstable bones in the neck exerting pressure on these structures.
Concussion Association with White Matter Lesions
If an individual is diagnosed with white matter lesions and has a history of concussion, it is reasonable to assume a connection between the two, especially if cognitive decline is also present. In these cases, the concussion may have contributed to some form of brain injury.
- Mechanism of Injury – When a concussion occurs—such as during participation in sports or as a result of a car accident—the individual typically experiences a sudden impact to the head. The body’s normal response to such trauma is a rapid twisting motion of the head. This quick, unexpected twist can injure the upper cervical spine.
- Injury to the upper cervical spine can lead to damage of the upper cervical ligaments. Such ligament injuries can impede the normal flow of cerebrospinal fluid and restrict drainage through the jugular veins. The combination of these factors can increase pressure within the brain.
When the brain cannot properly drain fluids and toxins, its condition deteriorates over time. This process can result in increased fatigue and, ultimately, cognitive decline.
When persistent post-concussion syndrome turns into a neurologic mystery
Role of Prolotherapy and Dynamic Structural Medicine
Human posture and motion directly influence the body’s structural integrity, and conversely, the structure of the body impacts the functioning of the nervous system. Addressing structural issues and correcting misalignments are essential, as these changes promote better nervous system function. By rectifying structural misalignments, particularly those affecting neck stability, it is possible to restore proper function.
Prolotherapy is an injection technique designed to stimulate cervical spine ligaments and provide stability in the neck where there is currently instability. By resolving instability with Prolotherapy, the cervical spine’s curve can be corrected, and issues such as obstruction of the jugular vein by the atlas can be addressed.
Through proper structural correction and stabilization, the jugular veins are able to open more fully. This improvement can be documented using ultrasound imaging, which visually confirms increased openness of the jugular veins. Over a period of six to eight months, typically requiring around ten visits for Prolotherapy, gradual improvements in jugular vein function are observed.
As jugular vein stability improves, patients often experience a reduction in symptoms such as brain fog. Over time, cognitive function begins to return, and the prognosis for individuals with white matter lesions, when the cause is ligamentous cervical instability due to breakdown in the neck curve, is generally favorable. Both the curve and cervical instability can be corrected, leading to positive long-term outcomes.
Our research
References
1 Manly JJ, Jones RN, Langa KM, Ryan LH, Levine DA, McCammon R, Heeringa SG, Weir D. Estimating the prevalence of dementia and mild cognitive impairment in the US: the 2016 health and retirement study harmonized cognitive assessment protocol project. JAMA neurology. 2022 Dec;79(12):1242-9. [Google Scholar]
2 Breitner JC. Mild cognitive impairment and progression to dementia: New findings. Neurology. 2014 Jan 28;82(4):e34-5. [Google Scholar]
3 Jia J, Zhang Y, Shi Y, Yin X, Wang S, Li Y, Zhao T, Liu W, Zhou A, Jia L. A 19-year-old adolescent with probable Alzheimer’s disease. Journal of Alzheimer’s Disease. 2023 Jan 31;91(3):915-22. [Google Scholar]