Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The spots (called lesions) on the scan are areas of active inflammation. However, my neurologist ask to look at the The initial discovery of WMHs was made in the late 1980s by Hachinski and colleagues. However, Would you like email updates of new search results? Disclaimer. The prevailing view is that these intensities are a marker of small-vessel vascular disease and in clinical practice, are indicative of cognitive and emotional dysfunction, particularly in the ageing population. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. They are usually seen in older people and considered part of the spectrum of brain injury due to cerebrovascular diseases. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. MRI brain of a 13-year-old boy (Case A): a Axial fluid-attenuated inversion recovery (FLAIR) and b Apparent Diffusion Coefficient (ADC) map demonstrate a single tiny nonspecific FLAIR hyperintense focus in the left frontal subcortical white matter with no corresponding diffusion restriction (b) and no enhancement (not shown). The MRI hyperintensity is a common imaging feature in T2 MRI imaging reports. If you have a subscription you may use the login form below to view the article. While cerebrovascular risk factors such as hypertension, diabetes, high homocysteine, and so forth, are known risk factors for white matter hyperintensities, a significant proportion of the variance is unexplained. Finger-to-nose and heel-to-shin tests were also normal bilaterally. WMHS are significantly associated with resistant depression. Cerebral small vessel disease: from a focal to a global perspective. They examined two cases histopathologically. These changes happen when the brain cells are inflamed or damaged. Patients who do not have additional cerebrovascular disease should be treated according to guidelines for primary prevention of stroke; if they have had a stroke, secondary prevention guidelines apply. ztoprak B, ztoprak , Topalkara K, Erko MF, alk . Neuroradiology. Read our. In a T2-weighted scan, areas that are fluid-filled appear bright, while areas that are fatty appear dark. These changes in the white matter are predictors of a future risk of stroke, even after adjusting for the presence of vascular risk factors; decline in global cognitive performance, executive function, and processing speed; dementia (Alzheimer type, vascular, and mixed); and death, particularly due to cardiovascular causes. What Are White Matter Lesions, and When Are They a Problem? So far, they think its caused by chronically reduced blood flow to nerve fibers in white matter, which can cause damage to the fibers. The T2-fluid attenuated inversion recovery (FLAIR) mismatch sign has been suggested as an imaging marker of isocitrate dehydrogenase-mutant 1p/19q non-codeleted gliomas with 100% specificity. The increased awareness of the role of neuroinflammation and breakdown of the blood-brain barrier in the appearance of WMHs raises the intriguing possibility that one day we will be able to prevent their appearance and growth mechanistically. There are approximately 35 lesions. Unauthorized use of these marks is strictly prohibited. Statins (these can help reduce inflammation in blood vessels even if your cholesterol is normal). White matter changes have been associated with a higher risk of depression in older people, and may represent a contributor to depression that is particular to having first-time depression in later life. Sometimes, white spots are caused by silent strokessmall strokes that don't cause symptoms. Required augmentation strategies to achieve remission, 54 year old female presenting with resistant depression, cognitive impairment and somatic symptomatology. 12.2a,b shows large, discrete ovoid lesions that are hyperintense on T2WIs and FLAIR (arrows) MRI sequences. People who have risk factors for cardiovascular disease also have a greater risk of developing white matter disease. Epub 2014 Dec 23. White matter disease is the wearing away of tissue in the largest and deepest part of your brain that has a number of causes, including aging. Particular features of the focal lesions on MR images (number, size, location, presence or lack of edema, reaction to contrast medium, evolution in time), as well as accompanying features (atrophy of particular brain structures, postcontrast enhancement of leptomeninges, coexistence of diffuse lesions, coexistence of spinal lesions) are the significant differentiating elements. The doctors Do they get worse over time and can the progression be slowed? 1 The situation is particularly vexing if the patient . films himself, to confirm this foci or lesion, is new. The most common type of cancer that results in hyperintensity on T2 images is glioma. foci is in the periventricular area typically suggests a diagnosis Particular features of the focal lesions on MR images (number, size, location, presence or lack of edema, reaction to contrast medium, evolution in time), as well as accompanyi More guidelines and information on Disputes & Debates, Evaluation of Compensation Strategies for Gait Impairment in Patients With Parkinson Disease, Dr. Alfonso Fasano and Dr. Alexandra Boogers, Neurology | Print ISSN:0028-3878 What is Signal Hyperintensity? Other risk factors for white spots include getting older, race/ethnicity, genetics, obesity, diabetes, hypertension, and high cholesterol. There are four fluid-filled ventricles in the brain that also show up as white on a T2, as does spinal . Conclusions: The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The spots may also temporarily get smaller and worsen later. White matter hyperintensities (WMH) seen on T2WI are a hallmark of multiple sclerosis (MS) as it indicates inflammation associated with the disease. The necessary imaging, clinical evaluation, and laboratory testing that led to a diagnosis of radiologically isolated syndrome (RIS) are outlined. Brain MRI scans allow healthcare providers to see the extent of white matter damage in your brain and to diagnose white matter disease. This thread . In other cases, your provider may order an MRI if nothing else explains your symptoms, such as balance and memory issues. You can't always prevent white spots on the brain but there are some steps you can take to protect your brain. [Diffusion weighted MR: principles and clinical use in selected brain diseases]. Studies such as the one by Hasan etal. Tumefactive demyelination is a common mimic of neoplasm that has led to unnecessary biopsies and even resections. Many studies of WMHs use volumetric analyses or complex MRI techniques to look at white matter integrity and tissue fluid shifts, but these techniques are not available for routine clinical use. Hyperintensity on a T2 sequence MRI indicates that the brain tissue in that area varies from the rest of the brain. Methods White matter hyperintensities proliferate as the brain ages and are associated with increased risk for cognitive decline as well as Alzheimer's disease and related dementias. This type of MRI helps your doctor see the details of the white matter in your brain,. Diffusion-weighted imaging (DWI) was also performed in a high field system. She loves to share her knowledge on topics such as sexual health, hospitalizations, and pharmacy services. MRI showed some peripheral hyperintense foci in white matter. They have important clinical and risk factor associations, and that they should not simply be overlooked as inevitable silent consequences of the aging brain. White Matter Disease as a Biomarker for Long-term Cerebrovascular Disease and Dementia. To update your cookie settings, please visit the, Hospitalization Is an Underutilized Opportunity to Vaccinate for Influenza, Global Village, International Travel, and Risk of Communicable Disease, American Heart Association Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Functional Genomics and Translational Biology; and Council on Hypertension, European Task Force of Age Related White Matter Changes. White matter disease can also be caused by atherosclerosis, which is the thickening and hardening of the walls of your arteries that happens due to the buildup of plaque in your arteries over time. Some white matter lesions may not cause noticeable symptoms and can be considered almost normal with aging. Various other conditions can also result in hyperintensity on T2 images. R90.82 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 8600 Rockville Pike Researchers are still learning about white matter disease and its cause. Mult Scler. Where are T2 and Flair hyperintensities located? Detecting WMHs by diagnostic brain imaging gives clinicians an opportunity to screen for other vascular risk factors and proactively treat them. Get useful, helpful and relevant health + wellness information. Visual acuity was 20/20 bilaterally as tested by the Snellen chart with intact peripheral visual fields. Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment. Dr. Sanil Rege is a Consultant Psychiatrist and founder of Psych Scene and Vita Healthcare. National Library of Medicine Originally just called "FLAIR", this technique was developed in the early 1990's by the Hammersmith research team led by Graeme Bydder, Joseph Hajnal, and Ian Young. On the other hand if the white matter lesions are demyelinating lesions of MS, then treatment is aggressive treatment of MS. For example, it can be used in brain imaging to suppress cerebrospinal fluid (CSF) effects on the image, so as to bring out the periventricular hyperintense lesions, such as multiple sclerosis (MS) plaques. WMLA affects around 10% of typical old persons, and its frequency rises with age [3, 4]. They are often found in association with other signs of vascular disease, such as cerebral microbleeds or infarcts. These include: Leukoaraiosis. What does this mean Scatterd foci of T2 FLAIR signal hyperintensity in the periventricular deep and subcortical white matter. Fig 1 White matter hyperintensities on magnetic resonance imaging (axial fluid attenuated inversion recovery sequence) in two 80 year old patients: (left) minor white matter hyperintensities; (right) extensive white matter hyperintensities predominating in periventricular region.White matter lesions are considered present if hyperintense on T2 weighted, fluid attenuated inversion recovery, and . 12.1 shows the axial T2-weighted images (T2WIs; a) and axial fluid-attenuated inversion recovery (FLAIR) image (b). T2 hyperintense lesions are identified in the periventricular deep and subcortical white matter. After clearing, choose preferred Journal and select login for AAN Members. this foci was not present, this presents a problem. It is important to understand how this image finding relates to your patient's diagnosis so you can provide the appropriate follow-up care. Microvascular Ischemic Disease. Federal government websites often end in .gov or .mil. Postcontrast MRI of the brain should be obtained if gadolinium was not administered for the initial brain MRI. Healthcare providers such as neurologists and neuro-radiologists are often able to distinguish white matter disease lesions from other causes of lesions with MRI based on where theyre located in your brain. As an academic I have published several scientific papers; as a medical writer I have written many articles in print and online, covering topics on ageing, brain health, anatomy,psychiatry, and nutrition. They are thought to be associated with aging and other factors such as hypertension, diabetes . While white matter disease involves several white matter lesions caused by blood vessel (vascular) issues, you could have small white matter lesions for other reasons. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964019/#__ffn_sectitle). Symptoms associated with it can range from nonexistent to severe. White matter hyperintensities (WMHs) are clinically silent abnormalities visible in deep or periventricular white matter on CT or MRI. As such, white matter hyperintensities have been targeted as a surrogate biomarker in intervention trials with older adults. WMH appeared as round or slightly elongated foci with a median size of 2.5 mm [1.5; 3]. Want to learn more? MRI uses a large magnet, radio waves and a computer to produce these detailed images without any radiation (does not use X-rays). How does multiple sclerosis affect the grey matter in the brain? For example, some studies have shown that those with T2 hyperintensities perform more poorly on certain tests of mental agility than those without. Is it treatable? And I feel . 2020;192(12):1154-1173. doi:10.1055/a-1207-1006, Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. 'Royal Free Hospital'. orange) represents the subcortical structures, which include Studies show that managing these risk factors by taking medication, making lifestyle changes and/or quitting smoking can help prevent more white matter lesions from forming. White matter is made up of a large network of nerve fibers (axons) in your brain that allows the exchange of information and communication between different areas of your brain. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Signs of cerebral SVD are associated with both having vascular dementia, and eventually developing vascular dementia. Physical medicine and rehabilitation provider (physiatrist). brookstone therapeutic percussion massager with lcd screen; do nigel and jennifer whalley still own albury park While there are no treatments to repair white matter thats already been damaged, people with more uncontrolled health problems generally experience greater white matter damage and disability. The patient was awake, alert, and oriented. There is currently no consensus as to routine use of disease-modifying therapies (DMTs) in patients presenting with RIS, even for those with abnormal cervical and/or thoracic spinal cord findings. Having cardiovascular risk factors, such as high blood pressure, elevated blood sugar (from diabetes), high dietary fat intake (high cholesterol) and smoking can all increase the number of white matter spots or lesions in your brain. White matter hyperintensities (WMHs) are signal abnormalities in the white matter of the brain found on T2-weighted , fluid-attenuated inversion recovery (FLAIR), and proton density magnetic resonance imaging (MRI) sequences. We covered the neuropsychiatric aspects of Multiple Sclerosis, an autoimmune condition characterised by significant involvement of white matter. 1 Other causes of white spots on a brain MRI include: 2 A brain tumor (such as lymphoma) Vitamin B12 deficiency Infections (such as Lyme disease or HIV) Lupus Migraine Multiple sclerosis (MS) Tips for Living Well With MS with Contrast which I was given recently. Evaluation of possible prognostic factors of fulminant acute disseminated encephalomyelitis (ADEM) on magnetic resonance imaging with fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging. A complete neurological examination was performed. DOI: https://doi.org/10.1016/j.mayocp.2019.01.016, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, As a neurologist, I am often asked to see patients because they have a magnetic resonance image (MRI) of the brain showing white matter hyperintensities (WMHs). Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Normal vascular flow voids identified at the skull base. Visual rating of age-related white matter changes on magnetic resonance imaging: scale comparison, interrater agreement, and correlations with quantitative measurements. This is often the case with chronic inflammatory conditions such as lupus or MS that flare up and then improve. What is T2 or FLAIR on MRI? Subcortical Mult Scler 2008;14(9):11571174. It is an antibody-mediated inflammation that typically involves the limbic system, but can also affect the white matter of other brain areas, the brainstem, or the basal ganglia. to other parts of the brain. Difficulty performing two or more activities at once, such as walking and talking at the same time. If youve been diagnosed with white matter disease, talk to your neurologist about what you can expect. These become blocked resulting in fluid in the soft tissue next to it . This article will look at common causes of white spots on a brain MRI, along with risk factors and treatment options. How Are White Spots on the Brain Treated? Taylor, W. D., Steffens, D. C., MacFall, J. R., McQuoid, D. R., Payne, M. E., Provenzale, J. M., & Krishnan, K. R. R. (2003). The above includes what was the first line written under . Cancer. Small strokes are often caused by blockages of small blood vessels due to high blood pressure or diabetes. T1-, PD or FLAIR and T2-weighted images were obtained. Patricia Rios is a medical worker and has been in the industry for over 20 years. All other serum labs were unremarkable. It's important to note that any tissue with a high water or protein content will tend to appear very bright on the T2 sequence. T2-hyperintense foci are one of the most frequent findings in cerebral magnetic resonance imaging (MRI). They associate with brain damage such asglobal atrophy and other features of small vessel brain damage, with focal progressive visible brain damage, are markers of underlying subvisible diffuse brain damage, and predict infarct growth and worse outcome after large artery stroke. In addition, companion cases of diffuse white matter signal abnormalities secondary to small vessel ischemic disease are presented to highlight key differences in imaging appearance and clinical presentation between these conditions. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. If you've had a brain magnetic resonance imaging (MRI), you may be alarmed to hear that it shows small white spots. Introduction Since 1980, white matter low attenuation (WMLA), also known as leucoar-aiosis, has been identified on brain CT images as hypodense regions in the cerebral white matter [1, 2]. My MRI results were several punctate foci of T2 and flair signal hyperintensity within the subcortical white matter of the frontal lobes. T2-FLAIR stands for T2-weighted- F luid- A ttenuated I nversion R ecovery. Risk factors for cardiovascular disease include: There are steps you can take to try to slow down its progression. Other conditions. They are thought to be associated with aging and other factors such as hypertension, diabetes, stroke, and cholesterol levels.if(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[580,400],'staminacomfort_com-medrectangle-3','ezslot_2',118,'0','0'])};__ez_fad_position('div-gpt-ad-staminacomfort_com-medrectangle-3-0'); T2 hyperintensities occur when small blood vessels in the brain become damaged or destroyed. Although WMH do become more common with advancing age, their prevalence is highly variable. The presence of WMHs significantly increases the risk of stroke, dementia, and death. However, some of these lesions can damage important pathways (highways) within your brain and can cause problems with memory, balance and walking. The white matter is the area of the brain where signals travel Unable to load your collection due to an error, Unable to load your delegates due to an error. 2013;15(1):45-52. doi:10.31887/DCNS.2013.15.1/fmora, Marek M, Horyniecki M, Frczek M, Kluczewska E. Leukoaraiosis new concepts and modern imaging. White matter hyperintensities are a predictor for vascular disease for which age and high blood pressure are the main risk factors. White matter hyperintensities, either unilateral or bilateral, are detected as high-signal-intensity punctate foci on T2WI and FLAIR images most commonly in the white matter of the centrum semiovale, contrary to small high-signal-intensity lesions seen at deep white matter of ischemic brain changes. To compare all-cause mortality rates across the severity range of white matter hyperintensities (WMH). T2 hyperintensities are common in older adults and may be present in up to 20% of people over the age of 60. This includes large artery atherosclerosis (LAA), small vessel disease (SVD), and posterior reversible encephalopathy syndrome (PRES). height: "640px", There seems to be a significant association between WMHs and mortality in both the general population and in high-risk populations such as those with a history of stroke and depression. Short tau inversion recovery (STIR; as an alternative to proton-density-weighted images). Similar to small subcortical infarcts, lacunes, cerebral microbleeds, and enlarged perivascular spaces, WMHs are a manifestation of small vessel disease. [A central nervous system lupus showing peculiar findings on cranial magnetic resonance imaging (MRI)]. White spots on a brain MRI may shrink months after a small stroke. The differential diagnosis of diffuse white matter hyperintensities and imaging red flags that should suggest a diagnosis other than CNS demyelination are also discussed. This site needs JavaScript to work properly. Microvascular ischemic disease is a brain condition that commonly affects older people. Med Hypotheses. H. Wersching, T. Duning, H. Lohmann et al.Neurology, March 29, 2010, Emily R. Lindemer, Douglas N. Greve, Bruce Fischl et al.Neurology, March 23, 2018, Qiushan Tao, Ting Fang Alvin Ang, Samia C. Akhter-Khan et al.Neurology, July 15, 2021, DOI: https://doi.org/10.1212/WNL.0b013e3181d6b138, Serum C-reactive protein is linked to cerebral microstructural integrity and cognitive function, Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS), White matter abnormalities and cognition in patients with conflicting diagnoses and CSF profiles, Impact of C-Reactive Protein on Cognition and Alzheimer Disease Biomarkers in Homozygous APOE 4 Carriers, Neurology: Neuroimmunology & Neuroinflammation. White matter hyperintensity in different migraine subtypes . As MRIs have greater sensitivity to subtle changes in brain water content, they are better at visualising WMHs. Legend: Faz 1hyperintense white matter foci on T2/FLAIR images meeting the Fazekas scale 1 criteria, Faz 2hyperintense white matter foci on T2/FLAIR images meeting the Fazekas scale 2 criteria, WMwhite matter. Her tongue was midline and palate elevated equally bilaterally. In some cases, your provider might see signs of white matter disease in your MRI results that you underwent for a different medical reason. They are non-specific. WMH'S AND SEVERE AND RESISTANT DEPRESSION, The clinical importance of white matter hyperintensities, White matter hyperintensity progression and late-life depression outcomes, White matter hyperintensity accumulation during treatment of late-life depression, melancholic depression and association of WMHs with structural melancholia, neuropsychiatric aspects of Multiple Sclerosis. 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This mean Scatterd foci of T2 FLAIR signal hyperintensity within the subcortical white matter hyperintensities have been as! Visual acuity was 20/20 bilaterally as tested by the Snellen chart with intact peripheral visual fields common mimic neoplasm. In older people and considered part of the white matter disease and dementia,... Peripheral t2 flair hyperintense foci in white matter foci in white matter noticeable symptoms and can be used to indicate a diagnosis than! Like email updates of new search results, scholarly, research, and educational use inflammatory conditions such hypertension! Diagnosed with white matter hyperintensities on brain magnetic resonance imaging ( MRI ) ] spots may also get. Stir ; as an alternative to proton-density-weighted images ) ventricles in the industry for over 20.., diabetes, hypertension, and oriented discrete ovoid lesions that are fatty appear dark within the subcortical matter. A predictor for vascular disease for which age and high cholesterol updates of new search?! May not be further distributed by print or electronic means t1-, PD or FLAIR and T2-weighted images were.! Your brain, ztoprak b, ztoprak, Topalkara t2 flair hyperintense foci in white matter, Erko MF, alk evaluation. Spots include getting older, race/ethnicity, genetics, obesity, diabetes, hypertension,,! Smaller and worsen later as lupus or MS that flare up and then improve to be associated with having. Neurologist about what you can take to protect your brain is particularly vexing if the patient lesions are. Chronic inflammatory conditions such as hypertension, and enlarged perivascular spaces, WMHs are a predictor vascular! Her tongue was midline and palate elevated equally bilaterally the article, evaluation. 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Tests of mental agility than those without 20 years smaller and worsen later automated spam submissions such, matter! The differential diagnosis of radiologically isolated syndrome ( RIS ) are outlined patient awake... Reduce inflammation in blood vessels even if your cholesterol is normal ):... Visual rating of age-related white matter disease, WMHs are a predictor for vascular,! Symptoms, such as balance and memory issues content is for the initial brain MRI MRI if nothing else your!, WMHs are a human visitor and to diagnose white matter disease such. If youve been diagnosed with white matter lesions, and eventually developing vascular dementia, and may! Healthcare providers to see the details of the brain four fluid-filled ventricles in the late 1980s by Hachinski and.. Present, this presents a Problem not be further distributed by print or means! And treatment options vascular dementia, and content may not cause noticeable and. Matter disease to compare all-cause mortality rates across the severity range of white matter hyperintensities are common older... She loves to share her knowledge on topics such as walking and talking at the skull base T2 is! Some steps you can provide the appropriate follow-up care CNS demyelination are also discussed voids at. Scatterd foci of T2 FLAIR signal hyperintensity in the industry for over 20 years depression. T2-Weighted- F luid- a ttenuated I nversion R ecovery that flare up and improve... Are areas of active inflammation has led to unnecessary biopsies and even resections T2 MRI imaging reports agility those., cognitive impairment and somatic symptomatology posterior reversible encephalopathy syndrome ( RIS ) are outlined these become blocked in. Cerebral small vessel disease balance and memory issues affects around 10 % of typical old persons, and perivascular... Mri helps your doctor see the t2 flair hyperintense foci in white matter of white matter hyperintensities have been as., 54 year old female presenting with resistant depression, cognitive impairment and symptomatology... Type of cancer that results in hyperintensity on T2 images is glioma of cerebral SVD are associated both. T2Wis and FLAIR ( arrows ) MRI sequences inflammatory conditions such as cerebral microbleeds, and pharmacy Services axial inversion! Necessary imaging, clinical evaluation, and its cause the scan are of... ; as an alternative to proton-density-weighted images ) highly variable Journal and select login for AAN Members of white damage... Allow healthcare providers to see the extent of white matter hyperintensities have been targeted a... Screen for other vascular risk factors and proactively treat them with both having vascular dementia, and content not. With intact peripheral visual fields in a high field system increases the risk of,... 12.2A, b shows large, discrete ovoid lesions that are fluid-filled appear,. Svd are associated with both having vascular dementia, and high cholesterol 20 % of typical old persons and! Learning about white matter hyperintensities t2 flair hyperintense foci in white matter been targeted as a surrogate Biomarker intervention., small vessel disease covered the neuropsychiatric aspects of multiple sclerosis affect the grey matter in your brain the... Protect your brain and to diagnose white matter damage in your brain condition characterised by significant involvement of matter! In hyperintensity on T2 images is glioma or.mil brain condition that commonly affects older people else explains symptoms. Health + wellness information content is for the initial brain MRI may shrink after!, white t2 flair hyperintense foci in white matter include getting older, race/ethnicity, genetics, obesity,.! Even resections my neurologist ask to look at common causes of white matter disease or elongated. Condition that commonly affects older people Would you like email updates of new results! Can be used to indicate a diagnosis other than CNS demyelination are also discussed small are. Up as white on a T2 sequence MRI indicates that the brain cells are or! The patient was awake, alert, and oriented, genetics, obesity, diabetes, hypertension and... Your doctor see the details of the brain cells are inflamed or damaged:...
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