[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-606634-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-606634-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","the-dark-side-of-the-white-matter-dark-white-matter-systematic-review","The Dark side of the White Matter - Dark White Matter - systematic review","","Systematic review addressing “Dark White Matter” (DWM), defined as diffuse subcortical white matter hypointensity on T2/FLAIR, a sign frequently overlooked compared with seizure-related cortical hyperintensities. PubMed search in August 2023 included studies reporting this imaging pattern, mostly case reports with patient-level data when available. Among 56 studies and 228 patients, DWM often co-occurred with seizures and was most commonly linked to non-ketotic hyperglycaemic hyperosmolar state (NKH).",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & Report",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/the-dark-side-of-the-white-matter-dark-white-matter-systematic-review/606634/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/the-dark-side-of-the-white-matter-dark-white-matter-systematic-review/606634.png","ImageObject",300,407,{"name":42,"@type":43},"Franzy","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-10-16",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What is “Dark White Matter” (DWM) in this review?","Question",{"text":62,"@type":63},"DWM refers to diffuse subcortical white matter hypointensity on T2/FLAIR. The review focuses on this sign when white matter “turns dark,” distinct from more commonly reported cortical FLAIR/T2 abnormalities.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"Which conditions were most frequently associated with DWM?",{"text":67,"@type":63},"The most frequently associated disease was non-ketotic hyperglycaemic hyperosmolar state (NKH) at 32%, followed by encephalitis, Moyamoya disease, genetic causes, and subdural hematoma.",{"name":69,"@type":60,"acceptedAnswer":70},"How strongly is DWM linked to seizures?",{"text":71,"@type":63},"Across the included cases, DWM was associated with seizures in more than 61.4% of patients. In the seizure subgroup, DWM indicated NKH in 51.4% and encephalitis in 26.4%.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},606634,1792863205,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},7,"Healthcare",40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":112,"slug":113},8,30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":111,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":115,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144},2336478945519,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Journal of the Neurological Sciences 457 (2024) 122882  \nContents lists available at ScienceDirect  \nJournal of the Neurological Sciences  \njournal [homepage:](homepage: www.elsevier.com/locate/jns)[ www.elsevier.com/locate/jns](homepage: www.elsevier.com/locate/jns)  \n| The Dark side of the White Matter. Diffuse subcortical White Matter Hypointensity on T2/FLAIR: A systematic review of a frequently underrecognized sign |  | |\n| --- | --- | --- |\n| Giuseppe Magroa, *, Federico Tostob, Vincenzo Laterzaa, Olindo Di Benedetto c\u003Cbr>a Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University, Catanzaro, Italy b Department of Neuroscience, \"Giovanni Paolo II\" Hospital, Catanzaro, Italy\u003Cbr>c Department of Medical and Surgical Sciences, Institute of Neuroradiology, Magna Graecia University, Catanzaro, Italy |  |  |\n| A R T I C L E I N F O\u003Cbr>Keywords:\u003Cbr>Dark White Matter\u003Cbr>Subcortical White Matter Hypointensity on T2 FLAIR\u003Cbr>Black white matter\u003Cbr>Subcortical reduced signal on T2 FLAIR White matter low signal intensity on T2 FLAIR MRI Hypointensity\u003Cbr>Seizures\u003Cbr>Encephalitis\u003Cbr>MOGAD\u003Cbr>Hyperglycaemic hyperosmolar non-ketotic syndrome | A B S T R A C T\u003Cbr>Background and objectives: Many reversible brain MRI abnormalities have been described, among these the most frequently reported are cortical hyperintensities on FLAIR/T2 occurring during seizures. Much less attention has been given to those situations where White Matter goes Dark: subcortical white matter hypointensity on T2/ FLAIR. Our aim is to identify the medical condition “Dark White Matter”(DWM) is more frequently associated with. This is the first systematic review on DWM.\u003Cbr>Methods: PubMed was searched in August 2023. Included studies were those reporting Diffuse Subcortical White Matter Hypointensity on T2/FLAIR. Mainly case reports were included. Individual patient-level data was included whenever available. Frequency measures of the different diseases were calculated.\u003Cbr>Results: 56 studies were included, 228 patients were eligible for analysis. DWM happened in isolation, with no cortical abnormalities, in 71 cases and was associated with seizures in >61.4% of cases. The most frequently DWM-associated disease was Non-Ketotic Hyperglycaemic hyperosmolar state (NKH), followed by Encephalitis, Moyamoya disease, Genetic Causes, and Subdural Hematoma. Frequency of NKH was 32%. NKH was associated with seizures in 100% of cases and the most frequently involved lobe was the occipital one. When considering only the subgroup of patients with seizures, DWM was indicative of NKH in 51.4% of cases and Encephalitis in 26.4% of cases. Key limitations are heterogeneity and missing data.\u003Cbr>Discussion: DWM is frequently underdiagnosed. This sign can exist alone and it is not merely a consequence of cortical involvement. Moreover, it has important implications, both diagnostic and therapeutic, as it is more frequently associated with NKH, especially in the context of seizures, where anti-seizure medication is not the first line of treatment. We also discuss the pathogenesis of DWM by finding a common link between the most frequently associated diseases. |  |\n\n1. Introduction  \nMany reversible brain MRI abnormalities have been described, among these the most frequently reported are cortical hyperintensities on FLAIR/T2 occurring during seizures [1–3]. Much less attention has been given to Subcortical White Matter alterations, and among them to those situations where White Matter turns Dark. In the most recent review of the literature about seizure-induced brain MRI abnormalities, the “Dark White Matter” sign, or Diffuse Subcortical White Matter Low Intensity on T2/FLAIR, has been reported only once so far [4]. The largest case series on Dark White Matter included 29 patients, the  \nmajority of which (75.9%) reported seizures and almost half of them had associated extrinsic compressive lesions, such as subdural hematoma (SDH), which was the most freque","cbCaibW1JuwBB567","https://ap.wps.com/l/cbCaibW1JuwBB567","pdf",2179932,"English","# Introduction\n# Methods\n# Results\n# Discussion","[{\"question\":\"What is “Dark White Matter” (DWM) in this review?\",\"answer\":\"DWM refers to diffuse subcortical white matter hypointensity on T2/FLAIR. The review focuses on this sign when white matter “turns dark,” distinct from more commonly reported cortical FLAIR/T2 abnormalities.\"},{\"question\":\"Which conditions were most frequently associated with DWM?\",\"answer\":\"The most frequently associated disease was non-ketotic hyperglycaemic hyperosmolar state (NKH) at 32%, followed by encephalitis, Moyamoya disease, genetic causes, and subdural hematoma.\"},{\"question\":\"How strongly is DWM linked to seizures?\",\"answer\":\"Across the included cases, DWM was associated with seizures in more than 61.4% of patients. In the seizure subgroup, DWM indicated NKH in 51.4% and encephalitis in 26.4%.\"}]","The Dark side of the White Matter - Dark White Matter - systematic review | PDF",1792185401,23]