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There are two types of ischemic white matter lesions: Lesions involving the watershed distribution of the major brain arteries Lesions caused by intrinsic disease of the small penetrating medullary arteries (arteriolar sclerosis) Enlargement of these perivascular spaces with age and hypertension, associated with thinning, pallor and atrophy of the adjacent myelin, is called état criblé Diffuse axonal shearing caused by acceleration, decel- eration, and rotation forces on the brain E.

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