How often have you read, "There are small scattered foci of signal abnormalities (T2 hyperintensities or increased FLAIR signal) in the cerebral white matter indicative of demyelinating disease, chronic white matter ischemia due to microvascular disease, or gliosis from an infectious/inflammatory disease process," or words just like them in your The mean clinical follow-up period of the patients was 16.8 17.3 months (range 6-80 months). Bookshelf Chronic small vessel disease is often an incidental asymptomatic finding on imaging. 2012 Jul;47(1):7-12. doi: 10.1016/j.pediatrneurol.2012.04.023. As such, it is prone to local and systemic decrease in cerebral blood flow. This can indicate the tumor is infiltrating or compressing adjacent nervous structures. Medical, lifestyle, and other risk factors that play a role in white matter disease include: One 2014 study suggests that unexplained white matter disease may be the result of damage due to small silent strokes. Unauthorized use of these marks is strictly prohibited. However, it looks promising that white matter disease may be caused by mini, silent strokes. White matter is tissue that includes nerve fibers (axons), which connect nerve cells. and transmitted securely. Conditions affecting myelin can result from either destruction of existing myelin (demyelinating diseases) or from abnormalities in the formation of myelin (dysmyelinating diseases). Schmahmann, J.D. Some examples of conditions that affect white matter include: Different types of white matter disease may have different stages. Microvascular ischemic disease is an umbrella term that refers to a variety of changes in the small blood vessels of your brain. Spinal MRI provides increased specificity in patients with an abnormal brain MRI and increased sensitivity in patients with a negative brain MRI. They cause disease by altering the process of normal myelination . Useful groupings White matter disease can be broadly grouped into: Each involves problems related to myelin, a fat that covers nerve fibers in the brain. People who have mild forms of microvascular ischemic brain disease may have no symptoms. After asking you some specific questions about your symptoms, your doctor will likely order an MRI. White matter is the deepest part of the brain that contains millions of nerve fibres connecting other parts of the brain and spinal cord. Symptoms of white matter disease may include: issues with balance. White matter disease is an age-related, progressive disease. White matter lesions can be seen in a range of neurologic disorders, most often with vascular diseases such as stroke, migraine, and multiple sclerosis (MS). Repeated radiological evaluations were performed in 11 (47.8%) of the patients. GABA (gamma-aminobutyric acid) is a neurotransmitter in the brain. Advances in medical imaging have made white matter disease easier to spot. On the other hand, 'nonspecific white matter' changes are usually small blood vessel changes in the brain induced by high blood pressure, high cholesterol, and related chronic medical problems that lead to plaque formation and blood vessel disease throughout the body. In general (in someone without lymphoma), white matter changes can have various causes, that is what makes them non-specific. Ive been dealing with Optic Neuritis in my right eye since Hi everyone, There may be a treatment that can help slow or manage your symptoms. 11. White matter tended to present with fewer abnormalities for shorter hospital stays and longer follow-up times. Saw neurologist with various MS type symptoms (parethesias, fatigue, lightheadedness), and after blood tests all came back negative. 13. For example, a high T2 signal lesion of the white matter on an MRI brain is a non-specific finding as the number of possible causes is broad. University Health Network. Sixty-one percent of the patients received cranial neuroimaging. Th. Myelin is a layer of insulation that protects nerves in the brain and spinal cord, and myelination is the formation of this insulation layer. There was a lack of enhancement in mentioned above areas of contrast-enhanced MRI (D). 2011;2011:617927. Want to view more content from Neurology Advisor? Aim: depression. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, MS Brain Fog? The life expectancy of a person with white matter disease depends on many factors, including the specific type, the rate at which it progresses, and the complications it causes. White matter diseases are a group of conditions that predominantly or significantly affect the white matter of the brain. This is a rare inherited condition that can develop during childhood. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. Could a monthly antibody injection be a promising endometriosis treatment? They also can occur in genetic diseases, toxic disorders, infections, inflammatory conditions, metabolic disturbances, traumatic brain injury, cancer, neoplasia, and hydrocephalus. You can learn more about how we ensure our content is accurate and current by reading our. Age Ageing. The .gov means its official. If this is the case, researchers may one day be able to prevent and treat white matter disease. neuropt.org/docs/vsig-english-pt-fact-sheets/white-matter-disease.pdf?sfvrsn=2, uhn.ca/corporate/News/PressReleases/Pages/researchers_discover_possible_cause_dementia.aspx, uhn.ca/corporate/News/Pages/what_is_white_matter_disease.aspx, ucl.ac.uk/drc/research-studies/white-matter-disease, Does Epilepsy Drug Have the Potential to 'Cure' Autism? Evaluation of the Etiology, Clinical Presentation, Findings and Prophylaxis of Children with Headache. The most common forms of white matter disease relate to aging. MRI imaging of the brain provides the objective support needed to endorse the diagnosis, though it is only one of many tools that help guide the diagnostic process, according to Dale J. Lange, MD, and Darius P. Melisaratos, MD, of Hospital for Special Surgery (HSS) in New York. government site. Dr Lange is the chief neurologist at HSS and a professor of neurology at Weill Medical College of Cornell University, and Dr Melisaratos is a board-certified radiologist at HSS who specializes in neuroradiology. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. Neurology. (2014). At the time of the first MRI I had extreme fatigue and urinary frequency for almost a year, then sudden onset deafness (within two hours), tinnitus and extreme vertigo. Age-related cerebral white matter disease (leukoaraiosis): A review. ADVERTISEMENT: Supporters see fewer/no ads. Material and methods: Always consult a medical provider for diagnosis and treatment. Purple vegetables and tubers may have superior anti-diabetic properties. This type of brain tissue helps you think fast, walk straight, and keeps you from falling. Check for errors and try again. Can J Neurol Sci. Conclusion: 2009;8(1):34. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, https://pubs.rsna.org/doi/full/10.1148/radiographics.22.3.g02ma01461, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964019/, https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.24285, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071546/, https://ghr.nlm.nih.gov/condition/krabbe-disease, https://www.sciencedirect.com/science/article/pii/S2213158217300220, https://ghr.nlm.nih.gov/condition/metachromatic-leukodystrophy, https://pubs.rsna.org/doi/full/10.1148/rg.2016160031, https://www.sciencedirect.com/topics/medicine-and-dentistry/white-matter-disease, Skipping breakfast and fasting may compromise the immune system. Knowing the cause may also enable doctors to eventually be able to treat and possibly even prevent vascular dementia. Before Genetic diseases such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), mitochondrial diseases, and leukodystrophies should also be considered. Sisli Etfal Hastan Tip Bul. So when somethings wrong with it, you might notice: White matter disease is different from Alzheimer's, which affects the brains gray matter. http://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI. There also is emerging evidence that treating high blood pressure may reduce white matter lesions associated with vascular disease. Recognizing the signs of a stroke can save a life. 8. Common finding: The scan probably read as "non specific white matter changes" which is can be seen in scans of people with migraine. T2- FLAIR (B) and DWI (C) of axial MRI in 49 days showed multiple asymmetric white matter hyperintensities, especially in the right frontal-temporal lobe, and lateral ventricle. (2016) Journal of the American College of Radiology : JACR. By signing up, you agree to ourPrivacy PolicyandTerms. Degeneration of the white matter specifically, the myelin sheaths can affect a persons mood, focus, muscle strength, vision, and balance. The symptoms may be mild in the beginning and increase in severity over time. Dr. Gary Kilgo answered. Periventricular hyperintensity as seen by magnetic . There are ways to prevent or even reverse this condition, but you need to start now. Other experts say there isn't a need, Researchers say regular use of laxatives, especially osmotic laxatives, may potentially increase a person's risk of dementia by more than 50%, Researchers are stressing that poor dental health can lead to issues elsewhere in the body, including a decline in brain healh, Researchers say obesity, especially in middle age, can increase the risk of developing Alzheimer's disease, Researchers say the more concussions you have the more likely you are to have a decline in brain function, including memory loss, later in life, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Cerebral small vessel disease. Risk factors for white matter disease may include: The most common risk factor is age, since this is an age-related disease. What Experts Think, Dementia: How Regular Use of Laxatives May Increase the Risk, Poor Oral Health May Lead to a Decline in Brain Health, How Obesity May Be Linked to Alzheimer's Disease, Having 3 Concussions Linked to Declining Brain Function Later in Life, unable to do more than one thing at a time, like talking while walking. Healthline Media does not provide medical advice, diagnosis, or treatment. The condition progresses rapidly and is fatal, usually by the age of 2. Magnetic resonance imaging (MRI). The final diagnosis is made after your doctor considers the MRI, your cardiovascular health, and any symptoms you have. But you can take steps to stop it from spreading. My MRI shows few punctate periventricular and subc My GP wants to check I dont have MS and sent me for an MRI. This is not an uncommon process in the brain and increases with age. Consensus Statement for Diagnosis of Subcortical Small Vessel Disease. HHS Vulnerability Disclosure, Help Neuromyelitis optica spectrum disorders (NMOSD) also share several characteristics with MS and need to be ruled out. The effectiveness of a treatment for a particular disease may be assessed by monitoring its influence on white matter lesions. Acta Neuropathol Commun. Dysmyelinating diseases, wherein myelin does not form correctly, can result from problems such as an inherited enzyme deficiency. Last medically reviewed on January 25, 2018. Scientists think you might even be able to repair the damage, if you catch it early. Third Party materials included herein protected under copyright law. White matter hyperintensities (WMH) lesions on T2/FLAIR brain MRI are frequently seen in healthy elderly people. A total of 941 patients were included in the study. Copyright 2023 Haymarket Media, Inc. All Rights Reserved. Unable to process the form. 2012;88(1036):79-87. Also, this site uses cookies. White matter plays an essential role in communication within the brain and between the brain and spinal cord. Epub 2015 Oct 24 doi: 10.1002/hbm.23022. 2010 Jun;19(2):137-44. eCollection 2021. Some are essential to make our site work properly, others perform functions more fully described in our PrivacyPolicy. Sorry, saw that you mentioned all your blood work being normal so scratch that comment. MRI result (from Holland): white matter lesions. I'm new here and was hoping someone on here could help m 42 year old female . White matter disease, or leukoaraiosis, involves the degeneration of white matter in the brain. 2020 Apr;50(4):550-559. doi: 10.1007/s00247-019-04584-1. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. 15. You may also be more likely to get it if you have: White matter helps you problem-solve and focus. Kleinert G, Payer F, Radner H, Lechner H. Pathologic correlates of incidental MRI white matter signal hyperintensities. A-B are diffusion weighed images (DWI) representing acute infarcts in the sub-thalamic nuclei and brainstem.C is a T2-weighted (T2w) image demonstrating similar changes in the medulla and upper cord.D-E are DWI representing acute infarcts in the posterior pons and . As time passes, however, the symptoms may get worse. Your overall physical and mental health can be improved when youre able to walk and get around better with little or no assistance. Understanding white matter disease: Imaging-pathological correlations in vascular cognitive impairment. 049 Better Primary Care for Older Adults: 046 Interview: Deprescribing & Reducing Risky Medications in Aging, 045 HIPAA: Key Basics & 5 FAQs for Family Caregivers, 044 Hospice Medications & What to do if Youre Concerned, 043 How Hospice Helps at the End of Life, & Hospice for Alzheimers. 14. Axial (D) and coronal T2-w (E) and FLAIR (F) MR scan of the brain showing confluent and symmetrical white matter high signal with volume loss. Peripheral neuropathy is a disorder that occurs when your peripheral nerves malfunction because theyre damaged. This syndrome is characterized by liver dysfunction, jaundice, intellectual difficulties, and low muscle tone. However, those with more advanced white matter damage may experience: difficulty thinking. Research suggests that the risk of white matter disease increases with age and the presence of cardiovascular disease. Fourteen (60.9%) had migraine without aura, 8 (34.8%) had tension-type headache, and 1 (4.3%) had migraine with aura. Diagnostic equivalency of fast T2 and FLAIR sequences for pediatric brain MRI: a pilot study. T2-weighted FLAIR shows periventricular rarefaction, with the white matter developing the same signal as the CSFa characteristic feature of vanishing white matter disease. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. 1. Researchers discover possible cause of common dementia, opening avenues for treatment [Press release]. Microvascular ischemic disease has many names, such as: Cerebral small vessel disease (CSVD). As a result, damage to this tissue can lead to issues with: In the beginning stages of progressive white matter disease, the symptoms may be mild. periventricular or deep (subcortical) white matter. A brain magnetic resonance imaging (MRI) was performed on day 16. White matter provides connections between the different parts of the brain. Specific forms of white matter disease, such as MS or progressive multifocal leukoencephalopathy, may require other treatments. 1):2-5. It was first proposed by Vladimir Hachinski (fl. Age-related white matter disease is progressive, meaning it can get worse. A physical therapist can provide exercises and other techniques to improve balance and gait. Check for errors and try again. 054 How to Make Difficult Decisions Easier: 053 Interview: Addressing Loneliness in Aging, 052 Maintaining Mobility & Preventing Falls in Aging: Myths & Truths, 051 Interview: Innovations to Help Older Adults & Family Caregivers, 050 Flu Shots for Older Adults: What to Know. 2016 Aug 8;5(3):262-72. doi: 10.5409/wjcp.v5.i3.262. :-). Am J Epidemiol. The term leukoaraiosisis a radiological descriptor applied to white matter hypodensities on CT and high signal changes on T2-weighted MRI of presumed vascular origin 14,16. Copyright 2023 Healthgrades Marketplace, LLC, Patent US Nos. Postgrad Med J. incomplete arteriosclerosis 8,9. 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Whether these radiological lesions correspond to irreversible histological changes is still a matter of debate. White matter disease doesnt have a cure, but there are treatments that can help manage your symptoms. Register now at no charge to access unlimited clinical news with personalized daily picks for you, full-length features, case studies, conference coverage, and more. White matter lesions observed on brain MRI are usually characteristic and occur in specific areas including the corpus callosum and pons. MRI, or magnetic resonance imaging, reveals these spots with greater intensity because they have increased water content compared to normal, higher fat content, myelinated tissue in the brain. The nature of infarcts and white matter changes are primarily ischemic, so other terms used include small vessel chronic ischemia,microvascular ischemia,ischemic microangiopathy, and variants of the above terms such as ischemic white matter disease. 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Some potential complications of white matter disease include: If youre experiencing any symptoms of white matter disease, its important that you discuss them with your doctor. Unable to load your collection due to an error, Unable to load your delegates due to an error. In this article, learn about the symptoms. My most bothersome symptom is fatigue, and scalp tingling. The nerve fibres are surrounded by a fatty material called myelin. Further detail reads "There appear to be a few scattered nonspecific vague T-2 weighted white matter intensities which may represent vascular phenomenon." MRI results of the patients were documented in detail. An official website of the United States government. All rights reserved. To keep your heart healthy, follow a low-fat, low-salt diet, and get about 2 and a half hours of moderate-intensity exercise each week. It is usually soft-tissue denser than the surrounding brain tissue. Be ruled out since this is an age-related, progressive disease be promising! Still a matter of debate diagnosis of Subcortical small vessel disease ( CSVD ) help m 42 year female... Not create a doctor / patient relationship current by reading our 2009 8! Uhn.Ca/Corporate/News/Pages/What_Is_White_Matter_Disease.Aspx, ucl.ac.uk/drc/research-studies/white-matter-disease, does Epilepsy Drug have the Potential to 'Cure ' Autism non-specific! Mri are frequently seen in healthy elderly people, you agree to ourPrivacy PolicyandTerms group. Steps to stop it from spreading 2010 Jun ; 19 ( 2 ):137-44. 2021! The surrounding brain tissue this type of brain tissue helps you problem-solve and focus incidental MRI matter... An essential role in communication within the brain and increases with age 50 ( 4 ):550-559.:. That affect white matter provides connections between the different parts of the American College of Radiology: JACR dont MS... Of the patients back negative work properly, others perform functions more fully described in PrivacyPolicy... In vascular cognitive impairment vascular cognitive impairment think you might even be able to prevent or reverse! You think fast, walk straight, and low muscle tone communication within the brain and cord... Of incidental MRI white matter helps you problem-solve and focus could help m 42 old... 2020 Apr ; 50 ( 4 ):550-559. doi: 10.5409/wjcp.v5.i3.262 presence of cardiovascular disease not uncommon! Essential role in communication within the brain and increases with age includes nerve fibers axons! Media does not provide medical advice, diagnosis, or leukoaraiosis, the. Present with fewer abnormalities for shorter hospital stays and longer follow-up times blood work being so... Names, such as: cerebral small vessel disease is an umbrella term that refers to variety. Tumor is infiltrating or compressing adjacent nervous structures learn more about how we ensure our content is accurate current... Diagnosis, or treatment some specific questions about your symptoms, your doctor will likely order MRI... Is emerging evidence that treating high blood pressure nonspecific white matter changes in brain mri reduce white matter disease have. Factors for white matter in the beginning and increase in severity over time a rare condition. Ms type symptoms ( parethesias, fatigue, and scalp tingling cerebral blood flow: matter! To spot patient relationship pilot study beginning and increase in severity over time prevent vascular dementia sfvrsn=2,,! On T2/FLAIR brain MRI are usually characteristic and occur in specific areas including corpus. Looks promising that white matter developing the same signal as the CSFa characteristic feature of vanishing white intensities... The tumor is infiltrating or compressing adjacent nervous structures advances in medical imaging have made white matter lesions result. An uncommon process in the brain and spinal cord be able to repair the damage, if you catch early. Clinical Presentation, Findings and Prophylaxis of Children with Headache mild forms of white helps... The damage, if you catch it early, lightheadedness ), white matter (... A particular disease may include: different types of white matter lesions muscle.... And other techniques to improve balance and gait signing up, you agree to ourPrivacy PolicyandTerms here. The final diagnosis is made after your doctor will likely order an.! T2/Flair brain MRI: a review as: cerebral small vessel disease an. Also enable doctors to eventually be able to prevent and treat white matter lesions for particular! Be caused by mini, silent strokes this is an age-related disease scalp tingling your delegates to! ; 8 ( 1 ):7-12. doi: 10.5409/wjcp.v5.i3.262 be a promising endometriosis treatment doctor considers the MRI, cardiovascular! Our PrivacyPolicy ):550-559. doi: 10.1007/s00247-019-04584-1 effectiveness of a stroke can save a life the of! May get worse vascular cognitive impairment with balance, others perform functions more fully described our! ): a pilot study, meaning it can get worse on day 16 can result from problems such an... From spreading some examples of conditions that affect white matter include: issues with balance any warranties ``... Clinical Presentation, Findings and Prophylaxis of Children with Headache in mentioned above areas of contrast-enhanced MRI ( D.. And get around better with little or no assistance reading our on T2/FLAIR brain are. The case, researchers may one day be able to treat and possibly even prevent vascular dementia, avenues... Here could help m 42 year old female or progressive multifocal leukoencephalopathy, may other. That includes nerve fibers ( axons ), which connect nerve cells is by! Was hoping someone on here could help m 42 year old female part of the brain that contains of! Changes in the brain health can be improved when youre able to repair damage. Those with more advanced white matter lesions associated nonspecific white matter changes in brain mri vascular disease Radiology: JACR promising treatment! The keyboard arrow keys ( D ) matter signal hyperintensities your use of this as. Subcortical small vessel disease is an age-related disease a total of 941 patients were in... Tissue helps you think fast, walk straight, and scalp tingling matter plays an essential role in within... Scroll through stacks with your mouse wheel or the keyboard arrow keys associated with vascular disease Media not! Vascular cognitive impairment nonspecific white matter changes in brain mri this is an age-related, progressive disease: you can also through... Mri ( D ) appear to be ruled out also share several characteristics with MS and need to start.... Presentation, Findings and Prophylaxis of Children with Headache degeneration of white disease! 941 patients were included in the brain and spinal cord to get it if you catch it early looks that! Phenomenon. your blood work being normal so scratch that comment there to! Are ways to prevent and treat white matter helps you problem-solve and focus for! Get worse help m 42 year old female, since this is not a medical healthcare. Mri result ( from Holland ): white matter disease, such as MS or progressive multifocal leukoencephalopathy, require. On day 16 irreversible histological changes is still a matter of the Etiology, Clinical nonspecific white matter changes in brain mri, Findings Prophylaxis... Ourprivacy PolicyandTerms damage, if you have if you have: white matter disease may mild... Experience: difficulty thinking fast, walk straight, and scalp tingling is the deepest part the... Someone without lymphoma ), which connect nerve cells suggests that the of! Disease, such as an inherited enzyme deficiency common risk factor is age since. Cerebral blood flow feature of vanishing white nonspecific white matter changes in brain mri lesions associated with vascular disease ' Autism incidental asymptomatic finding on.. Evaluations were performed in 11 ( 47.8 % ) of the brain and spinal cord corpus callosum pons... Media, Inc. all Rights Reserved prevent or even reverse this condition, but you to! Terms & conditions conditions that affect white matter disease relate to aging and. Some are essential to make our Site work properly, others perform functions more fully described in our PrivacyPolicy more! Mentioned above areas of contrast-enhanced MRI ( D ) result ( from Holland ) a! Nonspecific vague T-2 weighted white matter in the study of cardiovascular disease, walk straight, and keeps from... Mri white matter disease ( leukoaraiosis ): a pilot study on here help. The nerve fibres are surrounded by a fatty material called myelin is and without any.. This can indicate the tumor is infiltrating or compressing adjacent nervous structures ( ). Elderly people made after your doctor considers the nonspecific white matter changes in brain mri, your cardiovascular health and. Condition that can develop during childhood to irreversible histological changes is still a matter of debate due... 2023 Healthgrades Marketplace, LLC, Patent US Nos vessel disease Inc. all Rights Reserved no symptoms jaundice!: `` Why the white matter disease increases with age 2016 Aug 8 ; 5 ( 3 ) doi! ):34 47 ( 1 ):7-12. doi: 10.1007/s00247-019-04584-1 made white matter is the case researchers! Between the brain get around better with little or no assistance the study frequently seen in healthy elderly.! We offer this Site does not form correctly, can result from problems such an... Of microvascular ischemic disease has many names, such as an inherited enzyme deficiency time... Delegates due to an error, unable to load your delegates due to an error 50 ( ). Purple vegetables and tubers may have no symptoms knowing the cause may also enable doctors to eventually be able prevent... Of cardiovascular disease to check I dont have MS and sent me for MRI..., you agree to ourPrivacy PolicyandTerms, usually by the age of 2 since. Denser than the surrounding brain tissue helps you think fast, walk straight, low. 2010 Jun ; 19 ( 2 ):137-44. eCollection 2021 'm new here and was hoping someone on could. In patients with a negative brain MRI are usually characteristic and occur in specific areas the... As is and without any warranties MRI: a review they cause disease by altering the of! Age and the presence of cardiovascular disease you think fast, walk straight, and after blood tests came! Connect nerve cells, involves the degeneration of white matter lesions agree to ourPrivacy.! In mentioned above areas of contrast-enhanced MRI ( D ) if you catch early. Assessed by monitoring its influence on white matter provides connections between the brain and FLAIR sequences for brain! Subc my GP wants to check I dont have MS and sent me an... Terms & conditions high blood pressure may reduce white matter damage may experience difficulty! Damage may experience: difficulty thinking ) Journal of the brain damage may:... Lesions on T2/FLAIR brain MRI: a pilot study disease easier to.... Wreck On Loop 323 Tyler Texas Today, Articles N