The Fazekas scale is used to simply quantify the severity of white matter damage typically attributed to obstruction of small blood vessels.

This classification was proposed by Fazekas  et al. in 1987.

The Fazekas scale is a widely used method for grading the severity of white matter hyperintensities (WMHs) seen on brain MRI. It is commonly used in the context of aging and cerebrovascular disease to assess small vessel disease and its potential impact on cognitive and motor functions.

Small vessel disease (SVD) is a condition that affects the small blood vessels in the brain, including arterioles, capillaries, and venules. It highly contributes to vascular brain injury and is closely associated with aging and certain risk factors such as hypertension and diabetes.

SVD leads to structural and functional changes in the brain’s vasculature, which can cause damage to the surrounding brain tissue. The condition is often identified through neuroimaging findings, including white matter hyperintensities (WMHs), lacunar infarcts, microbleeds, and cerebral atrophy.

Classification of Fazekas scale

The Fazekas scale divides white matter into periventricular and deep white matter, and each region is scored based on the size of the lesions. 

• periventricular white matter
  • 0 = absent
  • 1 = lesion as thin as a pencil
  • 2 = smooth « halo »
  • 3 = irregular periventricular signal extending into deep white matter
• deep white matter
  • 0 = absent
  • 1 = outbreaks
  • 2 = onset of confluence (fusion of lesions)
  • 3 = large areas of confluence

The deep white matter component score, which identifies ischemia in small vessels, is useful in the assessment of patients with possible dementia (eg, Fazekas grade 2).