Neuroradiological alterations in patients with chronic hypoxia is an area yet to be explored. The purpose of our study was to evaluate the possibility of changes in cerebral magnetic resonance imaging (MRI) secondary to chronic hypoxia. Using healthy persons as control subjects, we studied the MRI findings associated with chronic pulmonary disease. The presence of high-signal areas in cerebral white matter was investigated in patients with hypoxia due to chronic stable pulmonary disease (41 obstructive, three restrictive and six with a mixed pattern) and in 50 control subjects. We recorded the gasometric (Pa_o2 Pa_co2; pH and CO₃H) and spirometric parameters (forced vital capacity [FVC], forced expiratory volume in 1/s [FEV₁], and analytical data for erythrocytes, platelets, hemoglobin and hematocrit in the patients and the vascular risk factors in patients and controls. The findings of the MRI were classified into five groups according to the number and extension of the lesions (0, no lesions; I, isolated spotted lesions; II, more than 10 spotted lesions; III, partially confluent lesions; and IV, bilateral confluent lesions). Vascular risk factors other than respiratory disease were detected in 42% of the patients and 48% of the controls (p > 0.05). Patients with chronic hypoxia showed a higher number and extension of high-signal areas in cerebral white matter (94% in patients as compared to 38% in the control group, p > 0.001). The presence of this lesions on MRI was related only to age (OR 1.2; 95% confidence interval, 1.17–1.41; p = 0.008) and intensity of hypoxia (OR-0.08; 95 % confidence interval, 0.026 0.086; p = 0.031), but was independent of the duration of illness, hypercapnia and hematocrit. In conclusion, the association between chronic pulmonary disease and the occurrence of high-signal areas on the MRI in white matter was demonstrated in our patients.