White matter lesions on MRI–a question and some answers

I thank one of my readers Sandy for writing in.  Sandy asks some important questions. As a lot of you may be dealing with some of the same issues as her, I am reproducing her question here. My answers to her query follow.

Again thank you Sandy for writing in.

Sandy

Dear Dr.

In june I experienced some very unusual headaches that felt think electrical shocks throughout my head. One night I experienced the worst headache of my life in my forehead only. It lasted all night and in the morning it was better; however I experienced dizziness and if I bent over a swell of pain would radiate through my head. A week later I experienced an eye problem and was told that it was uveitis. Because uveitis can be caused by a virus or autoimmune problem, I immediately began testing for an autoimmune problem. During this testing I continued to experiece overall nerve pain in by head (forehead, temple, back of head) as well as neck pain, should nerve pain through fingers, neck, ankels), joint & chest pain. The only positive test result showed a high ANA test of 1:640 but all other blood tests(c-reactive protein, RF, Sed Rad, SM etc..) were normal. I also had an MRI and the radiologist noted several tiny foci white matter in the frontal lobe area. He indicated that it is may or may not be of clinical significane but could be small vessel ischemia disease or possible dymlienation. I wonder if there is a correlation to the several headache I had in my forehead with the MRI results. My neurologist initially said I had occpital headaches and is normally caused by a pinched nerve; but after receiving this MRI, I don’t think he has it right. I feel the headaches and vision problems along with the other symtoms correlate together. Should I be concerned about this MRI. I don’t feel that this is MS because I’m not having muscular/walking issues; but greatly concerned that if these headaches continue, cognitive problems could occur. Your opinion would be greatly appreciated.

From MRI white matter lesions: does it represent MS?, 2008/09/26 at 2:24 PM

 

Dear Sandy,

                      thank you for writing in. Your case history is intriguing, since I do not have all the details my assessment is severly limited.  I can though tell you that white matter lesions are commonly seen when patients undergo a MRI study of the brain. Some of the times these white matter lesions (also referred to as white matter hyperintensities (WMH), this is because they appear as bright white spots on the MRI) are incidental findings and may have nothing to do with the reason the MRI was done in the first place. Let me explain. Lets assume you come to see me since you have being lately experiencing headaches. I order an MRI because I want to rule out a brain tumor. MRI result comes back. There is no brain tumor but incidentally note is made of several scattered white matter hyperintense lesions. Likely in the case I describe above, the WMHs are incidental findings and not the cause of the patient’s severe headaches.

So what do these white matter lesions represent? Many diseases can cause white matter lesions in the brain MRI.  One of the diseases usually mentioned in MRI reports is multiple sclerosis. Patients rightly get scared that they may have MS. While multiple sclerosis is characterized by white matter lesions (we call them plaques in the case of MS) which are scattered in the brain, I want to re-emphasize that not all white matter lesions represent MS (see my website for more details http://braindiseases.info). In the case of MS, the plaques are scattered in the brain in a particular way. Moreover if you do not have any signs or symptoms of MS (your examination is normal), more than likely the white matter lesions do not represent MS. The diagnosis of MS is clinical, at times supplemented by tests like MRI brain, CSF/ spinal fluid examination and evoked potentials.

A lot of work has been done to determine the significance of white matter lesions. The thinking now is that they represent ischemia (lack of blood flow) in the small blood vessels of the brain. Hence they are also at times referred to as ischemic small vessel disease. Hence these lesions are more commonly seen in the MRI of patients who have cerebrovascular risk factors like hypertension, diabetes and high cholesterol as well those that smoke. Their incidence increases as we age (meaning you are more likely to see them on the MRI of someone who is 60 and above rather than someone who is in his 20′s).

They have been reported in the MRI of patients who suffer for migraine. The reason they are more commonly seen in migraine patients is again not fully elucidated but the thinking is that migraine is due to vascular causes and hence WMHs are more common in these patients.

While I cannot comment of your case in particular, you have a positive ANA though rest of the autoimmune markers are negative and your ESR is low. I would rule out the usual suspects, vasculitis though remains in the differential and it would be reasonable to make sure you do not have any underlying vasculitic etiology.

Your last question is important. Though there is no direct correlation between the extent of WMHs in the brain and the development of cognitive decline, as I stated earlier they become more common as we age. People who have extensive white matter disease in their MRI frequently do exhibit cognitive deficts when carefully tested for. Whether this represents a form of vascular dementia is not clear.

I would advise you to follow with your PMD and neurologist. They would be the best people to guide further diagnostic workup and treatment.

Personal Regards,

Nitin Sethi, MD

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89 thoughts on “White matter lesions on MRI–a question and some answers

  1. Dr. Sethi,

    Your response to S’s inquiry about white matter lesions, which were shown on her MRI results, was very educational. I’ve worked with medical imaging centers for a number of years so am always interested in learning about specific cases as well as advancements in the imaging field.

  2. Hi
    I have a single white matter lesion in the right pons. I presented to the neurologist with a servere right sided headache when they found the lesion. Intially the neuro suggested MS, but no other real clinical signs and the lesion did not enhance. The neuro seemed unconcerned and suggested we see how things go and. I have since developed double vision and the opthalmic surgeon suggested adult squint. I also have continual pain and occipital neuralgia. MRI over last 1.5 years shows no change in the lesion, however I have noticed other symptoms as follows…. One pupil larger than other in dim light, muscle aches and pains, fatigue and more recently extreme itching all over. I have a history of depression and cervical arthritis. I am 40 years old and I smoke and drink. I have still no definate diagnosis after various tests that showed EVPs normal etc etc. I am just looking for somw answers as I have now been told to have a follow up scan in 6 months. All very scary.
    Can you help.?

    • Dear Rebekar,
      thank you for writing in. Unfortunately I cannot help you with your specific question since I have neither your complete history, nor have examined you and finally have not seen your scans myself. What I can tell you though is sometimes we find lesions in the pons on patient’s MRI whose etiology cannot be determined outright. One is not sure what the lesion represents: is it a slow growing tumor? is it a vascular lesion? is it a benign lesion or finally is it a plaque of demyelination?
      In cases like these other tests are run in an attempt to determine the etiology of the lesion. As the lesion is in the pons, a blind attempt at getting to it surgically at times is ill-advised (the pons is a very important part of the brain-stem and one has to be exceptionally careful in approaching it surgically). So sometimes we doctors may advise watchful waiting (meaning keeping the patient in close follow up and following the lesion with serial MRI scans). Depending upon how the lesion behaves, we can alter our management approach.
      My advise to you would be to follow what your doctors tell you, they shall be the best people to guide you through this.

      Personal Regards,
      Nitin Sethi, MD

  3. Dear Dr.

    Last year I had numbness in the left part of my head and face. I did an MRI and it showed 20 foci. They were located within the frontal lobes,parietal lobes, occipital lobes, right temporal lobes and right cerebellar hemisphere and bilateral middle cerebellar peduncles. Largest of these lesions was present within the right middle temporal gyrus and right inferior cerebellum and measuring about 6mm unit in size. This was what I read in the report. After near one year and a half, I felt tingling in right part of my face and my fingers.Now I’m getting better after 2 weeks. It’s worth mentioning that I have a weak migraine and lack of iron in my blood .I met both of these symptoms after a high level of stress. Anxiety is a great problem that usually brings these types of symptoms to me. Do you think these
    white matter lesions show MS?!

    Thanks

  4. Dear Sara,
    thank you for writing in. I again want to emphasize that not all white matter lesions on brain MRI signify multiple sclerosis.
    Talk to your doctor about your concerns. He or she shall be the best person to decide whether you need further work-up for multiple sclerosis.

    Personal Regards,
    Nitin Sethi, MD

  5. hello,
    my daughter was born with klippel trenaunay syndrome…a rare vascular/lymphatic
    condition.
    In addition to a large part of her body, it affects 1/2 of her brain
    causing hemihypertrophy of that side.
    She also suffers from daily migraines.
    SHe had a ct scan about four years ago and it showed a few areas
    of white matter hyperintense lesions in what was reffered to as”non consequential
    areas.”
    This past week she had an mri and we were told that it showed white matter
    disease of a thiry or forty year old.
    My daughter is 23.
    What does that mean…white matter disease that is that of a thiry to forty year old?
    thank you,

    • Dear Mon Sinci,
      I cannot comment on your daughter’s case in particular. White matter disease on MRI scan usually refers to changes in the small vessels of the brain (small arteries and other vessels showing microvascular changes). In your daughter’s case it is slightly more complicated because she has Klippel-Trenaunay syndrome (KTS) a congenital circulatory disorder characterized by hemangiomas and abnormal arteriovenous connections.

      Personal Regards,
      Nitin Sethi, MD

  6. hello….
    im a 35yr old epileptic w/a new neurologist, a new diagnosis & potentially disturbing mri results. since 1999 i have been told that i have a generalized tonic-clonic seizures (think i got that right) and that the frequent body tremors & “blackouts” that i used to get were a result. so after 10 yrs; 7 grand-mals, 5 different med changes and a slue of normal eeg’s, i had a weird unexplained loss of time in dec. so i decided to go see a new dr. she gave me a full work up and sent me to get an mri and a new eeg. she was looking for something other than epilepsy that might have caused an episode in dec. as well as explain the tremors i still experience- while faithfully taking two anti-convultents per day. i have not recieved the results of the eeg yet (although the tech said i did have a seizure and that even though my apparent post ictal state did not present any of the symptoms i would usually exhibit my seizures might be changing) but i did get the results of the mri. my neurologist said the mri presented with multiple white spots which she said was normal? what are white spots? and what the hell does it mean my seizures are changing? and my neurologist now says i have juvenile myoclonic seizure disorder…

  7. Dear JT,
    thank you for writing in. I understand your frustration. While I rather not comment on your case in particular, “white spots” on MRI can be seen in a variety of conditions and may or may not be related to your seizure disorder.
    Seizures may change during a patient’s lifetime (by change I mean, their character and clinical presentation). Juvenile Myoclonic Epilepsy is a well recognized seizure syndrome which starts in the early teens and is characterized by multiplicity of seizure types (meaning patients have different types of seizures: they may have “big” seizures or the grand mal convulsions, myoclonic jerks (sudden shock like jerks which occur in the early hours of the morning after waking up) and absence seizures (seizures in which patients stare). A well performed EEG which is done in the awake as well as asleep states shall aid in establishing your diagnosis.

    Personal Regards,
    Nitin Sethi, MD

  8. My son who is 38 years old has been hospitalized 3 times now since his return from Iraq. He is, as I write in a hospital in Oklahoma.

    They don’t know what’s causing his problems at this point, other then he has swelling on his brain stem, which is causing major (severe) headaches, dizziness and very blurred vision. Originally his MRI’s showed swelling of his brain stem with multiple lesions on it. The MRI’s and CT scans they have done in the last couple of days show even more lesions on his brain stem then before, along with lesions on his white matter. None of us know what to expect at this point. There are numerous soldiers (14 that we know of just in Missouri) that are suffering from the same or very similiar things. There are many ongoing studies relating it to the massive burn pits in Iraq and the toxic fumes emitted from them (burning medical supplies, body parts, etc etc).

    He has reached a point where the headaches are excruciating, his balance and dizziness get so bad he can not walk on his own. To say we are scared is putting it mildly!

    Can you offer any insight or suggestions of what we might expect with this?

    • Dear Bobbi,
      thank you for writing in. I am sorry to hear about your son. It must be indeed difficult times for your family. As like other Americans, I thank your son for his service to this nation. It is a debt that is indeed difficult to repay.
      I am afraid I cannot give you an answer to what plagues your son. The fact you mention that he has swelling in the brainstem may mean many things. Toxic, metabolic and infectious causes need to be ruled out in a systemic manner. At the same time while the work-up is in progress, he needs to be supported and symptomatic treatment needs to be administered. What is the cause of his severe headaches needs to be determined. Is it because of increased pressure in the brain? Is it because of blockage in the flow of spinal fluid?
      I am sure he is in capable hands and his doctors shall be able to figure it out. If I can be of any help with a specific question, please do not hesitate to write in again. Again I wish him my very best.

      Personal Regards,
      Nitin Sethi, MD

  9. Hi Dr. Sethi,

    I am 29 years old female with otherwise healthylife. Since a month I feel strange in my limbs, like heaviness at times, weakness at times, my coordination is normal, my reflexes are normal, my sensations are normal, grip is normal. I got an MRI done and my report says “On the axial and sagittal FLAIR images and on the axial T2 weighted images, note is made of approximately 8 x 4 mm focal oval area of abnormally increased T2 signal in the periventricular white matter adjoining the anterior hom of the left lateral ventricle. Additional, approximately 4 mm focal area of abnormally increased T2 signal is noted in the left anterior callosal and pericallosal region on sagittal images # 309 and #310 on series 15. There are at least two approximately 2 mm size foci of increased subcortical white matter signal noted in the right frontal lobe on image #232 series 12 and 3-3 mm focal area of subcortical increased signal noted in the left frontal region on image #233 series 12. On the postcontrast study, there is no enhancing lesion demonstrated. The white matter changes are nonspecific and at the patient’s age group, may be related to demyelinating disease, migraine, vasculitis, Lyme disease or may be secondary to previous nonhemorrhagic contusion and white matter gliosis. Clinical correlation and followup is recommended.”

    can you kindly review this report and let me know it is definative of some demyelinating disease or is there a likelyhood that it could be artefacts. since I have seen this reort I am unable to judge my symptoms as I am focusing a lot on them.

    can you please guide

    • Dear Minal,
      thank you for writing in. As I explain in my post, not all white matter lesions on a MRI of a brain are suggestive of or represent multiple sclerosis. I again want to re-emphasize that the diagnosis of MS is made on the basis of clinical history of previous attacks, CSF (spinal fluid) examination and MRI, not just on the basis of the MRI alone. Also there are certain criteria which have to be satisfied on MRI to make a definite diagnosis of MS. These radiological criteria for MS include the number of lesions on the MRI, their location and their size.

      Thus it is important to remember that a person who is noted to have white matter lesions on a brain MRI does not necessarily have MS. White matter lesions can be seen in numerous other conditions and they are more commonly seen as we grow older. The thinking behind this is that they represent microvascular ischemic changes in the brain (the smaller caliber blood vessels in the brain showing signs of ischemia or decreased blood flow). Hence these white matter abnormalities on MRI are more commonly seen in patients who have microvascular and macrovascular risk factors such as a history of hypertension, diabetes and high cholesterol (dyslipidemia/ bad lipid profile).

      White matter signal changes on MRI may also be seen in patients who have infectious and other inflammatory conditions. They have been reported in the MRI of patients with a history of migraine headaches (migraine too is a vascular disorder and that may explain the connection).

      So it goes without saying that the presence of these white matter signal changes on brain MRI has to be correlated to the history, clinical examination and other ancillary investigations.

      I recently answered a question quite similar to yours on the MS health portal website. Here is the link. I think you shall find it useful information.

      http://www.healthcentral.com/multiple-sclerosis/c/73302/63664/answers

      My advise to you would be to follow up with your doctor. He may send you to a neurologist for an opinion. A good history and examination will help determine if the lesions seen on the MRI scan of the brain have any connection with your current symptomatology (the reason for which the MRI was done in the first place).

      Personal Regards,
      Nitin Sethi, MD

  10. Hello my husband was in Iraq about one year ago and he was constantly out on missions that had IED blowing up all the time and hitting his vehicle. Although he didn’t have any external issues he is suffering internally. He has since had major headaches, his blood pressure is high and his attention span and tolerance level are extremely low. He has PTSD and he also just had an MRI done because of the headaches. His results are as follows (his has the results now but due to no availability can’t see the doctor for them to read it to him until the end of the month):
    Ventricles, cisterns, and sulci are normal in size and configuration. There are a few tiny foci of increased FLAIR signal in subcortical and deep white matter of both frontal lobes, nonspecific findings. No abnormal fluid collection, mass, hemorrhage, or enhancement. Central vascular signal voids and bone and soft tissues are unremarkable. IMPRESSION: Nonspecific bifrontal white matter signal changes.
    Is there anyway that you can briefly give me your take on this finding?

    • Dear Barb,
      thank you for writing in. The MRI findings you mention are quite non-specific and likely are not related to or the cause of your husband’s severe headaches (but it is the doctor who saw your husband and ordered the MRI who shall be the best to determine if there is any correlation between the MRI findings and his headaches). If no structural cause of the headaches is found (meaning no lesion in the brain) and other causes such as high blood pressure are ruled out, then we refer to the headache as a primary headache disorder. The doctor may then elect to treat your husband with medications to alleviate the pain.
      Please feel free to write in again. I thank your husband for his service to our country and wish him a speedy recovery.
      Personal Regards,
      Nitin Sethi, MD

  11. Hi Mr. Sethi,
    I do like the way you help people on the net from all around the world.So I thought maybe at least you can comment on our case too.

    We live in Turkey, and my wife is 35 years old.Our story begun about 2 months ago with a terrible headache.We went to a neurologist, and after we have told her the story, she requested a brain MRI.We got the results almost 15 days later, and the radiologists have only indicated an ependimal 1cmx1cm cyst in left hypocampus, which was most probably morphed during the birth process.The brain MRI stated no other thing such as white matters or something else.During this time we had an Xray of the neck, which showed a Cervical lordosis.Then after this Xray, our doctor requested a Cervical MRI to see what is happening.Also there was no white matter in this Cervical MRI, but there was almost a full Cervical Lordosis.During this period, my wife was experiencing headaches which were mostly felt in the left top of the head.She was also having some pain mostly on left shoulder.She was having some kind of anxiety problems also, which we have thought was because of Cervical Lordosis .She went to a psyciatrist for these anxiety and the psyciatrist gave her an antidepresant.After 1 week , this numbness with consciousness begun to catch more severely,especially at evenings.And almost for a week, my wife can barely speak, can speak very slowly, and can speak normal very rarely.We have seen almost 3 neurologs in Emergency centers of several hospitals in 1 week.She shows the symptoms of MS and Miyasthenia Gravis.Her right eye is slightly narrowed.But there is no loss of vision in the eye.And her chin has fatigue while eating something.She also has difficulty swallowing sometime, but the worst of all is her speaking slowly, as if she cant move her tongue.And she always tells me there is something on the upper left of her head above her eye, waiting for to come.And when it comes (she calls it something like a fog but her consciousness is always full, no blockouts), she can only speak very slowly and she has fatigue, she can breath hardly, she can walk very slowly, and so on.

    3 neurologs made some 10 minute physical diagnosis at the emergency clinic, and they said al sysmptoms show psychiatric case.Also after a brain and a cervical MRI, 3 days ago we had a CT in Emergency to check for the cyst in left hypocampus and doc said everything was clear, nothing to worry.I also asked him whether it could be MS or MG(miyasthenia Gravis) but he said no.

    So finally we went to see a psychiatrist, and he told us to give up the antidepressant we use, and he gave some other thing called Diazem, he told us to use it for 5 days and go and see him again.We will go to see him next Monday, so here are my questions if you can comment.

    1) There are no MS Plaques neither in Brain MRI nor in Cervical MRI.Do I need to make a further diagnosis for this MS issue?
    2) Can it be MG ? Why do you think they insistingly tell it is psychitaric?
    3) What other thing can it be? Can it really be because of stress? (Until this slow talking issue, I was also thinking it may be psychiatric but this slow speaking really makes me afraid)

    Please comment on this subject, because here in Turkey, it is really hard to get good health service if you dont have much money.I am eager to let you know about any further info you could need to know to comment.

    Very best regards…
    C

  12. Hi Dr. Sethi,

    it is extremely great to know that people like you are around to support needy ones like us. I wish to bring to your attention my history and take your expert opinion on the same. I have calf muscle weekness since like 2-3 wks now. my biological sister just got detected with MS three wks back. since she was detected with MS and I have muscle weekness on both my calves with my MRI saying “some small T2 hyperintensities in left periventricular white matter. on sagittal flair image these appear to have perpendicular orientation with corpus callosum. these are non specific but may be consistent with MS paques”.My cerival spine and throracic spine MRI is normal. my neurologist says there is just one plaque which seems like positive for MS but she does not want to rush to the diagnosis before getting the reports of all the following. she has done my CSF tap and VEP and BSEP with chores of immunolical tests the reports of which are pending. she did mention that the VEP is slightly positive but she said that the graph looks like the technician did not place the electrodes in the right manner and hence it again brings me back to square one.But my question is with this report what is the possibility of me having MS? is is that sulomedrol can itself cause muscle weekenss because i feel my calf muscles feel more week after injections (I am on 1 gm dose for 3 days) also sometimes the neurologist says my knee jerks are hyper but when my family physician tested them they were normal. I am aboslutely confused and feel very low as I do not understand what is the probable diagnosis and where would my life take me from here. Please kindly provide your opinion on my medical history. if there is a site where I can load my MRI images to get your opnion on them I would highly appreciate that too Dr. Sethi.

    Thanking you in anticipation,

  13. Dear Minnie,
    thank you for writing in. I am a little confused. Seems your doctor is not entirely convinced that you have MS, yet why are you on Solumedrol. Maybe I lost something in the translation here. In any case, as you would have read from all my posts on MS, the diagnosis at times can be tricky (especially confirming the diagnosis). I agree with your doctor and shall wait for the results of the spinal fluid (do you have oligoclonal bands, what is your myelin basic protein and IgG index). Also at times we do tests such as visual evoked potential and somato-senory evoked potentials to see if there are clinically silent lesions. If the VEP was technically inadequate, I would repeat it.

    I wish you my best, feel free to write in again please.

    Personal regards,
    Nitin Sethi, MD

  14. Hi Dr. Sethi,

    Thank you so much for replying back. my doctor is still unsure if could be MS or not. Actually since my biological sister got detected with it and I was hospitalized to rule out MS, my neurologist feels that sometimes the radiologists are extra cautious in diagnosing diseases than not diagnosing at all. Also they did do my Brain stem evoked potential response test which has come within normal limits. My VEP test like I mentioned my neurologist feels that the way the graph is showing up is probably because the electrodes were not placed properly. my CSF 3 day report says no growth or WBC. it does not mention anything about oligoclonal bands (not sure if some part of the reort is still pending). My MRI cervical spine and throcic spine is negative for MS lesions. so far the poisitive finding is in the MRI which says some small hyperintense lesions in left side of periventricular space which may be non specific or consistent with MS plaques. I am not quite sure why I was given solumedrol, probably because my treating neurologist saw brisk knee relfex and I had pain in my calf muscles. she said the brisk knee relfex can be typical of MS or could even be because of my anxious personality, but she said since i have a family history and one “could be MS” type lesion, she put me on solumedrol. I am still awaiting results of the immunological tests done but at this point can you guide me knowing the above history what is your opinion on my case?

    Again thanking you very much. It is indeed kind of you to respond back.

    • Dear Minnie,
      you are very welcome. I shall not offer an opinion on your case, since I am not in possession of all the facts and I have not examined you. The answer usually lies in a good history and examination. All I would say is that if the VEP was technically inadequate, it should be repeated. A somatosensory evoked potential (not a brain stem auditory evoked potential) and the results of your spinal fluid (I mentioned the tests earlier) shall help in determining if you indeed have MS or not.
      Personal Regards,
      Nitin Sethi, MD

  15. Thank you so much for all the hep and advice. I am hoping to get all my results in a weeks time and I would inform you with regards to the same. Thank you again.

    Regards,

  16. Hi Dr. Sethi,

    I wrote to you a while back about some white matter lesions that were detected in my MRI a month ago. the purpose I did the MRI was because I felt my legs were behaving clumsy. I visted my orthopedic consultant who had prescribed MRI brain with/without contrast. in the MRI there were small periventricular white matter lesions (4-5) ranging from 1 mm to 8 mm. I was asked to F/U with neurologist who then prescribed me CSF, immunological blood work, VEP/BSEP and MRI thoracic and cervical spine.
    my reports are as follows
    MRI brain: as mentioned above
    MRI cervical and thoracic spine: no white matter lesion and unremarkable
    blood work negative for Lupus, ANA, RA, CRP, UA-normal
    Cardio IgA < 0.4, lyme-negative, IgM west BLO-negative, MYE BAS PROT-< 0.2, CSF IgG INDEX-0.47, IgG CSF-1.42, ALBUMIN CSF-9.39, IGG/ALBU CSF-0.15,SYNTH RT CSF-0.00, IgG SERUM 1340, ALBUMIN SERUM 4200, IgG ALBU SERUM 0.3, DRVVT 1.2,CSF: No oligoclonal bands seen, no WBC,
    BSEP-NORMAL
    VEP-P100 LATENCY ON LEFT EYE IS 128 (NORMAL 101.15), P100 LATENCY ON RIGHT EYE IS 129.6 (NRMAL 102.16) INTERPEAK LATENCY IS 1.6 AND NORMAL FOR FEMALES IS 4.71.

    My family physician says, reports are like on the fence which may or may or may not suggest MS.

    clinically my muscles of all my limbs are good with power, I have no issues with coordination, i feel clumsy sometimes in my legs. as far as vision goes i do have some blurring of vision which goes off when i wear my glasses. i have no problems with color identification and no pain in eyes.

    can you kindly provide your opinion on the reports. I am anxious because I there two doctors whom i am following up with, with one telling it could be MS the other one not convinced it is MS.

    Regards,

  17. Hi Dr. Sethi,

    I wrote to you a while back about some white matter lesions that were detected in my MRI a month ago. the purpose I did the MRI was because I felt my legs were behaving clumsy. I visted my orthopedic consultant who had prescribed MRI brain with/without contrast. in the MRI there were small periventricular white matter lesions (4-5) ranging from 1 mm to 8 mm. I was asked to F/U with neurologist who then prescribed me CSF, immunological blood work, VEP/BSEP and MRI thoracic and cervical spine.
    my reports are as follows
    MRI brain: as mentioned above
    MRI cervical and thoracic spine: no white matter lesion and unremarkable
    blood work negative for Lupus, ANA, RA, CRP, UA-normal
    Cardio IgA < 0.4, lyme-negative, IgM west BLO-negative, MYE BAS PROT-< 0.2, CSF IgG INDEX-0.47, IgG CSF-1.42, ALBUMIN CSF-9.39, IGG/ALBU CSF-0.15,SYNTH RT CSF-0.00, IgG SERUM 1340, ALBUMIN SERUM 4200, IgG ALBU SERUM 0.3, DRVVT 1.2,CSF: No oligoclonal bands seen, no WBC,
    BSEP-NORMAL
    VEP-P100 LATENCY ON LEFT EYE IS 128 (NORMAL 101.15), P100 LATENCY ON RIGHT EYE IS 129.6 (NRMAL 102.16) INTERPEAK LATENCY IS 1.6 AND NORMAL FOR FEMALES IS 4.71.

    My family physician says, reports are like on the fence which may or may or may not suggest MS.

    clinically my muscles of all my limbs are good with power, I have no issues with coordination, i feel clumsy sometimes in my legs. as far as vision goes i do have some blurring of vision which goes off when i wear my glasses. i have no problems with color identification and no pain in eyes.

    can you kindly provide your opinion on the reports. I am anxious because I there two doctors whom i am following up with, with one telling it could be MS the other one not convinced it is MS.

    Regards,

  18. Dear Minal,
    good of you to write in again. While I rather not comment on your results per se as I have not seen you and giving advise over the internet is in my opinion not good (as it may further confuse you). But what I can tell you is this.
    Your visual evoked potentials are significantly delayed in both eyes, the spinal fluid results look ok (normal IgG index, myelin basic protein is normal and oligoclobal bands are absent). The way you describe your MRI of the brain makes me think that the lesions do not meet the MRI criteria for MS.
    So I can understand the conflicting opinions you have got from your doctors–the VEP suggest demyelination of the optic nerves, MRI is non-specific but not completely normal, spinal fluid results are normal, brain stem evoked potential is normal and the other tests which were done to rule out conditions that may mimic MS like Lyme disease, lupus and other connective tissue disorders came back all negative.
    Just a word of advise. A somatosensory evoked potential (SSEP) may yield additional information. Also I shall check for aquaporin 4 antibodies. This is a very sensitive test for a disease like MS which goes by the name of neuromyelitis optica (patients have demyelination in both optic nerves and further demyelination in the spinal cord. The disease is also called Devic’s disease).
    Please follow with your doctors.

    Personal Regards,
    Nitin Sethi, MD

  19. Hi Dr. Sethi,

    thank you for your suggestions. I did discuss them with my neurologist and he has also prescribed the same tests as suggested by you. I just had one final doubt in my mind…if you could address that, I would be a great piece of knowledge to me. My neurologist did a very detailed examination of eyes…he checked for the peripheral and temporal visual fields, nystagmus, he did the retinal examination too. he said that clinically I do not have signs of optic neuritis. that relieved me a lot but also I was confused since my VEP was showing delayed response, he said that there could be many reasons for the VEP to be positive some resons being as simple as you not wearing the righ number glasses during the procedure or not coperating during the procedure or procedure itself not being done the right way. it is important to corelate the CEP findings with clinical findings and there are no clinical findings in your case’. Also I have been asked to re-confirm this by scheduling an appt with a neuro opthalmologist. but if a patient is clinically negative for optic neuritis, can it possible for VEP to be inaccurate?

    Regards,

    • Dear Minal,
      you ask a tough question. The VEP may be abnormal or technically inadequate due to numerous causes. That said and done, refractive error (not wearing your glasses during the test) or lack of fixation (not cooperating and not looking at the screen while the test is been done) should not cause a delay in latency. It may very well cause a decrease in amplitude of the waveforms but the latency delay is quite specific for optic nerve demyelination.
      Have the test repeated.

      Personal Regards,
      Nitin Sethi, MD

  20. Hi,

    My neurologoy has ran numberous of testing including MRI and Spinl tab. All of my testing came back negative but the MRI test came back with an possible of MS because of the white matter that was seen. I do have symptom of leg and hand weakness, loss of balance, vision and hearing loss and was unable to walk for about 10-20 minutes. My neurologoy stated that he do not believe that I have MS but I have the symptom. How can that be when my other two neurologoy stated that I did and prescribed Avonex for treatment. What do I need to do about this one neurologoy diagnosis when the other two MRI and neurologoy result. Should seek another neurologoy or what. PLEASE HELP!

    God Bless,

    • Dear Michelle,
      you give me little details so not sure how to advise you. The diagnosis of MS at times is not straight forward and requires the use of ancillary investigations like MRI brain, MRI cervical cord, spinal fluid testing and evoked potentials such as visual evoked potential and somatosensory evoked potential. Further the answer lies in a history of multiple attacks separated in time and examination findings suggestive of multiple lesions scattered in the brain or spinal cord.

      Personal Regards,
      Nitin Sethi, MD

  21. Dear Mr Sethi,
    I know this blog mostly concentrates on the white matters and MS, but I would like to ask you a question again about my wife.Last week I told you we have been to an assistant professor of neurology, and she told our situation was psyciatric.I also know you do not want to comment without seeing the patient, but I desperately need your comment here, before consulting a neurologist again next Tuesday.

    We had the first MRI of the brain almost 2 months ago, and an ependymal hippocampal cyst was observed on the left hippocampus of my wife.And strangely her speech started to deform since 20 days.I have digged a little on the net, and found that there is a region of the brain which controls the speech motor called broca.And what is more strange is that, she can sing very very smoothly without any disturbance at all times without exception.This really makes me curious, because I also have some stuttering from my childhood, and I can also sing well but when I try to speak, I fail most of the time.And my problem is permanent.
    By the way we use Efexor and diazepam (turkish names) once each every day.

    1) In psychological disorders, is this scenario observed ? I mean singing is perfect but speech is slow and defective.The neurologist told there was nothing to worry but they may have forgotten to consider that the MRI was almost 2 months old.

    2) We also had a CT after this speech disorder was observed.Can a CT give a clue about any development in this hippocampal ependimal cyst? Because after talking to my wife about the cyst, the doctor requested a CT, but we dont know for what purpose he requested that.Maybe the CT does not show as accurate as MRI, but they had an initial MRI of about 2 months old.Can you comment especially about this for me please ?

    3) Can a developing cyst in hippocampus cause something like this to happen?

    I also noticed that the hippocampus and the region called brocal region are very close to each other.
    Thank you for your replies in advance.

    • Dear Mr. Cengiz,
      good to hear from you again. It is difficult for me to comment on a scan I have not seen. The Broca’s area is the motor speech area of the brain and in people who are right handed, the Broca’s area is found in the left inferior frontal convolution. It is named Broca’s area after Dr. Broca who first localized it to be the part of the brain concerned with motor production of speech/ language.
      People who have strokes involving this area or a tumor in this area may have problems with language. We call this Broca’s aphasia. In classical Broca’s aphasia the person can understand (comprehend) everything said to him/her, but the fluency, repetition and naming is impaired.

      Personal Regards,
      Nitin Sethi, MD

  22. 3-4 weeks ago suddenly I realized I had a partial loss of hearing in the left ear (everything else is fine with me so far and I am 54 years old). As it did not improve I went to the ear Dr that after many test determined that, the speed of sound transmission from the ear to the brain was somehow delayed; therefore he order a MRI with and without contrast to look for the VIII nerve.
    To his surprise, the nerve was fine but they identified 6-7 possible lesions.
    The radiologist report indicated:
    Abnormal enhancing lesion of the right carona radiata. Differential considerations include primary neoplasm, metastatic disease, lymphoma, granulomatous type process or potentiall enhancing demyelinating plaque
    Also focal edema adjacent to right lateral ventricle masuring 1.6. by 1 cm.

    I showed the MRI first to a college radiologist and brain tumor expert that indicated they were likely MS. By talking with him I realized that approx 14 years ago I had an optic neuritis on the left eye that recovered after intravenous cortisone. He thought that supported the MS theory. Yesterday I saw a neurologist that also favor that idea and ordered a CF, a complete MRI of the spine and brain again, but also a CT of the pelvis and abdomen.
    My question for you is he ordering the CT because he thinks these could be neoplastic lesions and is looking for metastasis or why is he doing it? WHy is he repeating the brain MRI?

    • Dear MRI brain-55,
      thank you for writing in. As I stated in my post, not all white matter lesions on a brain MRI represent MS. There are many other conditions that can resemble the MRI picture of MS. It is likely that your doctor is trying to rule out some of these conditions. The CT scans of the pelvis and abdomen are steps in that direction–done primarily to rule out neoplastic, infectious and inflammatory conditions. The examination of the spinal fluid (CSF) and MRI of the cervical spine shall give additional information to rule out or rule in multiple sclerosis.

      Personal Regards,
      Nitin Sethi, MD

  23. Dear Dr. I am a fifty-eight year old woman who has presented with pulsatile tinnitus for about two years, ear fullness, and now blurred peripheral vision for the past six months , all on my right side. I went to the neurologist who did evoked response tests, completely normal, normal reflex testing in office, had an mri with contrast that shows lesions suspicious of ms. Had an mra, normal. I have no muscle weakness and no other symtoms. I suddenly got hypertension 220/110 in the end of january when previous reading in december was 140/80. Complete blood tests showed all normal results except ana titer was reactive 1:320, speckled pattern. Cae total complement was 170.. All the other readings were negative, lymes, electrophoresis normal, c reactive protein.5, rheum. arthritis factor
    normal. All heavy metals, normal. Opthalmologist said everything was great…No cataracts, or glaucoma..Optic nerve looked very healthy.. ENT said my hearing was that of a three year old. I fell pretty healthy, but am getting depressed with my eye…I have hashimotos, treated, on celexa for panic disorder and now micardis for hypertension. Too many drugs! Any ideas would be gratefully and humbly appreciated….

    • Dear Patti,
      thank you for writing in. Hmmm let me start in this way, your MRI findings may or may not have any correlation to your current clinical presentation. Patients who have microvascular risk factors such as hypertension, diabetes, high cholesterol, smokers may show lesions on the brain MRI which superficially resemble those seen in multiple sclerosis. Your ANA is positive and you have some microvascular risk factors.
      Your doctor shall be the best person to decide whether you have microvascular small vessel disease and if yes, due to what. Also he shall rule out any connective tissue disorder and finally do your MRI findings have any correlation to your current clinical presentation.

      Personal Regards,
      Nitin Sethi, MD

  24. I am a 58 year old woman who has experienced muscle weakness most of my life although it comes and goes (every 5 years or so). My parents said that when I was young I was diagnosed with Juvenile Rheumatoid Arthritis and that my bouts were probably arthritis related. I am extremely athletic (I run half marathons and go to the gym every other day). About 4 years ago I noticed that my left eye was larger than my right along with blurry vision, halos and was experiencing severe problems with leg movement(I could barely walk). After seeing an opthomologist, he has stated that I have optic nerve damage and according to an MRI that was done they have noticed subcortical white matter of both frontal lobes. My doctor prescribed zanaflex for my legs (I have hyperreflexia and hoffman sign bilaterally) but I only take the meds when it gets painful.

    Other than problem with my vision (still blurry, halos) not getting better and my legs shake when I walk downstairs, I have progressed to a point where I am now again training for a half marathon.

    My family are a little nervous about me taking on this endeavour as I was training about 4 years ago when the last bout occured.

    I look forward to hearing your input on what may be causing my symptons and as to whether they could progress.

  25. I am a 48 year old woman who has experienced muscle weakness most of my life although it comes and goes (every 5 years or so). My parents said that when I was young I was diagnosed with Juvenile Rheumatoid Arthritis and that my bouts were probably arthritis related. I am extremely athletic (I run half marathons and go to the gym every other day). About 4 years ago I noticed that my left eye was larger than my right along with blurry vision, halos and was experiencing severe problems with leg movement(I could barely walk). After seeing an opthomologist, he has stated that I have optic nerve damage and according to an MRI that was done they have noticed subcortical white matter of both frontal lobes. My doctor prescribed zanaflex for my legs (I have hyperreflexia and hoffman sign bilaterally) but I only take the meds when it gets painful.

    Other than problem with my vision (still blurry, halos) not getting better and my legs shake when I walk downstairs, I have progressed to a point where I am now again training for a half marathon.

    My family are a little nervous about me taking on this endeavour as I was training about 4 years ago when the last bout occured.

    I look forward to hearing your input on what may be causing my symptons and as to whether they could progress.

    (sorry I made a typo on the previous e-mail. I am 48 not 58)

    • Dear Patricia,
      thank you for writing in. Your history and examination findings as reported by you intrigue me. While I shall not attempt a diagnosis here since I have neither examined you nor taken a history by myself, there are certain points of singular interest namely the muscle weakness that comes and goes (is it a myopathy or a neuromuscular transmission disorder such as myasthenia gravis), eye problem (is it actually optic neuritis or rather a III CN palsy) and finally the signs of bilateral pyramidal tract dysfunction (hyperreflexia and Hoffman’s sign).
      Hmmm these are the times when I wish I could reach out via the Internet and examine someone in person. In any case, my advise to you would be to follow up with your doctor and a neurologist . Relatively simple tests to rule out diseases like Myasthenia gravis, Vitamin B12 deficiency and spinal cord disease may be in order and would help determine what plagues you.

      Personal Regards,
      Nitin Sethi, MD

  26. Dr. Sethi,

    Please take the time to answer this brief question. I am a 32 year old healthy female. 3 years ago I had a grand mal seizure. I went to a neurologist who diagnosed me with epilepsy even though my EEG came back normal. My MRI 3 years ago was normal. I took the medication (Keppra) for a while but then discontinued without the advice of the neurologist. I had another seizure 6 weeks ago followed by another MRI. This MRI showed scattered <5 mm subcortical white matter hyperintensities bilaterally. No mass or infarct indentified. My neuro said the MRI was normal and said not to worry about it. He won't even discuss it with me. I have not symtoms of MS but I am concerned that there has been a change in my MRI and that according to your posts, such findings are found sometiems with age (but I am still very young) or migraines – which I have never had. My only symptoms have been 4 seizures – one 3 years ago – 2 in one day 6 weeks ago and another 1 month ago while on Keppra. Also, I have had headaches – all left side of my head – since the seizure – one odd period where I felt like I couldn't talk – while on Keppra – I have missed my period – which I have never done before and I have very frequent urination. I am on Tegretol now and my life is miserable on this drug. I live in a small town and can't get an appointment with anyone for help. I am very frustrated. Do you have any idea what could be causing the seizures or why I would have this change in MRI and what the MRI findings could mean? I am at the end of my rope. It is 3 am here and I finally found your website. Any help you could give would be greatly appreciated.

  27. Dear Bawa,
    I am sorry I do not understand your language. If possible please write in to me in English or let me know what the language is above so that I can translate it with the help of google language tools.

    Personal Regards,
    Nitin Sethi, MD

  28. dear sir!
    first of all i would like to thank you for this blog . i came across your blog by chance on the google.but was thoroughly impressed with your approach to each of the queries recieved .i too have a doubt and would like to have your expert opinion on it.

    sir! i am 33 yrs now and to begin with i had continous twitching of my right eye one day in march or april.i was disturbed but thought it would get all right. then it was over .after few days i felt movement of my right thumb for few moments and then it was ok.but since then i find twitchings in my whole body even in abdomen once in a while. i consulted the neurologist at my hospital and he asked me to have an MRI done.which i did 2-3 days back.the MRI reveals partially calcified granuloma (thickwalled ring lesion 3x2mm in size) in right hemi pons with no perifocal oedema.the lesion is showing peripheral hypointense rim with central fluid like signal characteristics on T2w /flair images with blooming on GRE images.i showed this to him again and he asked for an EEG.
    what has happened to me? since past two-three years i repeatedly had on and off diarrhoea for which had taken antibiotics.and recently got to know that my vit b12 level is very less 177pg/ml ,taking oral methycobal-500mg od and folvite 5mg od.i have also developed reddish pustular rashes in my face (around nose,mouth,cheek and chin.skin biopsy from chin showed irregular acanthosis,focal parakeratosis with mild upper dermal edema,fibrosis and capillary infiltration.there is upper dermal chronic inflammatory infiltrate composed of plasma cells.
    is all of my conditions brain,stomach and skin interrrelated? what should i do?please help…

  29. Hi Dr Sethi,

    I am Jennifer a 34 yrs old female. I’d like to tell you my story and see what you can tell me. I am very confused and a bit scared since I 3 children.
    Few years ago, I have noticed a sharp pain on the upper left part of my back, it seems to be on the spine. I thought nothing of it so I massage it whenever it comes to relieve the pain it sometimes makes it hard for me to breath. One day my left leg just stiffened and I felt like I was not in control of it. It was heavy and it lasted few hours, I believe. It only happened once so I did not think about it more. One day as I was resting I can feel tingling sensation on my left arm and radiating to my face so i finally went to my doctor. He did a CT scan and reveled nothing abnormal. He then saiad it was due to hormonal changes which by the way, I had an oopherectomy done because of Endimitriosis. I was relieved. Then it happened again,this time I almost fell because my leg suddenly got tight and went heavy while I was walking.( few months after) Since he said it was hormonal I did not do anything about it. Then another symptoms came, I felt a head tremor while I was sleeping,it woke me up and my husband said I may just be dreaming so again, did nothing about it. One day while with friends my leg tightened and then I felet the same tightness on my left arm and then my fingers involuntarilly shook for few minutes. Now, on and off, I feel the heaviness on my left leg.

    I finally saw another doctor and luckily my leg was acting up for a couple of weeks that I was able to show him. He asked me lift my right leg and it was no problem, lift my left leg, I felt like it was against me. So he told me to go to a neurologist. While waiting for my appt, I experimented: I lifted my right leg, no problem then lifetd my left and it was heavy, but what was puzzling was that, if I lifted both legs, I have no problem. I niw keep getting the tingling sensations on my left arm and the heaviness would sometimes radiate on my head. I am also tired most of the time.

    Brain MRI was initially ruled normal by the radialogist, byt when my neurologist read it, there was a couple of what he called ” white spots” I get this symptoms on and off now for about 2 years. I am going to do a spine MRI tomorrow and my neurologist is working on getting my spinal tap done soon.

    Can you please share your expertise with me? I would really appreciate some answers.

    Thank you for giving us your time.

    • Dear Jenn,
      thank you for writing in to me. I am unsure what plagues you since your symptoms are episodic and if you take the entire history into consideration do not localize to any one part of the neural axis. The MRI findings may be non-specific but have to be correlated to your history and examination findings. The spinal MRI may be helpful. Follow up with your neurologist. He shall be the best person in guiding this workup further. I wish you my best.

      Personal Regards,

      Nitin Sethi, MD

  30. I was in a car accident where a lady ran a red light and T-BONED ME at about 70mph knock out cold my head didnot hit anything just from the force. MRI 3 weeks later showed T2 hyperintense areas in frontal lobe white matter measuring 5mm. Then goes on to blow this off as questionable? significance?. Then goes on to say likely due to some type of prior microvascular ischemic insult? I am no rocket scientist but to say no big deal do to a major big deal microvascular ischemic insult. The only reason I see is to give Neurologist a way out of a bad situation. This was one of many things to many to list that came from this accident and because with multiple injuries it is not profitable, for reasons of time and research that would have to be done. I would just like someone that is a doctor to assure me that this goes on and because of a person’s criminal negligence I have to suffer for a year and a half now, completely house bound and no help in sight. also just in the brain MRI was dialated perivascular spaces in the parietal white matter bilaterally and cerebellar atrophy.

  31. Hello, I have a very complicated Diagnosis w my daughter, she is 31 months and She has Severe Dysphagia w no answers as to why she has this most of her Specialist are puzzled and cannot explain why her condition is getting worse, she is no longer protecting her swallow to close her airway off when liquid or food should go into her stomach well they don’t work so she gets pneumonias really easy, she is aspirating everything except we are thickening her Liquids and solids to Pudding thickness and have started Vital Stim at Phoenix Childrens Hospital 4 days a week for 48 weeks, so we are working w ENT’s, Pulmonologists, Gastroenterologists, Neurologists, Speech Pathologists, Therapists trying to get these muscles working, but no one knows why she is like this, but they cannot find anything wrong w her. She had a Brain MRI and it was normal except her Neurologist said there was some small White Dots in her Brain Matter, he said its normal for a child that has been in the NICU and had nothing else to offer..Her GI. Pulmonary and ENT Docs are saying it has to be Neurological since she continues to get worse…….Its been a Super Frustrating almost 3 yrs, she was a preemie at 34 weeks because she shut my kidney down at 17 weeks and she was in the NICU for 2 wks…….I am in need of some Wise words of wisdom, I need help, Abigail needs help…. If you get this and can offer any advise I will do whatever it takes to find out how to help my babygirl……….

  32. Pardon for the length of this question, but I wanted you to have a little back ground. In 1999 I had a back injury that resulted in L4-S1 bulging discs (I have received injections for these and they are manageable) plus normal arthritis (age 45). Until this past year I have been relatively active, manage a business, teach, hike, swim, etc. In 2006 I had some pain in my ribs and lower abdomen, felt like major cramps/spasms that came and went. All tests upper gi/ lower gi normal (but still continue to have them). In 2007, my left eye lost sight temporarily and I was tested for stroke (MRI normal no stroke), eye still periodically goes in and out and vision changes. This year I had some loss of bladder and bowel control, numbness in my leg (right) and weakness in my arms and hands and went to a neurosurgeon who performed C5/6 fusion. Things were great for about a month and then all the weird symptoms came back 10 fold. In addition to numbness in spots on my face and tremors in my lower jaw when I try to place my teeth together. I was then sent to a neurologist who performed a number of tests on me. He stated they were all borderline, but the one that confuses me is the MRI on my brain. It reads “In the FLAIR and T2 weighted images, I do not see hemorrhage, mass or subdural hematoma. The ventricular system is normal in size. (I understand all that…the next part is the confusing one) Scattered deep hemispheric white matter lesions are seen which are nonspecific. These appear to be due to Hyperform myelination. Could you please explain the last sentence to me and if it would have anything to do with the current symptoms I am having. Unfortunately this neurologist has passed me off to another one at another hospital and my appointment is not for 3 weeks. My leg symptoms are still there with an addition to a burning sensation as well as my hands being able to concentrate on small tasks such as buttoning a shirt, picking up a pen, folding paper, etc.

  33. I do not see much autism since I am not a pediatric neurologist. The autistic patients I see are the adults with seizure disorder mostly hard to control epilepsy. In their scans at times I do notice some amount of white matter disease but it is hard to make out how much of it is because of autism per se and how much is because of other microvascular risk factors such as hypertension and high cholesterol.

    Nitin Sethi, MD

  34. Hello
    I am a 58 year old female who has had an MRI because of tinnitus. The scan showed normal internal auditory meati. However a number of peri ventricular white matter lesions were also reported. The radiologist recommended further imaging but my consultant thought it was not in my interests to pursue and considered it part of the normal ageing process. He did say that I have more than expected.
    I have high blood pressure that is controlled with medication.
    I am uneasy and wonder if I should take any further action with reagrd to the white matter lesions?

  35. Dear Dr. Sethi,

    My son is 4 years, i noticed that he has short memory or can not remember names or songs easly. So i bring him to a pediatrician, who requested him MRI. the radiologist wrote: A few tiny millimetric slightly high T2/FLIAR signal foci are noted in the inferior bi-frontal white matter. the gray and white matter signal intensities are otherwise normal.

    can you give me please your diagnosis? i have concern

    thanks a lot

  36. Dear Rohan,
    thank you for writing in to me. You give me precious little information to go on. Like for example what is your age? Why was the MRI ordered? My advice at this point is for you to follow up with the doctor who ordered the MRI study.

    Personal Regards,

    Nitin Sethi, MD

  37. Dear cpmandautism,
    T2 weighted brain MRI refers to a MRI sequence in which the cerebrospinal fluid (CSF) appears bright (high signal). Demyelinating lesions in multiple sclerosis appear as bright spots on a T2 weighted MRI sequence. These correspond to the areas where the myelin is damaged.

    Nitin Sethi, MD

  38. My son is 23 and in the past month has exhibited the following symptoms: confusing thoughts, insomnia, loss of appetite and weight loss, some mild hallucinations, paranoia, personality changes. Blood work all normal. He just had an MRi which indicated the following: FLAIR and T1 weighted images show a few scattered white matter hyperintensities in the anterior high frontal convexities. No other areas of the brain show high or low signal lesions. findings could relate to vasculitis… He does not have a history of migraines or drug abuse and is not on any medications. He has always been in excellent health. He will be seeing a neurologist next week. I just wondered if you could advise me on questions to ask, how to know if the doctor is exploring all possibilities of the cause and thus the treatment, when to get a second opinion and how potentially serious this is.

  39. Dear Dr. Sethi,

    I wonder if I might ask for some advice, as I am yet another person with white matter lesions on my MRI. My problems in this area began at the age of 40 with a series of headaches and feelings of dizziness/light-headedness. I had a CT scan of head and abdomen at the time, which revealed enlarged abdominal lymph nodes: CT head was reported as normal. This was eventually diagnosed as lymphoma and treated successfully with chemotherapy. Unfortunately the light-headedness did not resolve, and I also started to experience cognitive problems. A few months after finishing treatment, I had an MRI which showed diffuse white matter lesions. I had an EEG (normal), two further MRIs with contrasts, and two lumbar punctures which showed elevated serum protein in the CFS. On the basis of the MRI appearance, I was given a diagnosis of small vessel disease, and put on a statin and blood thinner as elevated cholesterol was my only vascular risk factor. My neurologist subsequently discharged me.

    There are a number of things about which I am unclear, and would appreciate any suggestions you may have.

    The fact that the strange feelings in my head were the initial symptom leading to a diagnosis of lymphoma makes me wonder if the two were connected? I have read about paraneoplastic disorders, and wondered if the white matter lesions could have been caused by something like this?

    I have also read extensively about chemobrain, and one of the chemotherapy drugs prescribed is strongly associated with this condition. As my pre-chemo CT head was normal, and the cognitive problems emerged during the chemotherapy, I wondered if the white matter lesions could be related to the chemotherapy?

    I have never received an explanation regarding the elevated serum protein, as my neurologist said it was a “non-specific” sign. Could you shed any light on what it may mean? Is that something seen with small vessel disease?

    Finally, I do not feel I have got to the bottom of what is going on here and am worried that the dizziness and cognitive problems are getting worse. I do not think my original neurologist will see me again, so is it worth requesting a referral to someone else?

    A response to any of these questions would be greatly appreciated.

  40. Need one help….my husband is facing severe headaches from last 15 days specially in the morning and dizzyness followed by vomits..his all tests were normal then ENt suggested for MRI of the brain ….report of MRI of the brain are as follows…….multiple lesions of variable size,variable shapes seen in the deep white matter of both cerebral hemisphere mostly the right frontal lobe and body of corpus callosum.Lesions demonstrate low signal in T1-weighted images,brighter signal in T2-WI,PD-WI and FLAIR sequences.Thee largest lesions(+/-0.4 cm) seen in the right posterior frontal lobe..pateient age and peri-ventricular location raise the possibility of MS over lacunnar infarctions,clinical correlation may exclude this possibilty from differential.NO evidence of haemorrhage of mass lesions.No cortical dysplasia or heterotropia is identified..The ventricles are normal in size and configuartion….There are no extraaxial collection or vascular abnormilities.The temporal lobes are symmetric with normal appearing hippocampia bilaterally.The orbits,paranasal sinuses and skull base are normal.Normal signal intensity of both petrous bones.
    Please suggest something is it really serious?

  41. Hi Dr. Sethi, I have read your reply on Sandy’s condition and I have a good underderstanding to what you wrote. I have the same symptoms as Sandy and my neurologist diagnosed me with diabetes according with my MRI, GTT and EEg, however my primary dr. promises me that I am not! I’m on the borderline to become diabetic but according to my blood result I’m not. Both doctors read the same blood results and work in the same clinic. I’m 37 years old, I dont smoke nor drink alcohol. I think I suffer from migraine, but I wasn’t diagnose with it. I probably only had severe headache/migraine maybe 4 or 5 times in my life…I don’t know what to make out of this. Do you have any input?

    • My most important question I forgot to ask…If I just became diabetic can it be seen on the MRI so soon? Or only if I have been diabetes for many years? You mentioned that diabetes can be seen on MRI on someone of age (60>) rather someone half the age?

  42. Dear Dr.Sethi,
    My 6 yrs old Son is a known patient of hypothyroidism with delayed milestone. After two febrile convulsion with a gap of one year doctor suggest for MRI of brain. In his MRI report two abnormalities found:
    1. Trigones and occipital horns of both lateral ventricles are widened.
    2. Small gliotic foci in right parietal sub-cortical white matter.
    Neurologist said it is a defect by birth but not explain clearly.
    I want your advise and want to know his future difficulties if any.
    With warm regards.
    Amitava
    West Bengal.

  43. dear sir my 2 and half year old nephew is going through some neuro problem..his brain plain study report shows that he has a normal brain morphology except tiny calcified granuloma in left periventricular white matter.so kindly suggest me the right treatment for him..will he be able to work like a normal kid..

  44. Hi,
    I am 30 yrs female. I have experienced lots of headaces and have pasted out 2 or 3 times with this my docter caused me to go for an MRI. I had it but the resulth says that: ‘Bilateral small peripheral white matter abnormalities’. Please tell me is this some thing to worry about cause I am experience some joint aces and some time get confused with words as well.
    please help.
    Naushin.

  45. Dear Dr.,

    I would greatly appreciate if you could help me. I am a 25 year old female who was diagnosed with occular migraines a year ago in the 1st trimester of my 2nd pregnancy. Was believed to be hormone related and they went away. Developed horrible temple pain after baby so saw a neurologists. Had an MRI and everything was normal except a white spot on the left side of my brain. The MRI report said something about ischemic but the Dr read it outoud quickly. After, he just stated it was an abnormal spot and said not to worry. He told me a lot of people have one for no reason and that he probably had a few as well. I kept demanding to know more about it but he wouldn’t tell me. He just kept saying not to worry and that it was a signal something had changed but he wouldn’t say what. I was freaking out at this point and still couldn’t get an answer, other than don’t worry. He said it didn’t require any more testing or follow up. I feel at a loss. I googed it and read horrible cases. So how does he know it’s so harmless and not a stroke or Ms? Is it really that common and can u help me in any way? Oh and blood work was excellent. Thank u so much!!!!

  46. Dear Dr.

    At last i found a site where a doctor replies directly to patients….

    I had severe headaches, electrical shocks frequently and one day i had for whole day…immediately i met a doctor and he suggested a MRI….i took it and went to doctor.

    He read and said i’ve cluster headache. I don’t know what exactly it is….

    In the MRI, Radiologist impression was “Small Hyperintense Foci in the right globus pellidus on T2W & Flair Imaging.”

    Can u explain what does it mean?

    Doctor said tiny blood clots are there and he suggested me to keep check the BP.

    Is it a big problem???

    It’s been 2 years that i took MRI…..now i’m getting my headaches again…very severely …..

    Please reply…..

    Thanks in advance,
    Harsha,

  47. Dear Dr. Sethi,

    I am very worried about my husband and was wondering if you could shed some light on his MRI results before we manage to see a neurologist next week. He was taken to A&E with severe headache, stiff neck and nausea a few days ago. His CT scan and lumbar puncture were normal. However his MRI/MRA revealed the following: “MRI revealed no evidence of vascular malformation, but numerous foci of abnormal signals in the subcortical and deep cerebral white matter, with a more prominent focus in the postural orbital gyrus which are non specific in nature.” He was released yesterday and told to wait for a follow up with a neurologist. I of course fear some degenerative neurological disease, and would like to have some light shed on possible diagnoses. Thank you so much for your help! Best wishes, Caroline

  48. I I am 24 and last Friday I was told that I have white spots scattered though out my brain what could this mean? Everyone has been telling me it probably nothing but for a year now I have gotten dizzy spells headaches. I could be dirtying still and my hand just starts to shake as well as sometimes I feel in my leg like there’s a worm running down it and it kinda tickles. I am very confused and my fieance has noticed changes in me in the past year as well I have a hard time concentrating on something I forget stuff alot now! What might be going on, and are white spots scattered though out the brain ever normal, or is it always some type of disorder.

  49. Dear Doctor, On May 5th 2012 I had a Mri of the brain without and with contrast. Technique Multiplanar and multisequence imagaing of the brain performed. Exam limited by motion artifact. This is an upright signal in the right parietal lobe in the centrum semiovale measuring 1 cm and a second vague area of similar like signal abnormality is seen in the right occipital lobe. No other lesions are seen. These lesions do not enhance. There is no mass effect or mid line shift. There i no abnormal area of enhancement. Brain stem and cerebellum are unremarkable. Impression…Limited study, due to motion artifact, shows 2 nonspecific foci of T2 signal abnormality. This can be sequela of chronic small vessel disease or vasculitis or demyelinationg process. Clinical correlation recommended. Can you explain what is means and should I be concern?? Cheri

    • Dear Cheri,
      Follow up with your doctor/ doctor who ordered the MRI brain in the first place. He shall be the best person to correlate your clinical history and examination findings with the MRI report (that is what is meant by “clinical correlation is recommended”) and decide whether this is a matter for concern or not.

      Personal Regards,

      Nitin K Sethi, MD

  50. hello good day!
    I am 25 and last month I had a terrible headache, dizziness, vomiting and numbness in my right arm. I went to my Internist and she told me to do MRI brain without contrast and they found out a three white matter in my left brain then He referred to me a neurologist, I had my physical exam all normal i did lab test also all normal, but i had this feeling when i go to sleep and early in the morning i feel dizzy. What does the white matter means and why I fell dizzy all the time..

    • Dear Ann,
      I advice that you follow up with your neurologist. It is possible that you have migraine attacks. White matter lesion have been reported in migraine patients.

      Personal Regards,

      Nitin K Sethi, MD

  51. Hi Dr. Sethi,

    I am a 51 yo woman who for the last 2 years have been going thru a number of mild to severe symptoms. I have had chronic headaches which at this point are constant daily. I have short term memory distrubances, I have pain, tingling and numbness in my left leg and foot, numbness in my right foot, lower back pain that does not ease with medication and I have difficulty walking, with some foot dragging on the left, occasionally on the right. I have insulin dependent type 2 diabtes, and in treatment for depression and severe anxiety, panic disorder. I have been experiencing for the last year some difficulty swallowing, maiinly liquids but some food as well. I also have constant left neck and shoulder pain. A recent cardiac stress test showed normal although CAD. I was sent to a neurologist in October of last year who did an MRI of the brain, but did not give me the results. I found this week, (through my disability attorney) that the impression reads “multiple lesions within the white matter of the brain, MS vs Vasculitis, as well as a diagnosis each visit of Cerebral Infarction. The EEG was normal. In April he did nerve conductions of upper extremities which showed bilateral CTS. He has since April ordered 2 nerve conductions on my lower extremities and lumbar region. I’ve been to the er 2x in the last 2 weeks for pain. A lumbar MRI showed a view bulging disks in the lumbar regions but also stated a decrease in signal intensity on T1w. My county insurance will not issue authorizations for these tests and denied another MRI due to running out of money and only “severe needs” are given authorizations. I’m very scared and nervous. Can you please offer your opinion as to what this all means. I would really appriciate it.

    Lisa

    • Dear Lisa,
      thank you for writing in to me. Unfortunately at present I do not have an opinion on what plagues you since I have neither examined you not reviewed your studies. Your current neurologist shall be the best person to guide you further. I wish you my best.

      Personal Regards,

      Nitin K Sethi, MD

  52. My mri scan show a few puntate white matter hyperinties frontally which may present small puntate foci of ischaemic demylination. exclude vasculitus. white matter towards posterior in the parietal lobe with symmetrical distribution and appearance consistence with virchow robi spaces rather tha demyelination. what does this mean as i hax severe headaches on my left side

    • Dear Portia,
      the MRI findings need to be interpreted taking the history and examination findings into context. Without that any advice would not be prudent.

      Nitin K Sethi, MD

  53. Doctor,
    Beginning three years ago, I experienced mild to severe symptoms of myelopathy. After several Neurologists, Neurosurgeons and Spinal surgeons, I was diagnosed with severe spinal stenosis. I had surgery on April 23rd to decompress the spinal cord C-3 through C-7 with implants and fusion. I have been improving slowly and working on flexibility and exercise.
    Prior to surgery, I had 2 CAT scans and a brain MRI. The MRI showed several scattered small white foci in the left and right frontal lobes. They were deemed to be insignificant and associated with my age(59) or from a concussion some time in my life.

    During my surgery, it was discovered that I also had OPLL and the scar tissue was removed to decompress the spinal cord. My surgeon and I had discussed the possibility that there might be more than one cause attributed to my symptoms.

    During my recovery from the surgery, I started to smell cigarette smoke starting 2 weeks ago. It has subsided this week. After discussing this symptom today with my surgeon, he mentioned that the cause might be a brain tumor or ms. He stated that the small white foci seen on the MRI could be ms or ms-like plaque. Since I had the MRI 6 months ago, we are going to wait and see how the symptoms will reveal themselves.

    My question pertains to the small white foci and OPLL. Is there a correlation with OPLL and the white spots? Or is MS the culprit responsible for the symptoms that I originally began to experience?

    Your thoughts?

    • Dear Don,
      to my knowledge there is no relationship between OPLL and white matter lesions discovered “incidentally” on brain MRI. There are many causes for white matter spots on brain MRI and it would be foolhardy to rush in and diagnose you with MS. I advice that you follow up with your doctors. How confident are they that you indeed did suffer from a compressive myelopathy. Were any lesions ever seen on spinal (cervical) MRI? Further testing with the aid of EEG and evoked potentials may be helpful to clarify the diagnosis. Were metabolic, toxic and nutritional causes (such as Vitamin B12 deficiency) excluded?

      Personal Regards,

      Nitin K Sethi, MD

  54. Dear Nitin K Sethi, MD …

    I have had a long term sleep issue, consisting of non restorative sleep and minimal deep (delta) sleep in the sleep profile. Generally, the architecture of sleep is quite disordered.

    I consulted a neurologist (who is a headache specialist) regarding this. I should mention my hx also consists of classical migraine from age 18 – 53 years old — at which time they spontaneously resolved.

    To the point: a recent MRI of the Brain was essentially normal with a notation of findings of “a few high signal infarcts bi-laterally in the frontal lobes”. I know these are not uncommon in migraine pts. I also know that they can be pathognomic of MS (demylenation) and/or of vascular stenosis . I should mention that my father did experience dementia (alzheimers) in his late 80′s.

    I have a plan to address the sleep issues, part of which will involve an updated PSG. I haven’t had one in 20 yrs.

    In past, took Ambien with some success, but I have become habitutated and it no longer has an effect. Now taking Lyrica (R/O Fibromyalgia).

    My question — how concerned do I need to be abt the high signal findings in the white matter. I’m not to happy abt them being in the associational cortex… especially w/ my dad’s hx.

    The manner in which the radiologist wrote the report leads me to believe that the finding was incidental – and of subclinical significance.

    I would appreciate any comments you might have.

    I am a medical professional — although this is not an area of expertise.

    Thanking you in advance.

    C

    • Dear Charles,
      thank you for writing in. You mention that the MRI brain was reported as few high signal infarcts bilaterally in the frontal lobes. It is not unusual for patients with migraines to have few white matter hyperintense lesions scattered about in the brain. These are thought to represent microvascular disease and thus in my eyes are different from lacunar infarcts which represent small and at times subclinical strokes. More than likely what was noted in your MRI scan were incidental white matter lesions likely due to migraine (especially if you do not have any other vascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoker and so forth).
      While I would not worry about multiple sclerosis taking your age and history into consideration, vascular disease of the brain has been associated with cognitive impairment and there is literature which attests to that.
      I would advice that you discuss the same with your physician.

      Personal Regards,

      Nitin K Sethi, MD

      • Dear Dr. Sethi –

        Thanks for the information. I have become aware that you are on the staff of the Sleep Disorders Service. As I indicated, I sought nuerologist consultation locally for sleep issues mainly. The neurologist readily admits she is not up to speed on sleep disorders (mainly a headache specialist). She has done an office neurological, ordered up extensive blood-work (R/O fibromyalgia), and sent me for MRI Brain. She is treating sleep issues as secondary to fibromyalgia. Did one month on Lyrica 50mg hs. Marginally positive result. Now have gone up to 200 mg (am, supper, and 2 a bedtime). Just started this regime. Too early to report results.

        I would like to consult your sleep disorders service for a second opinion. I can provide all of the above recently completed evaluations. I would be interested in an opinion on the need for a PSG. Would also like you to take a look at the white matter on MRI (I have a disc and report). Also would be interested in potential need for screening for early cog inefficiency (considering the familial history).

        Do you think this sounds like a sensible plan.

  55. Hi NItin,

    At last i found a site where a doctor replies directly to patients….

    I had severe headaches, electrical shocks frequently and one day i had for whole day…immediately i met a doctor and he suggested a MRI….i took it and went to doctor.

    He read and said i’ve cluster headache. I don’t know what exactly it is….

    In the MRI, Radiologist impression was “Small Hyperintense Foci in the right globus pellidus on T2W & Flair Imaging.”

    Can u explain what does it mean?

    Doctor said tiny blood clots are there and he suggested me to keep check the BP.

    Is it a big problem???

    It’s been 2 years that i took MRI…..now i’m getting my headaches again…very severely …..

    Please reply…..

    Thanks in advance,

  56. Hello, my husband is an interesting case. He is 26 with no known abnormal medical history. Following treatment for sinusitis (with antibiotics and steroids), he developed myoclonic movements in his head and neck as well as worsening of pre-existing nystagmus. The (non-contrast) MRI revealed white matter hyperintensities. The largest was 4 mm in the left parietal subcortical white matter. The myoclonus is constant, painful and unrelenting. No one seems to have an any clue. Finally referred to a movement disorder specialist. He cleared a psych. evaluation to rule out a psychogenic problem. He has a positive lyme disease ELISA blood test, but neg western blot and no history of tick bite. EEG shows no seizure activity. I’m stumped, and so are the doctors.

  57. I was curious if by chance anyone has been diagnosed w/chiari malformation who has been experiancing headaches? I saw borderline chiari malformation on my mri in August and since have had decompression surgery. The doctor I was seeing said it was nothing to b concerned about. I researches chiari and found all my symptoms since I was a child to be the same as. those wwith chiari so I saw a neurosurgeon who confirmed I had a 8mm herniation and agreed this was my problem. I had a spinal tap and the tap herniated my brain 6mm further! The radiologists said my 1st mri showed a 2mm

    • Cont…the 1st mri, the radiologist missed the 2mm herniation so dr ordered spinal tap. The Neurosurgeon said the reason I had to have 3 spinal taps to get csf fluid was because the chiari was blocking my fluid and unfortunately this worked as a vacuum & made the herniation worse. Chiari seems to be missed on mri scans often from my findings because lack of awareness. Spinal taps are dangerous for Chiarians and after mine , my health went downhill. Even w/decompression surgery I’m still having memory issues & head & neck pain. It just scares me when someone says they have headaches & symptoms of Chiari because in my experience I have to , nurses etc because when I go to ER for severe head pain they say. They’re not familiar w/chiari. Then act like I’m just seeking meds like a junkie when their morphine doesn’t touch the pain. So so frustrating! Thank you

  58. Good evening Sethi,
    My concern is such. little over a year ago my left side ,became painful . Nerves were jumping in my legs, along with burning sensation ,throbbing. Had been going on for about 2 years. I do have spondylosis in my lower back, along with OA ispurs as well . I went to a neurologist and a EMG was done.. Came back I have motor sensor polyneuropathy and carpel tunnel in both hands. Medication was given with no relief . My family Dr ordered complete blood work . My Anticlear Antibody came back ABN and positive. He then sent me in for a M.R.I on my brain with and without contrast. to rule out M.S. sTILL AM VERY CONFUSED . i have a copy of my M.R.I IN FRONT OF ME RIGHT NOW. tHE FINDINGS was MOderate Cerebral atophy was noted. Multiple foci of increased flair signals are located within the subcortical white matter of both frontal lobes with a few additional foci in the left parietal lobe subcortical white matter. Findings may be related to small vessel ischemic demyelination or could be associated with basculitis. . impression was. Moderate cerebral atrophy GREATER than would be for this age. . I was 50 at the time of this M.R.I in 2011.Scattered foci of increased flair signal predomination in the subcortical white matter of both frontal lobes as discussed above. No enhancing mass or no signs of mass effert. I was then sent for a spinal tab., all I was told I did not have M.S. i I requested a D.N.A. test be done. to confirm i did not have M.S.When it came back, my family Dr. told me I did not have M.S. I also got a copy of it. The one item of the result test that worried me the most was it showed One positive, one negitive and one undetermined .By last sept my legs were hurtting so bad, I could hardly walk across the floor, I requested to see a Arthritis Dr. His findings were Fibromyaligs. . Medication seem to ease the pain, but I know it is still there. I. I I feel electric shocks from time to time in my head, they will last for only a short period of time. Some days I will feel them more than others, some times not at all. Has me very concerned. I have looked up cerebral atrophy. and says it is the loss of my brain cells. and the brain shrinks more than is expected for my age. and can lead to more complications and even be fatal . My Dr. left me hanging and nothing else has been done. What should my next me be ? or is this something I should not be concerned about at all ? Thank you for your time :)

  59. Dear Dr.
    I recently had an MRI done that stated their 2.33 mm focus of t-2 prolongination within the superior right frontal lobe within the sub cortical white matter. It was described as non-specific finding and it was noted that there was no evidence of demylanation. My dr. dismissed it? He said the location was not consistant with MS and that these types of small foci are very common? Is this the case?

  60. Hi
    i’m a 52 year all female i have white brain matter on both frontal lobes, i now have hand and leg tremors on my right side very bad pain in left side of head. sometimes my hand don’t move when i want them to move. confessions and memory lost stop driving because of dizzy spells have trouble walking and move at times had abnormal MRI

    • Dear Crystal,
      thank you for writing in to me. Whether the white matter disease is the cause of your symptoms and what is the cause of the white matter disease needs to be evaluated. My advice to you shall be to follow up with your doctor/ neurologist.

      Personal Regards,

      Nitin K Sethi, MD

  61. Hello Dr.
    For over 12 months I have been having what I can only describe as flare ups of symptoms. I suffer with a feeling of drunkeness and burning pains in my right leg and foot. I have a tremor in the left hand and headaches and feeling exhausted. I also experience weird visual things. It’s like I am looking through a fine fog so things seem ‘grey’.
    My initial symptom was the feeling drunk and fatigue with the headaches so 12 months ago I was sent for an MRI. The report states that there are multiple small foci high T2 signal in deep white matter both cerebral hemispheres.
    This is now been going on for over a year with some of the time being symptom free. Do you have any ideas as to what it could be based on the MRI report? I am due to see the neurologist in 6 weeks but I was wondering if you had any ideas.

  62. I have always been a high energy woman..have always worked multiple jobs and had a love of life and people.
    I too began having “jolts” shooting through my upper spine..sudden..sharp..then gone..this continued until July 14th 2012..when I awoke one morning with a paralizing headache. I have never experienced anything like it. It lasted for 10 hours..I was immobile throughout and refused the hospital at the urging of my family. It truly felt as though my brain was swelling..I finally got relief and was exhausted.
    The following day I had to leave work due to feeling out of breath after a few steps. It was near 100 degrees..my teeth were chattering and I stayed wrapped in blankets on my back porch. I finally realized that I was no longer myself and went to the doctor. An MRI with contrast showed a 2.2 cm “spot” as a “possible low grade glioma” with slight intensity on T2 flair

    • Sorry this is taking 2 posts..but I am writing from my phone…
      The spot is in my right temporal lobe..the differential diagnosis has changed 6 times..still unchanged on MRI..the last radiologist wrote “possible low grade glioma differential diagnosis post inflammatory sequelae”.
      I have now lost my home due to my inability to work. My left breast has somehow been affected and is much larger than my right..both breasts are stiff and painful. I am trying to be seen by a large neurology group..but..although my insurance will cover it..they will not see me until I am diagnosed. I really need guidance at this point. I am..in no way..the same person I was on

  63. When I was younger (about 25 years ago) I went to church camp and during that time a tick got under my skin in my head (how long it was there I do not know). I went home and my Mom picked it out. After that I broke out in a ringworm rash all over my body. Went to the doctor and was told it was ringworms and treated me with over the counter meds. Since then I brake out with blasters, my right eye is not very good, my right ear is always buzzing, I have had seizures (Grand mal, partial) all occur during the time. I had gone to different doctors and seems they just want to treat the one thing. Anyways, I have just recently had an MRI done.. See report notes below:

    1. Small developmental venous anomaly at the junctions on the lieft mid insula and frontal lobe, usually an incidentgal finding. No evidence to suggest an associated cavernous angioma. 2. Two Punctata signal abnormallties in the subcortical white matter of the frontal lobes, a common finding which is usually incidental and decondary to a prior small vessel ischemic, inflammatory or toxic insult.Also states, Two punctate foci of FLAIR hyperintensity within the subcortical white matter of the bilateral frontal lobes.

    I always had an EEG done as well and that was normal. I do have a appointment tomorrow,but, I just is just wondering what you input on this is and what kind of questions should I ask?

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