White matter disease of the brain: what do we know about it? Should I worry?

I frequently get asked about white matter disease of the brain. It is commonly reported when MRI scans are carried out causing concern to patients and family alike. So in this blog post that is the topic we shall discuss.

Just what is white matter disease of the brain? As you all may be aware of in very simple terms the brain is made of grey matter (comprising the cell bodies of the neurons) and white matter (fiber tracts). Think of white matter disease as changes seen in the white matter of different parts (lobes) of the brain visualized on a MRI scan of the brain. Either the white matter appears scarred or atrophic. If the white matter is examined under the microscope, degenerative (ischemic) changes are visualized in the small blood vessels hence the term ischemic microvascular small vessel disease is sometimes used. A point to remember here is that these white matter changes visualized on the brain MRI can be seen in many different diseases of the brain-diseases as diverse as leukodystrophies, nutritional deficiencies, toxic drug exposures, vascular dementia and multiple sclerosis (MS). So the radiologist’s report invariably lists all these differential diagnoses and when patients read their MRI report they get worried. Many write in to me asking me if they have MS.

White matter changes on brain MRI need to be correlated with the patient’s history and examination findings and that is where I as a neurologist step into the picture. Let me explain with a few examples:

1. A 29-year-old woman with history of acute loss of vision in one eye (optic neuritis) . MRI brain shows white matter lesions in a characteristic distribution (perpendicular to the long axis of the lateral ventricles). In this case multiple sclerosis is high up in the differential.

2. A 29-year-old woman with history of episodic headaches which are usually unilateral, throbbing in quality and accompanied by nausea and photophobia (brights lights bother her during the headache episode). MRI brain shows a few non-specific white matter lesions scattered in the brain. In this case the most likely diagnosis is migraine headaches.

3. A 75-year-old woman with complaints of memory impairment. MRI brain shows white matter lesions scattered diffusely in the frontal and temporal lobes. In this case vascular dementia is the diagnosis which comes to mind.

Should white matter disease of the brain be treated: if the white matter disease of the brain represents ischemic white matter disease it may be prudent to address vascular risk factors such as better control of hypertension and diabetes, lowering the cholesterol and advising the patient to stop smoking. There is now increasing evidence that white matter disease may cause cognitive impairment and may coexist with other causes of memory impairment such as Alzheimer’s disease in the same patient. On the other hand if the white matter lesions are demyelinating lesions of MS, then treatment is aggressive treatment of MS. If they are due to migraine then usually no treatment is warranted.

In children the cause of white matter disease of the brain is different. Various leukoencephalopathies, metabolic, hereditary and degenerative diseases are in the differential and have to be screened for and ruled out systematically.

I hope this small post helps to answer some of my readers concerns.

 
Nitin K Sethi, MD

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31 thoughts on “White matter disease of the brain: what do we know about it? Should I worry?

  1. Dear Dr. Sethi,
    I was doing some research on my recent MRI report when I found your very useful weblog. Thanks so much for this.
    I am a female, 32 years old. I started experiencing some tingling in my hands and feet and legs (mostly in my left leg and feet) 2.5 months ago. After a couple of weeks I went to see a doctor worried about neurological diseases including MS. I also asked him about vitamin D deficiency as I had read about it in my research as a reason for tingling. He sent me for a lab test and it turned out I had low vitamin D (62 nmol/L). So the doctor advised me to take 2000 IU vitamin D supplement per day. But I was still concerned about MS and he referred me for an MRI. After taking the supplements, maybe within a week or so, I started feeling better and within a month I had no tingling at all. My MRI was scheduled for last week and I thought it is better to get it checked even though I had no tingling anymore. So I went for the MRI (non-contrast and I was told it was 3T) and the results were back today. I went to the doctor and here are my results:

    FINDINGS: There are 3 or 4 small T2 hyperintensities identified in the subcortical white matter of both frontal lobes along with one small periventricular lesion adjacent to the frontal horn of the left lateral ventricle. No callosal, juxtacortical or posterior fossa lesions are seen. No intracranial mass. Extra-axial spaces are clear, sulci and cisterns are patent and there is no hydrocephalus. Major flow voids at the base of the brain are grossly patent. The mastoids and incompletely visualized paranasal sinuses appear clear.
    Minimal prominence of the central canal of the cervical cord is noted, measuring 1 mm in caliber, of doubtful significance. No cervical cord signal abnormalities. Mild straightening of the normal lordosis is noted buy the alignment is otherwise normal. No destructive marrow lesion or obvious fracture. The central canal and foramina are widely patent throughout with no significant degenerative changes identified.
    Normal thoracic alignment. No destructive marrow lesion or obvious fracture. No thoracic cord lesions are seen. Minimal mid thoracic degenerative changes are noted with no significant cord impingement. There is no central spinal or foraminal stenosis demonstrated.
    IMPRESSION: Minor T2 hyperintensities in the bifrontal white matter do not appear typical for multifocal demyelination and are nonspecific but may simply reflect chronic small vessel ischemic change. No cervical or thoracic cord lesions are demonstrated.

    So the doctor asked me if I smoke, have high blood pressure or high cholesterol or family history of stroke or heart attack. I don’t smoke, and don’t have high blood pressure and high cholesterol but my aunt had a heart attack when she was 50-60. I am so worried and confused about my diagnosis. The doctor said it is not MS and the lesions are not found in spine and only in brain. Could this be an early sign of MS? Could this later develop to other parts of my brain or spine? Or could it lead to a stroke in future? Do I need to ask for a contrast MRI and referral to a neurologist? Doctor said this “chronic small vessel ischemic change” is common in older people but considering I am quite young, it makes me so worried. I also need to mention something that I just thought about. When I was 11, I had a serious car accident and as a result broken fem-tib and collar bone. Could these lesions be the result of that accident? Is there any way to find out how old these lesions are?
    I really really appreciate your response to this.

    • Dear Jennifer,
      white matter lesions can be seen on a brain MRI and can be due to a variety of disease processes. As I stated in my posts just what do these white matter lesions signify can only be determined accurately by correlating the MRI findings to the patient’s history and examination findings. This is what I advice you. You should follow up with your doctor to discuss the MRI report in more detail. He may consider referring you to see a neurologist for a second opinion.

      Personal Regards,

      Nitin K Sethi, MD

    • Hey,
      Hope you are feeling good and having a better life. My friend also has same kind of symptoms and her MRI says similar kind of description too. I just want to let you ask that did you ever find the cause and right medication and how you feeling now? Please let me know ASAP. Thanks you so much in advance.

  2. Dear Dr Sethi,
    I have a couple of general questions regarding white matter disease. I will start with my personal history first ( I’m female 28years old)- about 4 months ago I experienced something like an electrical jolt inside of my head, very disturbing, like an urge of some kind of feeling in my brain (it was not pain). I went to the ER, got a painkiller and that was that. This feeling repeated next our every 10 minutes. After that everything was fine, I forgot about it. Two weeks later during a workout at the gym I experianced it again, this time with a strange taste in my mouth, a feeling of the swollen eyes This lasted almost all day, it made me really scared, I felt like something is wrong with my brain. I went to the neurologist, dr said that it was a panic attack ( I’m not a panic attack type of person). Next day I had MRI, which showed more than 10 non specific white matter lesions 1-2mm, mostly subcortical. The next days I experianced tingling in my feet and hands, numb spots all over my body- this lasted only seconds or minutes. I also felt a couple of days weakness in my right foot- but it wasn’t clinical weakness. From that time untill now I have lots of symtoms, mostly in the area in the head and neck. All of my symptoms come and go. Among them I had- burning tongue, one month long, my tongue became coated and scalloped, feeling of swollen right side of my face, eye and neck, I had blurry vision in my right eye, and eye ball pain ( no optic neuritis was diagnosed), a feeling like my right hand doesn’t belong to me. I feel malaise all of the time, like I have a flu without a fever, lately I developed face pain, headaches ( I have never had headaches in my whole life). I have extreme head, eye and ears pressure, From this “wave like sensation” in my head 4 months ago I became severly ill. I found a great ms specialist in Berlin, we had a conversation, and he saw my mri, that he said that according to the mri it’s very hard to explain my symptoms.. Than (after 3 months from my first MRI) I had a second mri- at my dr’s clinic. The radiologist evaluated the mri and wrote in the letter, that there are no significant changes in the mri, although I have 2 gliosis ( 10mm and 15mm) in both of my temporal lobes! The radilogist wrote that it’s due to a head trauma in the past ( I never had a head trauma, as well- the gliosis couldn’t be seen in my first mri). My neurologist said that if I will develope new lesions, we will repeat all diagnostic tests, but apparently gliosis are not new lesions for him. All the other diseases that may cause white matter lesions are excluded- I’m a non smoker, low blood pressure, no diabetes, no lyme, vasculitis. Well, I feel terrible, and I was (at least I thought so) a healthy person. My question is- is it like this that human medicine just doesn/t know everything about the brain, and that’s why it’s impossible to explain my symptoms? I certainly don’t meet the mc donalds criteria. Should I look somewhere else ? After the mri I just got dismissed by my neurologist, there may be no new changes but I feel really, really terrible.

    Best Regards, and greetings

    • Dear Aleksandra,
      thank you for writing in to me. I am not sure what to make of your symptoms since they are non-specific and do not localize to any one part of the central nervous system. My personal approach when I deal with patients like you is to do the minimum tests (preferably non-invasive) and then to wait and watch keeping the patient under close observation. I usually get the answer I seek in due course of time.

      Personal Regards,

      Nitin K Sethi, MD

    • WOW you and my 14 yr old daughter have way to many of the same symptoms and she also is being dismissed by her neuro saying take her meds she will be fine but shes not my baby is hurting and feels that this is going to kill her eventually and no matter how hard i try i cant make her understand because i dont understand no one can explain. Hope you find some answers soon and if you do would you please update this post and i will also for you if we find anything

  3. Dear Dr. Sethi,

    My 14 yr old daughter was diagnosed with BRE in November 2009 and has since been rediagnosed in June 2012 with Frontal Lobe Epilepsy and her MRI showed a 4 mm mass in the white matter of the Frontal Lobe. The mass was explained to us as nothing to worry about due to the “shape of the mass”. We had just come to terms with the fact that she was an epileptic and would have to take certain precautions to ensure that she didnt feel like she was not “a normal kid”, when 4 weeks she was riding the bus home and said that she “felt something switch off in her brain” she jumped and ran to front of bus and had driver stop immediately jumped out and began to vomit she was disoriented and shaky but after a few minutes she the recovered and THEN the 11 severe nose bleeds over a 3 day period began. On the 3rd day she was attempting to enter our car and had the same switching off feeling went to the ditch proceeded to vomit, sweat profusly, she then grabbed the right side of her forehead and began to scream and cry uncontroably. When we tried to console her she looked very confused and scared and didnt recognize anyone there. We immediately called the ambulance only to have them tell me after they calmed her that it was a panic attack no trip was needed to er even though her nose had started to pour blood again. I took her to er immediately after they signed off on her. Since she had been everyday in 3 days to the er they finally decided to cauterize the bleed that was in the right nostral. Since then we have made approximately 15 trips by ambulance to the er for headaches on right forehead that are dibilitating. Light does increase the pain her skin she says feels as though its on fire if you touch it. Her vision in right eye and hearing in right ear have been declining since she was 8. They have done numerous CT Scans, a Complete Health Panel of Blood Work, Ultrasounds, Xrays, Sonograms, and just lastnight she had a Lumbar Puncture. All test and scans have come back normal or within limits including her Depakote ER which was 78 (she takes a 1000 mgs a day od Depakote ER, .5 mgs Klonopin a day, and 25 mgs Topamax daily). She and I are both becoming physically and mentally exhausted because with each approaching day the episodes are becomeing more Frequent during the day (at school she is very embarassed) memory loss is present with each one, more intense, linger longer and have started to migrate to the base of her skull. I have even started researching these combined symptoms to only find that I am only scaring myself with possibilities., but mothers wwant their babies healthy and will go to any lengths to help. She is 14 yrs old 5’10 210 pds her skull measures 7.5. we have read just about all the Blogs and feel that you genuinly have answered each post in that persons best interest and to the best of your ability without actual examination and health chart so ANY suggestions you may have would be greatly appreciated by us both. WE NEED REST AND A BREAK FROM THE PAIN! ThankYou

    • Dear Ms. DeAnna,
      thank you for writing in to me and sharing your daughter’s history. I am sorry both of you are going through such a difficult time. While I cannot and shall not attempt to diagnose her over the Internet, a few thoughts that I would like to share with you. First are her seizures well controlled at present on current dosing of Depakote ER. Would a video-EEG to assess her seizure control be useful? Are these episodes of vomiting related to seizures or do they represent another disease process such as migraine attacks? As you may be aware of migraines do start in teenage years, headache episodes are severe and at times associated with vomiting.
      My advice as always is to follow up with her doctor. He/she shall be the best person to guide you forward, not me.

      Personal Regards,

      Nitin K Sethi, MD

      • Thank you for replying since the depakote er has been upped in dosage 2 wks ago to 1000 mg aday she has not had a seizure but is constantly plagued by these ” panic attacks” that come along with excruciating pain over her right eyebrow area sweating vomiting uncontrollable crying (due to pain im sure) hypertension and low blood sugar.. but ever since her first her first seizure she has kept a red spotchy rash on her cheeks (no bumps just coloration) has a brown disoloration on back of her neck and has had serious problems with weak joints (constantly rolling ankles tearing miniscus in her knees and her hips pop an cause pain) not sure how all of this is related or even if it is. Video EEG? Im not sure what that is can i just ask to have one for her? She had an EEG (sleep deprived) that found abnormal seizure pattern while she was sleeping (which is normal when her seizures took place until august 30). Are those the same test? Sorry if I dont sound so educated on the subject im trying very hard to research the tests and purposes for them. Thank you for your time.

      • to Ms. DeAnna, has she been checked for autoimmune disorders such as Lupus or Lyme. I have seen many of the symptoms you have described in friends that have both of these. The rash on her cheeks made me think of Lupus, that and all the joint problems. I’ve had horrific migraines since I was a child and I have learned that not eating often enough causes my blood sugar to drop,( not to hypoglycemic levels, just slightly above) and planning protein rich snacks every 3 hours helps prevent some of my migraine. I also get weakness, disorientation, photophobia, sweating, vomiting, and changes and decreases in sensation. just some suggestions based on my own experiences not on any medical training. There is nothing worse than seeing your babies in pain and feeling there is nothing you can do to help them. Good luck and God bless.

      • Thank you for your comments Shannon. There are many migraine triggers which have been reported. A migraineur is more likely to suffer an attack of migraine if he/she:

        –misses a meal
        –is sleep deprived/ has poor sleep hygiene
        –sometimes oversleeping can also trigger a migraine attack
        –stress (you are more likely to suffer a migraine attack if you are under stress)
        –certain foods can trigger migraine attacks (certain red wines, cheeses and so forth)
        –if you are a regular coffee drinker and suddenly stop drinking coffee or reduce your intake substantially
        –women are more likely to suffer a migraine attack at or around the time of their menstrual cycles

        Nitin K Sethi, MD

  4. Dear Dr Sethi,

    I am a 36yr old woman who was referred to a Neurologist as I have Migraines and had pins and needles in the night in my hands. I had an MRI brain scan and have recieved a letter to say it shows ‘high signal white matter lesions which are not entirely keeping with my age’? MR lumboscaral spine shows detailed L5/S1 pathology in contact with transiting nerve roots without compression’. I am not back t the hospital for 4months (this makes me think there is nothing to worry about? But I am quite worried and have to say following recent years of ill health (just lots of coughs, colds and infections to almost ever part of my body. I cannot seem to get an answer from my GP as he does not know what the above means either. Hope you can maybe point me to the what it could or could not be’s???

  5. hello
    i have recently had a MRI on my head and my results were that there are a few tiny non specific white matters .
    the other was a prominent appearance of an enlarged vein in the right occipital region.
    Would this create tingling in the neck, behind the nose and make you feel like you have block ears?
    Thank you

  6. Dear Dr. Sethi

    I am 41 year old woman and have been having tingling sensation in my hands and feet (mainly left hand) for the past 2 months. I was diagnosed with vitamin b12 deficiency and have been taking supplements. The tingling is much better since then but has not completely resolved (its been 2 months), so my PCP asked me to get an MRI done. This is what the report says. “There are scattered T2/FLAIR hyperintense foci in the periventrical and subcortical white matter of both cerebral hemispheres which are non specific possibly related to chronic microvascular ischemia”. The rest of the report is fine. Is this serious? Can b12 deficiency cause this in the brain? Or is it more likely to be MS? I am worried sick (my neuro appt is couple weeks out), I will really appreciate it if you can give me your expert opinion. Thanks so much.

  7. Dear Dr Sethi
    I am a female of 49 years old. Over the last five years I have had various problems with my spine. I have recently had a disection and fusion at c5/6.
    I have suffered from migraines since I was about 14 years old. Over the last few years they have got worse and last longer. I am on rizatriptan wafer and also a preventor sorry I can’t remember the name. On my last MRI my brain was also included. At the time the nurse asked me are u sure u have no metal on or in ur head. To which my answer was no. When I went to my dr for the results it stated one or two white matter abnormalities in both cerebral hemispheres. It was shrugged off with this is normal when u get old. I was 48 at the time and certainly don’t consider myself old. I am totally delibitated by these migraines. I can’t talk move or do anything and they can last from one to 4 days. Please can u give me ur thoughts on this

  8. This was very helpfull, and explained it in very clear laymans terms. Thank you. I have added your site to my favorites because my X-husband just had an MRI and at first we were told he had brain cancer. He just had gone through a long treatment for lung cancer. They remover his left lung. Then they did some more aggresive kemo treatments. I noticed he was having serious problems with his short memory. I got a copy of the MRI, and it said he had advanced subcortical white matter desease, which may be to small vessel ischemic chage, post raditation change, toxic/metabolic anonormality or demyelinating desease. At first the Dr.s said his cancer had travled to his brain, then 20 mins later they said it wasent. Thats why I have gone on-line to get deffinations of some of the things that were on the MRI. Is there any treatment for this?

    • Dear Lentz,
      I am happy that you found the blog posting helpful. Treatment of the white matter disease/changes depends upon the cause of the white matter disease. If it is due to systemic chemotherapy or radiation to the brain itself, there is no specific treatment apart from avoiding/changing the chemotherapy regimen. I wish you and your husband my very best.

      Personal Regards,

      Nitin K Sethi, MD

  9. I am a 24 year old single mother I work full time. While at work one day I was hit by a wave of extreme dizzyness and pain in the front of my headand blurry vision. The pain subsised and I drove home on the way I passed out while driving. I was seen by aneurologist and had an mri, he told me the mri was abnormal but was told that this was common in people that have migrains. Up untill this point I have never had a migrane. I was also told that these symptoms were brought on by stress. Since this first episode I have had trouble with my memory, I will be in the middle of a conversation and forget what I am saying, also I answer phones at work and will pick up the phone and I am unabel to speak because I can’t remember what I am going to say. I do not have a family history due to being adopted as a young child. I also have had weakness in my arms and pain in my neck and shoulders. Should I be concearned?

  10. Hi Dr, I’m a 47 year old female with vasculitis. Yesterday neurology assessed me with white matter disease from a previous MRI and symptoms, new labs and MRI will follow. My question is this: could this disease be brought on by a nearly fatal head injury at age 15? Could it be hereditary? I have 4 family members who died of brain and abdominal aneurysms (but skipped my mothers generation apparently, unless ischemic bowel disease counts). Or could this be a progression of autoimmunity after fibromyalgia and then RA? I know it’s not much info for those sort of questions but I’m beginning to think this has been going on for most of my adult life, I just never connected the dots. Btw Mrs DeAnna, i also have very bad nose bleeds on the right side, however most of my facial and brain pain is on the left. So sorry about your daughter, heart wrenching.
    Thank you Doctor

  11. I have been told I have white matter disease.
    My neurologist has me on 8 medications for severe stinging pain in my head. And 2new meds for the white matter. The side effects clearly say if u have stinging, burningan nunbness to go to ER. They told me to stop the meds for headaches. It was dangerous. My Dr. refuses to take me off of it. What can I do?

  12. Should I be worried I am 24…

    Findings: The sulci, ventricles, and basal cisterns are within normal limits for age. There is no intracranial hemorrhage, mass effect, or midline shift. No extra-axial fluid collections are identified. There is a possible punctate focus of T2 prolongation in the left high frontal subcortical white matter anteriorly (image 28). There is also a tiny, cystic appearing area in the right frontal subcortical white matter (image 22). No significant additional areas of abnormal parenchymal signal are identified. There is no restricted diffusion to suggest acute infarction. There is no abnormal intracranial enhancement.

    The visualized portions of the paranasal sinuses and mastoid air cells are clear. Patent flow voids are identified in the visualized portions of the intracranial carotid and vertebral basilar systems.

  13. Dr Sethi,

    I came across your article on white matter leasions today while searching for spectrum MS. I have been seen by a neurologist since 2008 for symptoms of MS which are not supported by MRI or any other tests. The last MRI showed incresed lesions compared to 2012, small and scattered. A cervical MRI in 2009 showed possible demylinating leasions which were not seen in 2012. I had a first attack of what suggested MS at age 26. The neuroligist at the time was and still is a specialist in MS in Washington state. He felt at the time that I had a cervical lesions then because of the symptoms that had manifested. Severe dizziness, tremor, reflexes off, nystagmus, etc. Lumbar was normal, all other tests normal. Clinical diagnosis was possible MS. That episode cleared after a couple of years, and I remained nearly symtom free with the exception of two episodes of fleeting peripheral vision loss and intermitten servere facial pain that would hit without any notice and then, gone, and of course periods of fatigue, sometimes sending me to bed.

    I am 55, female who spent years running, biking, hiking, vegetarian, do not smoke and only started to drink wine later in life, especially after living in Rome, Italy for a couple of years. I weight 130lbs, and I am 5’6. No Hx of hypertension, though my family does have a hx and heart disease. My father died of lung cancer due to his smoking, and mother died of a stroke. I have one sister diagnosed with MS and two sisters with seizure disorder.

    In 2008, everything changed and my life has been on hold. Fatigue hit hard, then weakness, pain in my right eye for three weeks, little vision change, blurring and some light changes. I developed treamor intention tremor in right hand, some in right leg. My eyes were shaking when reading, which was confirmed on exam. My evoked potentials were normal, MRI showed T2 hyperintensities but were not MS specific.

    During the summer, I was hit once again with a flare, when running, after about thirty-minutes, I began to feel dizzy, then my legs treamors so much so that I walked with a jerking movement the rest of the way home. After cooling down, the symptoms were gone, except for fatigue. After this I was referred to an MS specialist in Charlottesville, VA who was nine months pregnant, an hour behind, and very grumpy. She insisted I have a headache disorder, when I do not have headaches, I had one severe headache in the 80’s. She reported a positive Hoffmans reflex. Otherwise, she did not feel I had MS…She ordered a list of tests I did not have done per my internest did not feel they were necessary. My internest had been my doctor for ten years at the time. She feels I have a mild case of MS.

    Since 2008, I have experienced difficulty walking, fatigue, cognitive interruptions, periods of bladder issues, tingling, pins that suddenly stick my toes, acute itching, (this was my recent flare). A few months ago, I had the sensation of hot water down my right thigh, this subsided after a few weeks. AFter I work out I suffer often from fatigue making workouts very difficut to be consistant.

    I saw my neurologist who has seen me now for a couple of years. Dr Oh with Virginia Commonnweath University. He examined me yesterday, I had jerking when running my heal up one side of oposite leg, temor in left arm with finger to nose, balance is off, but mild. Dr Oh feeling he can only treat symptoms, and feels that my lesion load is abnormal but is not MS specific due to the number, I think I have 7-9 small lesions. The other tests, which I have had them all are normal. Blood work is normal except for a recent Hgba1c of 6. Vit D and B are normal. I take vitamines. I am depressed, my life is not my own and it has impacted the quality of my life and I am serching for answers. Recenlty resigned my position with Dentistry@VCU Private Practice as Registered Dental Hygienist. I also teach clinical dental hygiene and will continue PT as this is not as stressful.

    I don’t know what to do. Dr Oh gave me a presciption for Provigil yesterday only to find out my insurance will not cover it due to lack of diagnosis, it costs over a thousand dollars. Amantadine does help my fatigue but decreased my cognitive functions, I drove through a red light. My husband is full time dental faculty with VCU and attended my appointment yesterday. We walked into the exam room to find two third year students, I was not informed, and my husband had a lot of concerns. However, we felt uncomfortable with the students in the room. We understand students since we both teach, but I should have been given a choice. Dr Oh explained I am in the spectrum of the Bell Curve of MS, the low end, not the median. ???

    Thank you for your time and thank you for this Blog, it helps those of us in limbo. Please forgive the spelling errors.

  14. Hi Dr. Sethi, hoping you can answer me. For the past month I’ve experienced numbing in both feet, some diziness and fumbling in my hands ( that lasted about a week or so ) I have a hx of lower back pain and a bulging disc at L5-L4 that could be causing sciatica..but the numbness is only in the feet/toes. A recent non-contrast Mri of my head showed ” a few tiny scattered non-specific white matter hypertensity foci of 2-3mm noted on T2/ Flair sequences within the cerebral hemisphere. The rest of the exam is normal. My family dr “thinks” this is a negative report, however wondered why the radiologist didn’t mention or rule out MS in his findings as it was asked for in the requisition. Do they normally rule things out or maybe this dr wasn’t specific? What are your thoughts on this? I really appreciate your help as I am quite anxious over this recent event/ report in my life. thank you Doctor Sethi.

  15. 2 y/o male with onset of petit mal seizures approximately 1 month ago . First MRI was normal , MRI with contrast showed abnormal white matter signal changes. What could this mean ?

  16. Dear Sir, again another female. I am 53 yrs old but look about 45. Thats the good thing.
    I have had a CT scan. The thought was MS. Then an MRI which concluded I do not have
    MS. I have approximately 7 white dots in a close cluster in as explained in the frontal lobe
    of my brain. There is also some concern with the back of my lower brain. At times I get this tingling felling running from the top of my head to the middle back part of my head.
    My doctor is sending me for a second opinion to one of her Neurologists. She feels there
    must be more answers to this then just having another MRI every six months.
    You know I just thought alot of this had to do with menopause,the loss of memory,exhausted most of the time, vision loss. But when the tingling started to happen it did not make scene to me. There was something in the conclusion with the MRI that had to do with the capillary veins in my brain. The blood is moving slower. You know I am so happy it is not MS, I do not want to be a burden to my family. Sometimes I wonder if stress has anything to do with this?
    Well wish me luck. They have no idea what this is. I asked what is the worst that could happen to me, I was told full blown stroke-heart attach, Basically all over at once. Still a preference then MS.

    I really do not have a family history to explain anything.
    This not a sad thing, just reality.
    We are a combined family with 7 kids aging from 22 to 8 yrs old. Hey two sets of twins.
    My one concern could this happen to my 3 blood related children. Do they tell their doctors?

    And really what do they say?

    So what do you think?

    Thank you for your time.

    Always positive :)

  17. Dear Dr. Sethi,

    My MRI shows the following:

    Discreet and confluent foci of T2/FLAIR huperintesities scattered in sub cortical, deep and periventricular white matter of both cerebral hemispheres suggestive of non specific ischemic changes/ ischemic demyelination.

    I’m a 55 year old female, have been very active throughout and healthy.

    What does this all mean? Should I be worried at all Doctor??
    Many thanks,
    Kiran

  18. Dear Dr. Sethi,

    Your blog is fantastic. I have a question that is not so much technical, as it is hypothetical. I have been to two neurologists, and neither has given me any real indication what is going on with me. I am 36. I had several MRIs done last year to rule out MS. My only symptoms were tingling in my hands and feet, but my doctor did an MRI of my brain, just to be safe. The MRI came back with scattered, bilateral, punctate white matter abnormalities in the supratentorial brain (2 “suggestive” lesions in the corpus callosum), which were non-specific, but MS could not be ruled out. I went to a neurologist, who said that her gut was it wasn’t MS, but sent me for MRIs of my cervical and thoracic spine, which showed only multiple, slightly bulging discs (no lesions). I saw a neuro surgeon about the discs, and he said they shouldn’t cause the tingling and sent me home. I have never had an abnormal physical exam… symptoms are entirely sensory. I have had a lot of issues with anxiety, and rapid heart beat. Ever since I started exploring these health issues, my anxiety has gotten much worse. Is it possible that anxiety is the root of my sensations, rather than the brain lesions?

    Thank you,
    Linsey

  19. I am a 19 year old female that has frequent migraines that lasts several days medication help some. I had an MRI done and the results say nonspecific flair signal abnormality in the right frontal lobe juxtacortical white matter with somewhat linear distribution, possibly related to a developmental venous anomaly. can you explain this to me please, everything i look at refers me to multiple sclerosis but i do not have that. Thank you for your time

  20. Hi Doctor,

    I am 29 years old.

    I had weakness of left arm and leg. Neurologist did MRI Brain, it revealed T2 hyperdense scatterred foci suggestive of microvascular ischaemia, What should be the next step.

    I had history of high BP but it was not treated as it settled with exercise and diet.

    What could be the cause of Microvascular ischaemia.
    Do I need cardiac check up as well. I am worried if that was a Ministroke?? What you think…

    Thanks for taking time to reply

    • Good Day Doctor
      I am 62 yo fe.10 days ago I had a CT of head without contrast,due to fall with laceration to head.Impression white matter disease I had no symptoms,I have been “put to sleep” apx.39 times in the last 20 years secondary to placement of ureatheral stents(kidney stones) Could this frequent anetheasiea cause this.I fell because I was septic and spent 9 days in hospital.I wasn’t told about this only found out when I ask for my records.Should I be woried?

      • A very good day to you too Anna. White matter disease in the brain can have numerous causes but is more commonly seen in patients who have micro and macrovascular risk factors–such as hypertension, diabetes mellitus, high cholesterol and smoking among others. Anesthesia should not cause white matter disease. I would advice you to discuss the CT scan findings further with your doctor or a neurologist.

        Nitin K Sethi, MD

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