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

  1. What about White Spots in my 3 1/2 yr olds White Matter, she’s done Mylenating which was confirmed on 2 MRI’s done a year apart. She suffers from Severe Dysphasia, Speech Delays, Multiple GI Issues w Gastrostomy Tube, FTT,RAD w Lung Damage due to Silent Aspirating and 4 Aspirated Pneumonias a 34 wk Preemie 12 day stay in the NICU,Although she is Brilliant she tests socially and verbally is at a 7 yr old level w some minor speech delays no Delays anywhere else she runs, walk, talks, counts, ABC’s and more her Drs here in Phoenix are puzzled and say that she shouldn’t be as far ahead as she is, that she should ben fdelayed in everything

  2. Hello Dr Sethi

    My recent MRI showed 2 tiny white matter, nonenhancing frontal lobe lesions and a T2 hyperintensity. This was done due to a 3 week episode in March of tingling in various places at different times, blurred vision, ears ringing, lightheadedness, an electric shock, and intense buzzing in my chest as if standing on an electrical wire.

    Then in May/June I had another 3-4 weeks of left leg weakness and foot drop with many trips and falls… especially upstairs, bumping into doorways, grabbing onto furniture and side stepping to keep my balance, inability to walk after stepping out of the shower once, and many times I nearly passed out with nausea and tunnel vision.

    Finally I had 1 episode of extreme overall weakness where I felt like gravity was pulling me down. I literally looked like a marionette puppet on strings while I srruggled to stand upright but had no control.

    I still have lightheadedness, heavy legs and a feeling of falling backwards and side swaying while trying sit upright.

    My Neurologist feels this is all due to migraines with stroke like symptoms and anxiety after my LP, bloodwork, VER and brain/ cervical MRIs all came back negative.

    Is it possible for so many symptoms, and continuing symptoms to be caused by migraines and anxiety? I don’t remember any migraines with either episode in March or May. I would say any anxiety was caused by my inability to walk and continued dizziness. What is you opinion please?

    Thank you, M

  3. Dr. Sethi
    Can you please help me understand something I read on my MRI. I am new to this blog and I have really enjoying reading your posts on these problems. MRI of my head was done in 7/2011 due to me having headache and double vision following a normal heart cath. I had a double bypass in 10/09 and a stent before that. I am on BP pills and cholesterol pills and stomach pill. MRI said few tiny discrete foci of high signal on FLAIR sequences in the deep white matter in the cerebellum, possibly part of chronic small vessel disease. I have had cognitive trouble remembering, staying focus, calculating, very fatigue and I have blamed all that on heart surgery but now I am thinking could it be this vessel disease. I applied for social security last year to to neck pain (MRI showed c4 thu C6 problems) and extreme fatigue and trouble concentrating. At just turned 54. Anyway their doctor had me do heel to toe walking and I was shocked I could not do this I walked like a drunk person would walk. He had me stand on one foot to balance and I could not do this. I read small vessel disease causes the above poblems, No one has followed up on this should see someone? Rheummy Dr. said he thought I had fibrmoalgia and another Rheummy thinks it is sjogrens. What I am scared of so much right now is that MOM Dementia and it started around age70 and she is 84 now in a nursing home. Please answer. Thank you

  4. MRI also shows T2 axial imaging series shows minimal bilateral maxillary sinus mucosal thickening with minimal ethmoid involvement on the left and minimal mucosal thickening in the left frontal sinus and FLAIR axial and sagittal series shows minimal periventricular high signal. Ovoid plaques are present in the deep white matter on the left and deep white matter in the right frontal lobe, nonspecific.

  5. Dear Dr. Sethi,

    Thank you for your blog. I will try to be as brief as possible, taking your valuable time into consideration.

    I am a 40-year-old female with right-sided glossopharyngeal neuralgia. The high-definition MRI that was done to help the neurosurgeon diagnose this condition concludes:

    A. Essentially normal MRI of the brain except for a few small areas of chronic small vessel
    deep central white matter ischemic changes.

    B. A small mass lesion (6.5 mm) near the anterior aspect of the left-sided* parotid gland. (He mentions that he is not sure whether this is within the parotid gland or just outside of it, such as a normal lymph node.) Ultrasound is suggested for further evaluation. *NOTE: This is on the opposite side of my nerve compression and symptoms.

    While I do not have any kind of medical training, I was wondering:

    1. Is the nerve compression relating to my neuralgia missing from this radiologist’s report, or am I wrong? The neurosurgeon determined that there is “a vessel loop contacting the right IXth and Xth nerve complex”. I know he is right because of my symptoms, but don’t understand why it would be missing from the radiologist’s report.

    2. If not the nerve compression, what could the finding in A. above represent? I have suffered from migraines for 20+ years, in case that helps.

    3. How important is it for patients to follow-up on things like the ultrasound that the radiologist suggests in B. above? Having a history of thyroid cancer which was removed just this year via Total Thyroidectomy, I don’t want to be paranoid, but also prefer to catch anything suspicious as early as possible. (I do have a history of swelling of some lymph nodes in my mandibular region, which appeared in imaging prior to the cancer diagnosis and a biopsy was done on the largest of these, with no negative findings. I do not know if any of these previously swollen lymph nodes are still swollen, or if they had anything to do with the cancer that was removed.)

  6. 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.

    1. 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

      1. hi i`m a 50 year old male. i have been having theses episodes.left sided weakness,left hand stiff hard to open,left leg weak. slurred speech. had a mri. showed 10 lesions in the left hemisphere and 7 on the right. my doctor said this is normal aging process. should i be worried. thanks for your time barry b

    2. how does this relate to having a TBI ? or is there any relationship,long term and short term memory. is present and changing.. u.s. veteran

    3. 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.

  7. 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

    1. 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

    2. 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. Have you been tested for lyme by a lyme literate doctor? I had similar neuro symptoms for years, saw two neurologists, two infectious disease doctors, and an endless parade of other specialists. When I finally saw a lyme doctor, had a Western Blot test from a lyme literate lab and began treatment, I began to get better. I still have some residual symptoms but my life is so much better. I think the fear of not knowing makes everything worse. Take care and good luck on your healing journey.

    4. Hello,I am a 56 year old male,I am a smoker “cigars”I would say i was over weight 97 kl /1:82m. In the letter from the MRI scan dated 5/6/13 it states “cerebral sub cortical white matter chronic ischaemic changes”. I also have experienced similar symptoms as “anon Nov 13/12.”including the electrical jolt she experienced, although mine was more like a malfunctioning moment,That is the only way I can describe it,just for a few seconds,my left hand & foot tightened up in spasm,& also the left side of my lower face, from my eye socket to the corner of my mouth, as if trying very hard to stifle a yawn,The first time it happened,it was very weird as I was walking through a shopping mall,& although I did not loose my balance I must have looked as though I had been tasered, it was not a twitch or nervous tic, That was in or around the end of October2012′ I continued having these symptoms for months, I once timed them & had over a dozen in 2 hours, then as quick as they came,they disappeared for 3months, now they are back but not the spasms described in my hand foot & face, just this mental “jolt”My biggest worry is my vision especially my night driving vision quality has become poor,. The malaise that anon Nov 13/12 is also very prevalent in my symptoms, not just a lack of energy, no motivation or interest in anything & loss of memory to the extent that I have to write notes about everything, I have also experienced a strong taste of what I can only describe as “burnt nutmeg” in my mouth for weeks,and the numb area feeling the outside of my right hand right now from the tip of my small finger to my wrist ,but before that it was the heel of my left foot for about 6 weeks,I also suffer from insomnia and do not know how this affects this condition. My question would be are the symptoms likely to continue as they are, or become worse over time,What if any are the treatments for this condition. I am very worried as is my whole family is about this condition,I don’t want to drive my bike or car in fear of blacking out & injuring someone or myself. Thank you

  8. Had another brain MRI done a few weeks ago and radiologist impression says no change from a year ago, everything is still the same. Says to correlate for possible MS. My eyes crossing “feeling” is getting worse to the point it’s causing me to stumble and grab on to things to keep from falling. It also feels like I’m losing my thought process…getting lost when going somewhere and I just feel like I’m in a “daze” all the time. It’s hard to stay focused. Also left thigh keeps going numb and I’ve been having a lot of pain in lower back and hips along with bladder and bowel problems. Does this sound like MS to you? Second neuro says possible MS but not enough evidence. Thank you so much for your time.

  9. 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

    1. 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

      1. 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.

      2. 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.

      3. 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

  10. 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???

  11. 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

  12. 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.

  13. 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

  14. 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?

    1. 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

  15. 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?

  16. 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

    1. Ehlers-Danlos syndrome? please go and look over the information about eds So You Think You Might Have EDS?http://www.ednf.org/ you mentioned fibro RA and stated that you have family members with same types of symptoms could be you have A VARIANT OF THIS genetic collagen disorder . IF YOU HAVE VASCULAR VARIANT IT NEEDS ADDRESSED IMMEDIATELY. LOOK THIS INFO OVER AND TALK WITH YOUR DOCS PLEASE THE LIFE YOU SAVE COULD BE YOUR OWN.

  17. D/Doc sethi
    I am 49+ years old . I am having headache from very long may be at the age of 17 or so . I have no head injury. when I got headache sometimes half portion or sometimes back neck sometimes elbow joints starts paining very high. It has no particular time or season or weather it can starts paining anytime. The frequency of paining is now increased thrice a week or it continues for 30 hrs or so sometimes even if I used to have disprin tablet.
    I got MRI and the observation is:- There is e/o T2 & FLAIR hyperintense T 1 hypointense linear signals in the left periventricular white matter in the left parietal lobe.
    The normal gray matter-white matter differentiation is maintained in the brain
    The corpus callosum and deep cerebral white matter appears normal.
    No acute infarct on DWI. No focal lesion on SWI.
    B/L thalami, basal ganglia and the brainstem appears essential normal. No focal lesion is seen.
    The posterior fossa structure including 4th ventricle are normal.
    No mass effect/midline shift seen.
    Bilateral CP angle cisterns & 7th /8th nerve complexes appears essentially normal.
    The PNS, sella and orbits appears normal.
    Conclusion: Incidental note is made of deep venous anomaly in the left parietal lobe. No other significant abnormality is seen.

    with regards
    V.K.

  18. dear doctor
    recently my mother(65) have a problem with her face . one of eye is not closing fully even when she is sleeping.her face has turned to one side like facial paralises.she also have headache .herCT Scan report says this Impression: CT features suggest possibility of ischaemic lesion in left frontal white matter. MRI correlation suggested .Please give me a guidance what should i do now

  19. Can anyone help me please white matter severe head pressure

    I am a male 38 years old I have been having those head pressure for a month or more with other symptoms like having a stroke or Tia’s, when i walk or bend down it increases, shortness of breath and spike in BP
    and Heart rate, I went to the doctors several times and the ER but they returned me back claiming normal and anxiety and ct scan was Normal I Also had ten days ago ct scan with no contrast and also with contrast dye angiography of the brain, venogram and carotid
    with dye all came normal, I have no history of migraine or cholesterol or diabetes… but I had an mri a week ago and got the results today and it was not normal, how can it be, so I am very scared , I also have a left eye blurry vision a month ago called
    CSR condition , which is nothing related to MS , I read about it , no correlation at all, and I don’t think I have symptoms of MS because it does not cause sever head pressure pain, noe I have optic nerve, the eye Dr could have caught it Here is the mri test
    no contrast , can anyone tell me what it means or advise me Technique Multiple Sagittarius t1/t2, coronal t2, and axial t1/t2/gre t2*flair images of the brain were obtained. Findings There are few small non-specific white matter lesions of the cerebrum, the
    largest of which is a 1 cm lesion in the left frontal lobe laterally to the body of the lateral ventricle. A list of differential diagnosis for such white matter lesions is long but does include idiopathic demyelination such as multiple sclerosis. Other possibilities
    may include prior trauma,inflammatory processes, ischemia,etc. The silicon,ventricles and cisterns of the brain are appropriate size for age. No mass or shift is seen Are those tests I did accurate enough to rule out serious stuff, I heard small vessel disease
    and giant cell can cause this also, maybe lumber puncture is more accurate for brain bleeding

  20. I care for a 17 month old female. She recently had an MRI which showed her white brain cells are shrinking, and her brain is in an almost constant state of seizures, although it not always effects the body. How can I help her? How can I make her more comfortable? She used to smile, now her eyes look lifeless.

  21. My name is Rebecca, and I need help for my fiancé, Paul. He just turned 46 yesterday. He has an upcoming hearing for his disability appeal. He has a history of seizures since 2008, along with episodes of confusion,disorientation, and memory loss.We have no insurance.He had a CAT scan at the ER in 2011 after a seizure.The findings are: MILD PERIVENTRICULAR WHITE MATTER DEMYELINATION MORE PROMINENT IN THE PARIETAL LOBES THAN THE FRONTAL LOBES.FINDINGS NON-SPECIFIC BUT COMMONLY CAUSED BY CHRONIC MICROVASCULAR ISCHEMIC CHANGES.WHITE MATTER DEGENERATIVE CHANGES OF OTHER ETIOLOGIES CANNOT BE EXCLUDED.Please tell us what this means for him. Paul worked in the sheet metal trade for 22 years, but he can’t work now because his seizures and episodes endanger those around him as well as himself. But disability denied his claim, stating that he is still able to communicate. This man has 3 beautiful daughters and a 7 month old grandson that he would like to be around for. Please help. He is extremely upset and confused because he knows something is wrong but he doesn’t know what it is or how to cope with it. Please reply asap. Thank you and God Bless.

  22. Dear Dr,
    While I have an extensive medical history, I have had tremors for about 15 yrs, but the last yearsthey have been worse, they are not parkinsons. I also have Arnold Chiari type 1, I am female 52, recently diagnosed with this, but have suffered many years with migraines & severe head aches. My MRI finding are a few small T2 hyperintensities bilaterally to suggest mild chronic microvascular ischemic white matter desease or inflammatory process or migraiane. Cerebellar tonsils are low-lying suggesting Arnold Chiari type 1 malformation. Cortieal sulci, cisterns, sylvian, fissures and lateral ventricles appropriate for patients age. Grey white differentiaiation is normal. Extra axial spaces are normal. Visualized paranasal sinuses are clear. Flow voids are normal. Ventricles are midline position. There is no pass midline shift seen.
    I am having some memory problems that seem to be getting worse and have recently started stuttering, do you think this could be related?
    Thank you so much for your time and consideration.
    Robin

  23. For the past two years I have been having odd symptoms off and on… It seems I will have the issues for a few weeks and then they go away for a while and come back.

    It started by having issues starting to urinate and not being able to fully empty my bladder. I would go to my primary get tested for a UTI, but there was no infection. After a few weeks it would go away. About 6 months later it came back another UTI test with no infection. I started noticing numbness and tingling in my arm as well. Then weakness in my arms and hands. I started dropping stuff and things like opening bottles and buttoning my shirt would be more difficult. After few weeks it all went away and I was pretty much back to normal.

    This time around I had numbness in my feet, numbness/weakness in my arms, a burning sensation in my neck and down my spine about halfway down my back. My arms and hands started twitching that other people were noticing. The same old urinary issues and I am tired and hurt (body ache) all the time. I finally told my Primary something has to be wrong with me. She sent me to a Urologist, Neurologist, Sleep Doctor, and Endocrinologist.

    2 months later my Urologist diagnosed me with Neurogenic Bladder. She suggested given my auto-immune history and other symptoms that I be checked for MS. I kind of blew her off until my Sleep doctor said the same thing, So I mentioned it to my Neurologist who kind of blew me off … but agreed to order an MRI if my insurance approved. They did.

    I got the results today that said I have signs of White Matter Disease and leisons in my brain and that MS cannot be ruled out. My Neurologist read the results, refused to look at the scans. He asked me if the meds he put me on stopped the tremors (all of my symptoms have been disappearing again) and said if they come back then come to see him again.

    Am I crazy for wanting a doctor that can take 5 minutes to tell me if this is MS?

  24. Molly,
    I do know how your feeling and i understand you. I’m 36,been diagnosed with early alzheimers, brain lesions and others. I lost my job. Im now disabled for memory impairment. I too had a neuropsych evaluate me plus many tests ran. I’m so sorry but depression is not the sole answer if at all.

  25. DR SETH IM A FIFTYTWO YR OLD FEMALE WITH A LONG HISTORY OF MIGRAINE HEADACHES IN 2004 AN MRI WAS DINE AND THE OPINION WAS EXTENSIVE BILATERAL PERIVENTRICULAR WHITE MATTER DISEASE IN THE CEREBRAL HEMISPHERE PRESUMABLY MICROVSSCILAR ISCHENIC CHANGES OF MIGRAINES. IN 2004 HAD ANOTHER MRI WHICH WAS FOR MY NECK BECAUSE OF AN ACCIDENT WHICH CAUSEDME TO HAVE MY NECK FUSED AT THE C5&6 VERTEBRAE. IN 2012 I HAVE ALWAYS SUFFERED WITH MIGRAINES AND NOW IT HAS AFFECTED MY LEFT ARM SHOULDER TO HAND MY NECK CONSTANTLY HURTS. WHEN TI A DR WHERE HE SENT ME TO HAVE ASN X RAY AND CAT SCAN THEIR FINDINGS WERE CHRONIC MULTILEVEL DEGENERATIVE DISC DISEASE AND FACET ARTHROPATHY. MULTILEVEL FORAMINAL STENOSIS AND MINIMAL CENTRAL CANAL NARROWING AT THE C6 7 LEVEL. THE DR AlSO ADVISED mE TO GET AnOTHER MRI FOR tHAT PURPOSE. iT IS GETTING dIFFIcULT TO HOLD A JOB AND I HAVE HAd TO FILe FOR DISABILITY BECAUSE Of MY UPPER LEFT hAND sIDE AS U CAN SEE MY TYPInG

  26. iS NOT HE GREATEST ON MY LEFT SIDE. RECENTLY I FOUND OUT THAT MY SISTER HAS BEEN DIAGNOED WITH M S AND I HAVE GOT MY MEDICAK RECORDS AND WAS ASTONISHED OF THE INFO I HAVE FOUND WHIICH U HAVE THE FINDINGS. I AM NOW ANXIOUS TOI FIND OUT WHAT IS GOING ON BUT I HAVE NO INS OR DR TO HALP ME GET THE ANSWERS I SO DESPERATELY NEED.. IF U CAN PLEASE SHINE SOME LIGHT ON THIUS WHETHER GOOD OR BAD THANK U

  27. My son had a brain MRI that showed white matter lesions. He had no symptons for MS so far. Doctor said we have to wait for symptons to show so he can start treatment. I am very confuse.

  28. 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?

    1. Lisa, I had chronic sharp and stinging pains in my head for a solid year. They would come frequently off and on. Day and night. I finally saw a neurologist. I had a brain mri, a brain mra (which looks at vessels),a neck mri, and an extensive blood panel to rule out systemic diseases. After all testing, the conclusion was that he (the neurologist) did not know why I was having head pain. He did tell me that the mri showed I have significantly more white brain matter than I should for my age. BTW, I am a 60 year old female. He did not make this a concern to me. He said it did not mean anything, that we all get increased amounts as we age, and that mine could have accelerated and then slow. I have become a little more concerned with it and think I will get a second opinion. He prescribed a pretty serious drug for nerve pain.Carbomazipine, as I recall the name being. He had decided it was a nerve issue, although he didnt know the “whys” of it. I was scared of this drug. My trusted pharmacist asked if I was in a lot of pain, because unless I was, he would encourage me not to take it. I was in pain, but I was just too afraid to take this med. Alas, I sought a chiropractor. He pretty much fixed me! I had never been to a chiropractor and was not sure what I thought of them. I am a believer now. X-rays showed a misalignment at the base of my neck and top of the spine that was pressing a nerve. (or nerves). He prescribed 20 treatments, which involved a table that massaged my spine to warm the muscles before he adjusted me. BTW, they have this little tool called a chiropractor’s tool they use now. No jerking or twisting your neck. It is totally safe. Later in the treatments, he had me do neck exercise. I was skeptical. It wasnt until about treatment number 17 that the pains were gone! Totally! He said he couldnt tell me I would not ever have them again. He said we get out of line doing things the way we do them. The way we sleep, sit at a computer, etc. He told me I should have regular adjustments, not to let it get away from me. Stay ahead of it. I go once a month. I still get a few of the pains. Not a lot though. After an adjustment, I wont have them at all for a week or two. I really think I need to go twice a month. I wanted to respond to you because I had such a hard time trying to find out what was wrong with me.I googled and googled. There is so much info about migraines but nothing about head pain. I think you should see a chiropractor. Do your homework and find a good one.

      Suzie

  29. 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.

  30. 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.

  31. 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.

  32. 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 ?

  33. 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 🙂

  34. 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

  35. 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

  36. 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

  37. 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

    1. 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?

      1. 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

  38. Hi Dr Sethi, thank you so much for your blog. I am a 52 yo AA woman with a family history of stroke and heart disease. I am pre-diabetic, have cholesterol issues and am overweight. I was recently hospitalized for severe dizziness, room spinning, chest pain and lightheaded. The doctors in the hospital diagnosed me with Vertigo, but I just followed up with my primary doctor, who read my MRI results which stated that I had chronic small vessel ischemic disease. My concern is my risk for stroke and what does this disease mean exactly? Before the onset of the excruciating pains in the top and back of my head, I smelled smoke, but no one in my house smokes. I have had that smoke smell before and noticed that I was usually lying down and it was followed by minor chest pains for palpitations. I have an appointment schedule with a neurologist, but I am concerned as to if this could come back again. Is there anything I can do to keep the pain and lightheadedness from coming back?

  39. Sir nice to see such a nice blog on neuro diseases its truly an informational blog.
    I am 35 years old and from three years I was feeling muscle weakness in left side of my body. Its weakness which bothers my face arms and leg too. If I use much of affected side I am going to feel pain or spasm that side . It all happened in episodes and I had 10-12 such episodes (these epsodes don’t affect my walking balance or talking but yes I feel severe pain and in muscles.)
    2 years before I had MRI brain and report was normal. Recently I was diagonised with “NON SPECIFIC ISHEMIC WHITE MATTER CHANGES IN BILATERAL FRONTAL LOBES” ..one month ago . Now I am feeling the same phenomenon at my right side from two days.

    Sir plz guide me what are future complicatiins of this and what best measures I can/should take from my side.

    Thanks and regards

  40. Hi Dr. Sethi,

    My friend is having an bad headache since last 2 months. So, Dr ordered a MRI and MRI result shows some white matter lesions found in brain. She is 25yrs old and healty. She never had any issue with her health in the past. Painkiller doesn’t work every time. She is having continues headache.

    MRI result:
    several white matter T2 hyperintensities are present, mostly in the biparietal deep white matterbut mostly not periventricular and not assosciated with mass effect or enhancement.
    lesions lie closer to the grey-white junction then ventricles although a few albeit minimal periventricular lesions are present. In axial FLAIR view lesions size range from punctate to 1cm. Lesions are also present in the left anterior frontal white matter close to the gray-white junction but also less conspicuously in the right frontal lobe.A punctate pontine lesions is present on the right, best seen in non-FLAIR T2 weighted images.

    No cerebellar lesions are seen.The region of the sella appears unremarkable.
    Axial GRE images do not suggest any assoiciated hemosiderin.

    We are little worried after this result. Can you please tell us something about it. We have an appointment with our neurologist next month but we just want to know how bad it is and what are the side effects.

    Alos, her headache is still there and we really looking for something to stop it. Right now she is taking Aspirin and Diclofenac sodium 50 mg since last 2 days.

    Thank you so much in advance for you time and advice. Please let us know ASAP.

    Thanks!

  41. I am Asperger Syndrome Autistic. I have had a constant headache since mid 2005. I was diagnosed with White Matter Disease from an MRI. I have none of the symptoms but do have Post Traumatic Stress Disorder, Degenerative Disc Disease, Scoliosis, Arthritis, Asthma, and have had Pneumonia, Bronchitis and lung infection many times. Been a sickly child all my life. Is this just something else brought on by my Autism’ic brain or something else entirely?

  42. Dr Sethi, my 30 year old daughter was just diagnosed has having an Alfred Chiari Malformation. She has been having extremely painful headaches and went to her Dr and he ordered an M R I. This showed the brain set more to the back of the skull and the back tonsile set into the top of the first vertebra. The mri also showed white matter(?) And plaque around the brain. Please let me know what we are facing. My daughter is married with 3 children and her oldest child Andrew at the age of 9 also was diagnosed with this malformation but not as server has his mom.

  43. Hello Doctor, thank you for the information on white matter brain disease. When my MRI was done 2years ago, because of severe migraines, the radiologist told me without seeing me that he thought I was 80 years old. I’m a 65 years old. I was in a bad car accident in 1995, resulting in 4 TBIs. Since that my memory is getting very bad. My Dr. Told me I either have MS or a damaged brain, aren’t I lucky it wasn’t worse? No treatment or help. Is there anything to help my memory? I now have diabetes, HBP, Sleep Apnea, very bad arthritis, horrible stomach, depression, I’m having a stress test tomorrow because of indications of a heart attack. Is there any help for me? What can I do? Thank you Sir, I appreciate you input.
    P.S. My Dr. Said all people have White Matter disease If they live long enough. True?

  44. Hello Dr. Sethi,

    I am an 18 year old woman and had been having some pretty serious things going on, loss and change of sensation in hands and feet, foginess, loss of bladder control (releasing and holding) and bowels (releasing) and bothering me most is loss of cognitive and verbal functions.

    I lost vision in my right eye so they took me in for an MRI of my brain looking for MS or a brain tumor, which thankfully came back negative. I did however have 9 lesions on my brain, largest is 0.5 cm in my white matter, they have put on my file that I have white matter disease. I had a migraine once or twice as a kid, but never really had anything in the past 10 years. Past year my strange symptoms came on. I also have Graves Disease – Hyperthyroidism and osteo arthritis. Doc said I’m an old woman in a young woman’s body haha.

    They have yet to determine what kind of lesions they are and determine what has caused these lesions are. I’m hoping it’s nothing but every doctor I’ve met keeps trying to prepare me for the worst.

    I was pleased to find your post, very informative. Thanks for sharing it.

  45. Dear Dr Sethi

    I am 51 and had a stroke aged 38 and 45 as well as PE’s and DVT. I was diagnosed with multiple t2 weighted white matter hyperintensities aged 43. I also have lupus and APS. Recently they have increased my INR target because of small vessel disease. The lupus team are concerned about silent CVA’s but the neurologist says the scans not too bad all things considered. Who do I believe. I get migraines when my INR is low. My target is 4-4.5.
    I have just had a contrast MRI. Is it likely to show much more. Finally dementia runs in my family.

    Many thanks

  46. My left side went numb. They did a MRI on my neck. So they decided to give me fusion c spine sugery C-2,3 4 5 67 it was a two day procedure they went threw front of my neck and back they didn’t put me in a hello brace they put me in just a cotton brace . After they release me I had a seizure and couldn’t talk almost died. They did a MRI on my brain a year ago they said I had 10 white spots and they didn’t know what they were they did another MRI last Week cause its getting worse the pain and symptoms this MRI showed 40 white spots. Nuero says MS.. but 40 cells isn’t that bad don’t that mean its traveling fast..does it mean I’m gonna die.. and how long do have..
    Cause I’ve been feeling weird in my head.. please tell me

  47. Dear Dr. Sethi,

    I am a 57 year old male, nonsmoker, nondrinker and I consider myself healthy except for an enlarge prostate that I am taking medication for. This past Friday, I woke up with flu symptoms and the following day I woke up with a left facial droop and numbness. I rushed to the Emergency room thinking I was having a stroke. After the Doctor did some basic test he diagnosed me as having ‘Bell’s Palsy’. He also had me do a ‘Cat Scan’ and then based on the result he recommended that I do an ‘MRI’ as well, which I did. Based on the results of the ‘MRI’ he recommended that I should be hospitalized for further treatment. Because of professional obligations I chose to be released and went home.

    I am reaching out to you because I don’t know what to do and I’m asking for your help in reviewing the findings and maybe advise me on serious they are, they think it might be ‘MS’. I am including the findings below. I truly respect your generosity for taking the time from your busy schedule to analyze and answer these posts.

    MR MRI BRAIN W/O CONTRAST
    MRI BRAIN WITHOUT CONTRAST
    INDICATION- Left facial droop.
    COMPARISON- Recent noncontrast CT of the head.
    TECHNIQUE- Multiplanar, multisequence images of the brain were
    obtained without MR contrast administration.
    FINDINGS- The brain parenchyma shows FLAIR/T2 signal alteration
    scattered in the centrum semiovale, subcortical and periventricular
    white matter. A linear area of increased T2/FLAIR signal in
    the right
    periventricular white matter shows vague acute restriction on
    diffusion weighted imaging and EDC map. diffuse cortical

    atrophy is
    also present. There is no evidence of acute infarct, mass lesion, or
    acute hemorrhage. There is normal flow void in central vascular
    structures. The posterior fossa and brainstem are normal.
    IMPRESSION-
    Scattered foci of signal alteration in the centrum semiovale,
    subcortical, and periventricular white matter. Differential of
    demyelinating disease or patchy microischemic disease (often secondary
    to hypertension, diabetes, or vasculitis). Vague area of acute
    restriction in the right periventricular white matter suspicious for
    active demyelination.

    Procedure Types: CT HEAD W/O CONTRAST
    Verified
    CT CT HEAD W/O CONTRAST
    CT head without contrast.
    History- Left facial droop. Numbness. Technique- Axial imaging. No contrast.
    Findings- No large vessel infarct. No intraparenchymal hemorrhage. No
    extra-axial collections. There is subtle asymmetry with subcort i cal
    white matter lucency seen in the left frontal lobe. Consider further
    evaluation or followup with MRI.
    Impression-
    1. No acute process.
    2. White matter asymmetry. Consider MRI followup.

    Gratefully yours,

    Eric

  48. My recent MRI brain with and without contrast showed evidence of trauma in the frontal and temporal lobes. 30 yrs ago I did have surgery for a hole in the dura from congenital meningiocele at birth and they performed a cranioplasty and repaired the dura. So the frontal area is explained. The temporal “trauma” isnt explained in that this area was not touched. I have been having frequent aural migraines, some double vision, memory loss, weakness, numbness, etc in which they suspected MS but MRI ruled out. I cant account for trauma or falling and I have noticed when cleaning my ears after showering, in the left ear, there’s always a small amt of BRB on the Q-tip. I have haf severe nutritional deficiencies as I am 18 years postop gastric bypass, and have had severe anemia, B1, B12, B6 and D and protein malnutrition in the past. My PCP has attributed the left temporal “trauma” findings to my 30 yr old cranioplasty and dura repair. But this temp lobe trauma finding is new and never mentioned in prior MRI scans (at least adozen or more of them) thoughts?

  49. Hi Everyone,
    At the moment i am freaking out a bit.
    I have had Lyme Disease for a number of years…
    I have noticed a few differant things lately,so had a MRI..
    I see my Lyme Doc in a week…
    I know it has someting to do with Brain Scaring?
    Could be MS from the Lyme???

    The Results are-Low Grade Chronic Microvascular Leukodystrophy in Both Cerebral Hemispheres..
    What does it all mean????
    Thankyou Teen

  50. Dear Dr. Sethi,
    Thank you for you interest, have had 4 concussions in my life. 2 four months apart.7/12 and 11/12 I have been unable to work for the past 20 mos. I used to work 16/7 as a critical care RN. Spinal pain, cervical, extremely shaky hands and legs, Nausea and vomiting if I do anything, eyes heavy hard to see and the head is useless. Can’t spell do math. Depression stress angry. Over the past month facial seizures. Told post concussion syndrome. Make on sense 20 months and getting worse. Not getting answers so I tried 3 T MRI 1. foci of abormal signal intensity within subinsular regions bilaterally, more so on the right side. This could be due to traumatic white matter tract injury, ischemia or hypertension. Other possibilities such as migraine syndrome, demyelimation or vasculitis should be considered, however less likely
    2. Central atrophy verse mild communicating hydrocephalus
    3. DTI examination is planned, for assessment of possible occult white matter tract injury.
    Can’t live or function this way.. Does this have anything to do with the head injury?
    I wish they would just put me into hospital and decide what is wrong and how I can get help.
    They seem to be more interested in sports injuries.
    Have any ideas of where I could go for help, I can do nothing for myself. Can’t keep on track.. Gone to St Charles PJ go to speech, vestibular therapy. NYU Rusk and I can’t put anything together myself.. Any ideas I used to helping other people and I can’t care for myself
    Thanks hope you have some ideas of what to do or where to go to get help

  51. Dear Dr. Sethi-

    My neurologist put on my script, to rule out. 4-5 late hyperintensities were seen. In the interpretation, no mention of MS was noted. Wouldn’t a radiologist have put this as a possible diagnosis?

    Kindest

  52. Dr. Sethi,

    My mum had a cerebral/brainstem hemorrhage last 2012 and was been comatose for 3 1/2 months. she is doing better now, but she keeps on saying that her eye sight is not clear and she doesn’t remember everything and she sometimes saying non sense things.

    My mum MRI’s result says that there is a chronic hemorrhage, left basal ganglia, left periventricular white matter and splenium of the corpus callosum and hydrocephalus. what does these mean?

    Hoping for your reply. Thank u.

    -eyen

  53. Hi Doc

    I have been diagnosed with white matter ischaemic changes. Is this reversible with medication or yoga ?

    Sushma

  54. I am a 74-year-old male posting using my wife’s blog name. I have trigeminal neuralgia and recently had a contrast MRI which stated the following:

    “Mild burden of scattered white matter disease” which blew my mind and scared me.

    I exercise frequently (bicycle, resistance, swim, walk, stretch) and BP is generally in the 130-135/80-85 range. I take Trileptal and clonazepam for the TN – the Trileptal seems to raise the BP a bit.

    I frequently see the word “elderly” in the research literature – but no definition of elderly is ever given – in terms of age.

    I don’t feel “elderly”

    My neuro states that my white matter disease is very common in her “older” patients.

    I would appreciate any comments you may have.

    Thanks

  55. Dr. Sethi,

    First, thank you for this blog. It is very educational to the layperson. My 15 y/o son had an episode last fall that was ultimately diagnosed as a hemiplegic migraine. He also has Ehlers-Danlos Syndrome (Hypermobility Type), as do I. His history includes generalized anxiety and ADHD Inattentive type (these diagnoses made when he was 9). Neuropsych evals have shown normal intelligence, but a markedly wide gap between non-verbal and verbal intelligence–he shows very strong preference towards non-verbal. The EDS also causes some “brain fog” that is hard to differentiate from the ADHD, as well as orthostatic intolerance.

    During the episode last fall with the migraine and varying neurological symptoms, an MRI of the brain without contrast was done. The MRI report noted, “thinning white matter in the periventricular area” that was “not as much as would be seen with periventricular leukomalacia.” He was of normal birth weight (in fact, he was a large baby) and had normal development. None of his doctors, including his pediatric neurologist, have been able to tell me the potential causes of this thinning or what symptoms, if any, it could cause. I am growing more concerned, as he is now having some episodes of brief dizzy spells and blurred vision that are not otherwise explained. He has had exome sequencing for mitochondrial disease, but there were no mutations of note.

    I assume that by use of the word “thinning”, the radiologist was seeing more of an atrophic change vs. demyelinating. Is that correct? It seems every scholarly or research article I read is geared towards the very old or the very young with periventricular leukomalacia. If you could provide any insight towards potential causes that I need to explore with appropriate medical personnel, I would greatly appreciate it. With his EDS, I am concerned that he may be experiencing vascular issues that bear closer observation.

    Thank you so much!

  56. It seems these replies are dated a while back, so I hope this one gets noticed…

    I have an acquaintance whose 4 year son has a degenerative failure of white brain tissue.
    I do not know the name for the disease, but only that he is not expected to survive beyond age 8 or less… It is not Alzheimer’s, but something I am told only about 500 people World-wide have. And I am trying to get more information about it.
    Can you please help me find out more, and are there any things that can be done to help, or at least to slow down the progression? I will be grateful for ANY helpful information!
    Thank you!
    Sincerely,
    F Richard Burdett

  57. Hi, 4 yr ago my 52 yr old husband started to develope confusion at times, to the point he didnt know what was going on. He ended up seeing several neuro’s, to make this short, He had 2 brain bx. first one he was on high dose steroids , we didnt get the answer, the 2nd he was off steroids and we got the answer, he has cerebral amyloid angiopathy with granoulamatos angiitis. we have been told by all dr’s that they normally find this post mortum. we were also told patients normally make it 3-5 yr before a major bleed/death.he started having small bleeds nov 2011. he has been on cyclophosimide and steroids. then remicade infusions and now finally azathioprine, while on remicade the disease jumped to the other side of the brain. he has very bad headaches and sometimes cant open right eye when things swell up in the brain. he is now 4 yr out from diag. and we continue to fight this. we can only imange what these nasty drugs are doing to the rest of his body. My point is that Doctors need to start looking (out of the normal box). We were told by all dr (we really dont treat this in the brain we only suppress the symptoms)

  58. Hi Dr Sethi, Yes, I am one of the unfortunates diagnosed with some type of microvascular disease of the brain. However the radiology report reads “Advanced deep white matter changes LIKELY representing chronic microvascular ischemic disease with no acute abnormalities.” My symptoms are mostly unsteady gait, fluctuating memory, emotional flatness (I just don’t care) and general malaise. These symptoms have manifest over the past year, progressively worsening. I am 77 y/o F in (almost) perfect health. I do not have high BP, actually run quite low, no diabetes, do not smoke but did many years ago, cholesterol Is on the low side of high. What I do have is an almost toxic level of heavy metals, mostly lead. I grew up in a mining town almost next door to the smelter and played in the slag dumps and I am sure these metals were everywhere, especially in the water. The presence of these metals was just found about 5 yr ago.

    I am just starting a controversial treatment (IV Chelation) for the removal of the metals. I cannot tolerate any type of statin so am working on the cholesterol with the Mediterranean Diet. I do not take any prescription medications and since there is no other disease state to treat I am hoping that the Chelation will remove the metals from my brain (or at least stop any progression) along with other positive side effects. I have had 2 heart attacks and have 5 stents, one of which is already plugging up which is the original reason for the Chelation. The brain problem was just discovered from an MRI related to my numerous complaints. Have you heard of heavy metals causing this? My PCP feels it is probably the contributing factor.

    If the chelation does not clear up the (brain) metals do you think my problems will progress? To what degree? What do you think a likely prognosis may be?

    I will be seeing a Neurologist here soon but would really like to have your input…the more information the better. Thank You

  59. Dear Dr Sethi,
    My daughter is 39 & just received mri results that are abnormal.
    * 5 small hyperintensities on deep frontal white matter, nonspecific gliosis.
    History is very healthy, very intelligent & a career with TS defense systems/homeland security (all I can say on that). Family history; I’ve had brain surgery twice (meningioma), my grandmother unknown tumor/brain surgery. Her father (my husband) died of lung cancer with multiple metastatic brain tumors (Detroit/auto industry toxins/destruction of people & environment). Nothing otherwise, no heart problems in family, etc..
    Her symptoms was dizziness. However, she’s had an ongoing problem with esophagus, even making me worry about esophagus cancer. She’s been having problems swallowing; even recently “choking”/unable to swallow water; ccouldn’t breathe. SCARY!
    She has an appointment with a neurologist in a month.
    I can not find much information on this. I was surprised to learn about the connection to esophagus issues. Can you tell me more? Or give me a link to more info?
    So appreciated ♥
    Thank you

  60. What about DECREASED white brain matter in children? My grandson was born from induced labor. He weighed almost 7 lbs. he seemed totally normal. Later his motor skills were delayed. His soft spot did not close. Ultra sound was done. Said he had cysts in center of brain. MRI was done. No cysts. But has decreased white matter and more fluid than brain. Reg neurologist said he fine! Now at age 3 1/2. They say it’s not fine. Child is smart beyond his years. Knows things he shouldn’t know. Yet has no common sense.( put chocolate syrup in shoe cuz didn’t have a cup). Has other strange behaviors. Can you please give me some insight!

  61. I was diagnosed with “white matter ischemic changes” in 2005 after having a seizure brought on from Wellbutrin. Knowing that “seizures” was a possible side affect from this drug, it had been prescibed to help me quit smoking. This is the one and only “seizure” activity I have ever had in my life. I am now 60 and wished to continue my life insurance, and was denied coverage because of this 1 event in my medical record. I have not smoked in years, run 12 miles or so per week, and take no prescribed meds. Have a good weight/height ratio and perfect blood pressure. So, my question is….is this a sign of early Alzheimers? I asked the neuro doc years ago if this had to be disclosed if ever seeking insurance and his response was, “oh, you had a “spell”….nothing to worry about!

  62. Dear Dr. Sethi,

    I am in my early forties .

    I had an MRI two weeks ago and it came back with t2 non specific white matter intensities. I was referred for an MRI because I was getting terrible exercise headaches . I stopped going to the gym because I couldn’t cope with the headaches.

    I suffer from debilitating headaches . So bad that I have to stop whatever I am doing and just wait for the headache to go away. Lately the frequency of the headaches has increased. My eyes feel pressured. My jaw area is pressured. I get a dull ache in the back of my neck . I wake up in the morning to a headache these days . Over the counter meds don’t work anymore .

    I suffer from depression. I don’t know if I have bipolar – I am too scared to find out. I have extreme low mood and then very low mood within the same hour. I start crying when I am angry – like I am upset and angry at the same time.

    I used to have a sharp memory. Now I have started forgetting things. I can’t remember things. I make lists to remember. I get confused with memories and I get mixed up.I remember birthdays but get confused with incidents. I feel like when I am trying to recall things are foggy. For work too I forget things so I have to reread my material. I also find that increasingly I forget what I was saying mid sentence.

    What do you think is wrong with me ?

    Kind Regards

    Anjeli

  63. Dear Doctor,

    My wife had these severe headache and after diagnosis doctor referred her to Brain MRI and here is the report:

    MRI

    INDICATION: 31 years Female worse headache of life question intracranial mass
    or bleed

    COMPARISON: none

    TECHNIQUE: MRI BRAIN WO CONTRAST Sagittal T1, axial dual echo T2, coronal
    FLAIR.

    REPORT: There are several tiny subcentimeter foci of T2 hyperintensity in
    subcortical and periventricular white matter. 2 small subcortical white matter
    lesions seen in the anterior left frontal lobe best seen on coronal images 9 and
    11 of 32. There is also periventricular white matter T2 hyperintense lesion in
    the posterior right frontal lobe seen on coronal 22/32. Parenchyma of the brain
    otherwise normal. No midline shift or mass effect. No extra-axial collections.

    Major intracranial vasculature at the skull base patent.

    Orbits and globes intact.

    Paranasal sinuses, mastoid and ethmoid air cells clear.

    Midline structures including the corpus callosum, pineal region, pituitary gland
    and midline posterior fossa are normal.

    Impression:
    IMPRESSION: There are 3 tiny foci of T2 hyperintensity in white matter. These
    are nonspecific with a long differential diagnosis that includes small vessel
    ischemic, infectious, inflammatory and demyelinating processes.

    Dotor gave her some pain killers but she still got the same severe headache. Looking at the report/result, Do you think is there are serious problem?

    Your suggestion/comments appreciated.

    Raj.

  64. Are there any nutrients that can help with white matter issues? I recently heard on the radio that there is a nutrient linked to this problem but was not able to catch the name of it.

  65. Dear Dr. Sethi,

    I have read a number of the blog posts here on Brain disease’s Weblog and I am truly touched by what you are doing and the many people that you are helping. I would be very grateful if you would provide your thoughts on my mother’s case.

    My mother is a 54 year old, healthy, non-smoker, who has been experiencing chronic hypertension ever since a CVA that she experienced two years ago. The cause of the hypertension was never determined but after seeing a number of physicians, an endocrinologist noted that her high blood pressure began after an episode where she experienced visual disturbance, confusion, and aphasia for 30 minutes at work. This trend prompted him to consider the cause of her hypertension to be a CVA that affected the hypothalamus.

    MRI has confirmed she has white matter lesions along the lateral ventricles however the radiology did not comment on hyperintensities near the hypothalamus. I know that there are perforating vessels that supply the deep brain structures however I am not sure if it take a specially trained eye to see lesions to that area. Additionally I am not sure if there is a strong correlation between damage to the hypothalamus and hypertension in the absence of other symptoms (endocrine may be?)

    She has a history of migraines which from reading your other posts may be responsible for the white matter lesions. The headaches seem to be set off by jarring of her neck which is sensitive from many spinal injuries and surgeries. She fractured C7 spinous process in a neck hyperextension injury and has an anterior and posterior spinal fusion from T2-L2 which stresses her cervical spine. Many MD’s have commented on her brainstem which seems to be herniated slightly through the foramen magnum and all have commented on that space as perhaps causing trouble but no one has made any mention of that compressing arterial supply and thus increasing her risk for a CVA.

    She has had testing done to rule out a genetic clotting disorder and does not have any athormatous plaques present in the carotids. As I said she is very fit, eats healthy and does not fit the bill for the classic hypertension case.

    Despite the Corvediol treatment that the endocrinologist initiated, her bp is not controlled. It was controlled for about 2 months and then for the last three days she has been experiences flux from 160/90 – 220/175. The drug seems to not be working any more and this has prompted me to reach out into the ethereal net to see if there is a mind out there that may be able to put the pieces of this puzzle together and help us to protect my mother from a dangerous and potentially fatal CVA.

    If you Dr. Sethi could provide your advice I would be most appreciative.
    Thank you for your time and I will look forward to hearing from you soon.

    Sincerely,

    Charlotte Spear

  66. Dr. Sethi,

    I’m wondering if you could give me an opinion on my symptoms and MRI findings. I’m a 23 y/o female and have had new onset headaches that have lasted for 3 months. The headache is usually constant, not alleviated by rest (but made worse by lack of sleep), occurs in the front and back (also bilaterally), and is mostly dull/achy in nature (sometimes pressure and throbbing occur). I have these headaches all day long and usually every day of the week . Pain is mild to moderate, but annoying. I’ve had a couple instances of severe headache, with pain being an 8 or 9 out of 10. I don’t take OTC medication or prescription medication for my headaches. In addition, I’ve experienced lightheadedness and blurred vision (but no changes in vision). Generally, I don’t have much energy and feel tired often. My sleep pattern is not ideal, but it’s not horrible either. A couple days of the week, I only get a couple hours of sleep or none at all. The rest of the time, I sleep anywhere from 7 to 10 hours. I have low levels of vitamin D (confirmed by lab results) and probably low levels of iron (I’m a vegetarian). My last CBC/Metabolic Panel (6 months ago) was significant for a slightly low hemoglobin level. I have not taken vitamin D or iron supplements for months, but I’m currently taking magnesium and melatonin (hoping to help the headaches). I had an MRI without contrast done and the results are as follows:

    Minimal punctate FLAIR/T2 hyperintensities are present in the subcortical and deep white matter of the cerebral hemispheres. (Everything else is unremarkable).

    My neurologist says I have migraines, but I’m a little concerned with the other differential diagnoses. (I should mention, my neuro. exam was normal). Personally, I would have rather had an MRI with contrast, but it was not ordered. What is your medical opinion on my symptoms and MRI findings? Also, I have read an article about a study correlating hyperintensities in subcortical white matter and stroke/dementia/mortality and am wondering what your thoughts are on this issue. Thank you for your time.

  67. I am revisiting my 4 year old MRI. My initial diagnosis was silent migraines. I followed up with the neurologist who assured me that I didn’t have MS. My MRI results were numerous T2 hypertensive white matter liaisons are present bilaterally, without acute intracranial abnormality, without abnormal enhancement. Various blood work was done and everything was normal. At age 49 I went on with my life. I am now 52 and have declined. My major issues is my mussel seizing. I have been doiagnosed with fibromylega, but I still feel like it could be MS. Any options are welcome.

  68. Dr. Sethi,
    I am a 61 year old male who played tackle football years ago while in the military. During the season I would get “dinged” or as we called it the “have my bell rung” a couple of times. Prior to that I had no history of migraines, but since that times I have suffered from them. My question is…….is there any relationship with traumatic brain injury type migrains and white matter lesions?

  69. I am 62 years old and have suffered with migraines for many years. Also in the last 3-4 years, I have had significant memory loss. I am ready to lose my job of 17 years due to the memory loss.I just had an MRI of my brain. I’m a bit overwhelmed right now, as the time between my MRI and meeting with the Neurologist is 1 month. I still have another 10 days until my appointment for the results. The Neurologist did however respond to an email that I sent him. His response was “MRI showed Multiple areas of scattered punctate and confluent white matter T2 hyper intensity are nonspecific. there is a long list of causes for it, nothing to worry for now ”
    Unfortunately, my employment is in jeopardy. I had a warning from our HR representative yesterday at work, stating if I forget to do one I procedure I can be immediately terminated. Can anyone help me to understand what the reply from my Neurologist meant?

  70. I just want to know if their is any other reason for juxtacortical lesions…only thing I can find in search is ms…please if you can steer me in the right direction…or is it the only cause of juxtacoritcal lesions

  71. Hi Dr. Sethi,

    I recently had an MRI done on a 3T machine which showed several hyperintensities in the frontal lobes bilaterally in the white matter as the radiologist put it.I have had a history of stroke like episodes since 2004 which has produced various symptoms and deficits including muscle atrophy,cognitive impairment,assymetry,facial drooping,speech dificulties,imbalance and gait issues.Some of the symptoms has gotten better over time since 2004 but most still remain to some degree.I have had conflicting reports from my doctors because there were’t able to see anything on MRI on the 1.5T until this recent scan on the 3T machine.Could these white matter hyperintensities be the result of the stroke like episodes I have been having since 2004?.Are there other tests or scans that you might be able to suggest I could take to see what’s causing this?Thank you for your time and consideration.

    Sincerely,

    Steve

  72. I have moderate to severe ischemic white matter disease with multiple ischemic foci in the white matter of both cerebral hemispheres. Over 15 -20 “lesions” scattered through each up to 2mm to 1cm. I have no symptoms nor history for their common occurrences. But… in 2003-04 I did contract Valley Fever(cocci), which disseminated quick quickly to my joints and I was in intensive care for five days and longterm hospitalized for nearly 5 months afterwards with pik-line I.V. I received Dyflucon 500 ml three times weekly.

    Would that explain the white matter “disease” or scarring?

  73. hi i would like to seek your advise my mother (63 years old) was recently had her MRI and the impressions are:

    – Rounded foci with surrounding edema in the left frontal cortical, left temporal and left high parietal parasagittal region and right paramedianpons are highly suggestive of a metastatic process. suggest clinical correlation.
    – Microvascular ischemic changes, both cerebral hemispheres.
    – Cerebro-cerebellarvolume loss

    Does foci could be healed? Will she be ok? We’re so worried..any advises from your expert oppinion will be higly appreciated..:(

  74. HELLO DR. SETHI,
    SIR, MY 2.5 years nephew has been diagnosed with multple T2 hyperintense foci in bilateral frontal white matter. sir he is absolutely normal in everything (physical and mental development) except 3 episodes of unconsciousness that to in high fever—what it means—do need to worry—kindly advise

  75. Dear Dr. Sethi,
    I can’t express how helpful your blog is. I’m a 30 yr old female who has had a migraine for, well today makes 28 days. My doctor had me go to the ER for a third time for the following symptoms:
    *Migraine (unresponsive to medications)
    *Vision impairment
    *Speech difficulties
    *Hearing loss and ringing
    *Stumbling
    *Dropping things
    *Tremors
    *Fatigue
    *Muscle spasms/twitches
    *Numbness/tingling
    *And a strange incident of pain like I’ve never experienced before along my lower skull, spine and inner legs that can only be described as a stabbing fire.
    They decided to do an MRI through the ED and it read “a few T2 hypertinsities are seen in deep white matter bilaterally, non specific in distribution. Minimal non specific white matter disease in the brain. Migraine vasculopathy would be a consideration” However there’s one small detail that worries me, my mom has MS. It took them 5 years to diagnos her and she suffered horribly the whole time. Should I be worried the same could happen to me? Unfortunately I don’t see the neurologist for another almost 2 months due to a lack of them in my area. I don’t want to spend those months worrying myself into a fuzzy if I don’t have to. Thanks for your time and blog!

  76. Edited & Final Version

    Dear Dr.Sethi,
    Thanks for sharing this information. It helps a lot of us. I just wanted to share my personal experience – my wife’s similar symptoms related to migraine, vitamin deficiencies and being prone to infections and allergies, that a lot of the folks have talked about here – additionally she also has constant dizziness and boaty feeling (feeling as if one is on a boat). While there could be and definitely is some sort of an inflammation in the brain that needs to be neurologically addressed, as is also evident from MRI reports folks have mentioned here, the root of all that and numerous other symptoms different people talk of, is really the Gut and the digestive system, and related food allergies most prominently wheat and gluten. It’s called “The Leaky Gut Syndrome” leading to a leaky brain consequently. I’m in no way a subject matter expert neither am i proposing browsing internet for finding cure to your diseases, but if i may, with the kind permission of the doctors on this forum, please suggest to check out the info on leaky gut syndrome including a youtube video of Dr. Amy Mayers MD, on this subject, it may just help some of the people out here to contain the root cause and lead a happier, healthier life. Thanks ! and Thanks again Dr. Sethi for your kind gesture of sharing this information

  77. Dear Dr. Sethi
    pls help me on it’s brain mri report of my 6 months old son. how dangerous for him.

    MRI OF BRAIN
    Technique: MR imaging of the brain was performed in sagittal, coronal and axial planes using 8HR brain coil to
    obtain T1, T2 weighted, diffusion, gradient echo and FLAIR images.
    Imaging findings:
    There is diffusely reduced bulk of white matter in both cerebral and cerebellar hemispheres. No signal
    alteration is seen.
    Rest of brain reveals normal morphology and signal intensity patterns. There is no mass lesion or any active
    granulomatous lesion. There is no ischaemic or hemorrhagic infarct.
    Medulla, pons and midbrain appear normal.
    B/L basal ganglia, internal capsules are normal. Bilateral thalami appear bulky.
    There is asymmetric dilatation of bilateral lateral ventricles (predominantly frontal horns) with
    undulated margins. Nodular heterotopias are seen along ventricular margins (R>L).
    Third ventricle and fourth ventricles appear normal.
    Basal cisterns, sulci and bilateral sylvian fissures are normal.There is no midline shift or extra-axial collection.
    Pituitary gland & parasellar region is normal.
    Bilateral 7th and 8th nerve complex are normal.
    Bilateral CP angles are normal. No CP angle mass. There is no compression at the CV junction. Intracranial flow
    voids are normal. B/L orbits & optic nerves show normal MR anatomy & signal intensity. Paranasal sinuses are clear.
    IMPRESSION: MRI study of Brain reveals:-
    * Grosssly reduced white matter bulk with asymmetric ventricular dilatation with undulated
    margins with nodular heterotopias (R>L).
    * Mildy bulky bilateral thalami.

  78. Hi I am a 48 female that has had 2 vertebra removed in less than a year in my back , but have been having terrible falls , in the past 3 weeks I have been so dizzy I can not walk , I have very hard front load headache so badly I can’t stand to see light … my local ER did CAT and MRI on me because of family history ” my dad passed of heart disease at age 54″ … my mother has a long history of migraine headache and has had several mini strokes … they both have high blood pressure , high cholesterol , my dad is diabetic , they both drink a lot of alcohol and smoke cigarettes….. I do have high cholesterol , good blood pressure , my sugar stays low 40 to 60 , I quit smoking 3 years ago but do have COPD and I do not drink any alcohol… but the MRI showed I have mild chronic microvascular ischemic changes within the cerebral white matter of my brain … does this mean I have White matter disease?

  79. I find all of the above posts very interesting and wonder if it is in any way related to my own struggles, Some time ago a SPECT scan came back with mild, global cerebral profusion deficits along with distractability attributed to CFS. I have struggle with “brain fog” since I was in my 30’s, I am now 61. I continue to struggle with deep memory issues and in April 2012 my neurologist said, We don’t know why you are having such deep memory issues, you’re too young to have Alzheimers.” I believe the trauma that I have struggled with has contributed to these brain issues.

    A Professor at Harvard Medical School, Doug Powell, feels that I may have non-progressive Mild Cognitive Impairment and says that each of my symptoms reflect this – I have struggle in the past with periods of disorientation/confusion, episodes of blacking out, deep and unrelenting fatigue, difficulty with word retrieval, memory, concentration/attention, weak in organizational skills. Minor abnormalities in my immoglobublins, and positive antinuclear antiboidy in a titre of 1:160 in a speckled pattern. A recent MRI shows tiny little white dots thought to be tiny blood vessels closing. It is so frustrating to be seen by so many neurologists trying to figure things out and to have no one take the time to explain these things to me. I have been studying my neurological issues for a good decade.

  80. hello i just got my mri results and am so confused. It says There is some increased signal adjacent to the posterior horns of lateral ventricles bilaterally extending into the optic tract radiations into small punctate foci in the left frontal subcortical white matter the vertex.

    then it says visualized paranasal sinuses demonstrate bilateral mild mucosal thickening and polyps within the maxillary sinuses measuring up to 10 mm

    then its says
    IMPRESSION
    nonspecific bilateral white matter findings. The differential is extensive including demyelination, microangiopathic disease, post inflammatory or post infection etiologies, vasculitis and drug reaction. Neurologic consultation recommended.

    CAN SOMEONE please explain this to me in simple terms. I’m going crazy here.

  81. Can you explain this: There is a dominant right vertebral artery. Left vertebral artery supplies primarily the posterior inferior cerebellar artery with a minimal supply to the basilar perhaps. There is an approaching fetal origin left PCA. The left PCA is seen quite a bit distally toward the clavarium and than typica. The vessel tapers normally but is characterized by more intense flow and more distal visualization than the vessel on the right, likely a variation of normal as opposed to dural AV fistula. There is some flow in posterior paramedian cortical veins but no definite fistula. Mild infundibulum origin both posterior communicating arteries.

    also: have you ever seen: confluent asymmetric increased signal in the right paretal subcortical white matter that is T1 hypointense and measures 2.3 by 2 cm. Additional patch multifocal areas of increased signal most prominent in the peripheral subcortical white matter. There are T1 hypointense lesions. Impression was White matter abnormality is non-specific. Could be ischemic. MS is difficult to exclude.

    Have a complicated medical history, but have never done drugs/alcohol/smoker. Is there any way, other than autopsy to determine the difference between ischemic and MS lesions? Have had symptoms of a stroke but also symptoms of MS (optic neuritis). No lesions ever on the spine. Also have Ehlers-Danlos/POTS/MCAS and bone infarcts.

  82. Hello dr nitin K sethi
    I am a 34 year old female. In January i had sudden blurred vision in my right eye without pain. My ophthalmologist did OCT and FFA. He said it is neruoretitis. He said there is swelling in optic nerve and macular edema. He sent me to Nerurologist and i was sent for MRI brain and spine. The impression of my MRI says::::
    Non specific T2 and FLAIR white matter hyperintensities noted in bilateral supratentorial brain parenchyma as described.
    I was treated with steriods tablets for one month and i got my vision back though it is slightly blur.
    Almost a month ago i suddenly had headache in my right side of head and right eye. My ophthalmologist says its not related to eye and neruologist says it mirgraine.
    I want to know is my MRI normal?? Is this white matter is some kind of disease?? What should i do next???

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