MRI white matter abnormalities

This is to Nancy

Dear Nancy, thank you for your comment to the post on white matter abnormalities on MRI does it represent MS? While it is hard for me to comment on your case specifically, the MRI report reads suspicious for MS. The reason is the lesions are periventricular (around the ventricles of the brain) and such lesions are at times more specific for MS.

I would though correlate this information with your age, your symptoms and importantly your history and clinical examination findings. If there is suspicion for MS from your history or clinical findings, then I would recommend doing further tests to either rule in or rule out the diagnosis of MS. Tests like spinal fluid examination, visual evoked potential and somatosensory evoked potential. As I stated earlier one can see these white matter lesions in patients who have vascular risk factors like hypertension and diabetes mellitus. I am not sure whether the drug you mentioned for RA has been implicated in causing them. You should follow up with your doctor, who would guide you in how to interpret these MRI findings.

Please refer to the MS articles on my website for further information. Feel free to drop me an email if you have any further questions. I wish you my very best.

Personal Regards,

Nitin Sethi, MD

11 thoughts on “MRI white matter abnormalities

  1. I’m writing to you because I seem to have puzzled many doctors in the last week and I’m hoping you may have heard of something similar to what I have. I’m 22 and I have had headaches and migraines ever since I was little. Two weeks ago I went to a neurologist and he sent me to have a MRI. My MRI revealed that I have white matter lesions covering the entire right side of my brain with little black holes appearing in the white matter (they are not sure if it is blood or old scars). The left side of my brain was lesion free and appeared completely normal. There was an MRA done as well and it was normal. My doctor does not think it is MS because it is only on one side of my brain and he does not think it is a tumor due to the large size and shape of the lesion. Two days later I had and EEG, another MRI and an ultrasound of my carotid artery. I haven’t received the official results from these tests yet but the techs gave me some info. The EEG showed problems on the right side of my brain on the occipital lobe. The MRI was a different one then I had before and the techs said that it didn’t focus on the areas they had seen in my last MRI and they didn’t know what the test was for. The Ultrasound was normal. I’m having a TCD and an LP schedule for next week. My doctor says he has never seen anything like this before, he has called several other doctors and neither have they. My only symptoms are that I have a baseline headache that never goes away. I feel pressure on my head and I have chronic migraines. I also have had some short team memory loss and I have become nearsighted in the last few years. If you have any Idea what I could have please let me know. Thank you, Alissa

    1. Dear Alissa,
      thank you for writing in to me. Your case does intrigue me especially since the pathology is confined to one hemisphere.
      It is hard for me to give you an answer here as I have not seen the MRI scans myself. It seems your doctor is rightly ruling out an infectious Vs inflammatory Vs neoplastic pathology.
      I shall be happy to talk to you over the phone and answer any further questions which you may have.

      Personal Regards,
      Nitin Sethi, MD

  2. Hi I underwent an mri w/o contrast since I have non specific facial pain–dr. ordered w/ and w/0 contrast but i refused since I have allergies and have read about side effects to dye….report stated mild white matter signal abnormalities correlate cinically…dr. wants mri w and w/o again and mra to rule out but am thinking is this overkill–have not had pain but since initial mri am feeling little shots of pain in head is this too much and am I wrong to worry so about contrast agent side effects?

    1. Dear Annette,
      the decision to order an MRI of the brain with and without contrast is made depending upon what you are looking for. There are certain lesions which are better visualized after giving contrast. As regarding the contrast “dye” used in a MRI, it is actually not a dye. The contrast is a paramagnetic substance called gadolinium. Compared to conventional iodine based dyes this is quite safe.

      Personal Regards,
      Nitin Sethi, MD

  3. Aloha, I am 27 years old and I am feeling the worst I have felt in my whole life. Six months ago, I started feeling ill with headaches,muscle aches, light sensitivity, fatigue, slight fever, tingling in fingers and toes, weakness, throat discomfort, and urinary frequency. I was tested for meningitis and diabetes, and both were negative, although my blood sugar level was a little high so I got a more specific diabetes test which came out normal. My symptoms went away for a while (maybe a month), but then headaches started again. My doctor diseregarded my symptoms for a long time and claimed I merely had migrains. She prescribed me sumaptriptan, then midrin, but both did nothing. Then, my headaches became constant and brutal. Story short I got an MRI and it showed a white spot in my left cerebellum 9 mm big. I also had a blood test which was normal except for vitamin d deficiency. My condition has been getting worse as now I have horrible joint pain, jaw pain, stomach pain, anxiety, horrible headaches which travel around my head, TMJ pain, mouth and tongue pain, eye pain and blurring in left eye’s vision, weakness, weird feeling in hands and feet, and so on. I have been given very slow and unsatisfactory responses by doctors and my insurance to diagnose what is wrong with me. I fear my condition will deteriorate before anyone will act like they care to treat me. What are your thoughts about possibilities of what I
    might have so I can ask my doctor to give me the appropriate tests or referrals to specialists to start getting answers. I don’t want to die because my doctors made me wait so long.

  4. Dear Dr,

    I am 30 years old. I have had severe headaches (constant daily)migraines and pain since age 12 or 13. I had an MRI done about two years ago and they said they viewed lots of white brain matter. Since then I have had weird muscle pain, legs and arms, blurred vision at times and intermittent trouble swallowing. The dr at the time called and said because of my braces on my teeth it was difficult to read all of the MRI. After that, I switched companies and insurance, so I did not go back, assuming that never receiving a letter, it was not that serious. What did those MRI results mean? Thank you

  5. Dr. Sethi,
    Thank you for providing information about non specific lesions as I have found it difficult to find any information about this. I had an MRI done approximately 1 year ago due to an ENT issue that turned out to be nothing. What was found was non specific lesions on my brain. I’m a 28 year old woman, healthy with no symptoms. However, I do seem to be forgetful and I’m worried this has something to do with these lesions. I’ve always been somewhat forgetful or “scattered” and I’m not sure if it is that I’m worried about these lesions or if it indeed something to do with these lesions. I have no other symptoms and only recently have begun to worry that my forgetfulness is linked to this. Could this be so?
    Thank you so much.

    1. Dear Nichole,
      thank you for writing in. The non-specific lesions are likely just that–non-specific. They may or may not have anything to do with your forgetfulness. I would advise doing a few simple things: consult a neurologist. He may or may not want to investigate you further for “memory” problems. I would also check your thyroid and vitamin B12 status. But the best would be to consult a neurologist rather an initiating a costly work-up.

      Personal Regards,
      Nitin Sethi, MD

      1. I was also given an MRI with a nonspecific small focus of signal change in the subcortical white matter of the right frontal lobe with no diffusion restriction. Can you clarify what this means? I have had hearing loss from birth, and have developed tinnitus. I noted that the right frontal lobe is related to hearing, so was curious if this may or may not be related.
        The more significant finding was that I had a cavernous venous malformation in my occipital lobe that was causing a migraine, and loss of vision. I’m waiting to see a neurosurgeon and am trying to decipher the MRI in the interim.
        I have Crohn’s disease, and have read that brain issues sometimes are linked to immune diseases. Would this potentially be the case for diseases such as Crohn’s?

  6. This question is not related to the above. I’m pretty sure I had another TIA. I was at work and suddenly could not think right or find correct words. I kept apologizing and telling my co-worker that I was very tired.

    The next day I had herpes lesions. At first i thought the herpes was causing the tias (I always get a severe headache) before an outbreak.

    PS I do have white matter lesions propbably from tias.

    Thanks for any info.


  7. Dear Terri,
    thank you for writing in to me. There can be many causes of white matter lesions in the brain (migraines, microvascular ischemic small vessel disease, demyelinating diseases such as multiple sclerosis and vasculitis are some of them). The MRI scans have to be interpreted taking the patient’s history and examination findings into consideration.

    Personal Regards,

    Nitin Sethi, MD

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