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Suggest Treatment For Several Lesions In White Matter Of Brain
Question: Hello, I just had an MRI done today, and was informed I had 15 mini-lesions, which the Dr thought might mean a microvascular issue or demyelination...what insights can you give me and is it possible the lesions might be benign? What am I facing?
Brief Answer:
probably a benign white matter disease
Detailed Answer:
Hello. I have been through your question and understand your concern.
It is very important to understand the cause which lead you have the MRI. As I can deduct the MRI reports several lesions in the white matter (since the two options include only the white matter).
It is more probable that these lesions are within microvascular white matter disease, which is a benign situation, but uncommon at your age. Generally related to high blood pressure, once you optimise the blood pressure these lesions tend to stay stable. There are no other measures to prevent such eventuality, but is considered a benign situation.
Demyelinisation instead has lesions which have different timing (which can be seen in the MRI) and specific location, like periventricular, optical and corpus callosum. I see it less possible at your age and because generally demyelinisation is highly suspected clinically with the MRI just confirming it.
Hope this helps. Wish you the best health
probably a benign white matter disease
Detailed Answer:
Hello. I have been through your question and understand your concern.
It is very important to understand the cause which lead you have the MRI. As I can deduct the MRI reports several lesions in the white matter (since the two options include only the white matter).
It is more probable that these lesions are within microvascular white matter disease, which is a benign situation, but uncommon at your age. Generally related to high blood pressure, once you optimise the blood pressure these lesions tend to stay stable. There are no other measures to prevent such eventuality, but is considered a benign situation.
Demyelinisation instead has lesions which have different timing (which can be seen in the MRI) and specific location, like periventricular, optical and corpus callosum. I see it less possible at your age and because generally demyelinisation is highly suspected clinically with the MRI just confirming it.
Hope this helps. Wish you the best health
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Yes, I do have high blood pressure. Recently, I have had what are most likely panic attacks involving light headedness as well as occasional shooting pain/sensation that would radiate in the left arm (either upper arm toward tricep or at the wrist). That last symptom (shooting pain) is rare and only occasionally occurs at this point; usually in high stress situation. An EMG turned up nothing and the Dr, suspecting a possible but unlikely mini-stroke, ordered the MRI to be sure. Also did stress treadmill and echocardiogram which were normal. I can't remember where the assistant told me the lesions were located specifically.
Also, the symptoms/panic attacks were precipitated by an intense high stress scenario. Deadline at work, other obligations, pending life changes, etc.
Also, the symptoms/panic attacks were precipitated by an intense high stress scenario. Deadline at work, other obligations, pending life changes, etc.
Brief Answer:
Spinal MRI and LP
Detailed Answer:
Hello again,
At this point, since you had sensory involvement in the arm, you need further studies to rule out demyelinisation. A spine MRI and lumbar puncture to study your cerebrospinal liquor is essential to rule out demyelinisation.
Once you perform these procedures, you will be sure there is no demyelinisation. Until then it is difficult to say for sure it demyelinisation or white matter disease. If you had no sensory involvement then the situation would lead towards a white matter disease. But since the whole history began with pain in the arm I recommend continue with spine MRI and LP.
Hope this helps.
Spinal MRI and LP
Detailed Answer:
Hello again,
At this point, since you had sensory involvement in the arm, you need further studies to rule out demyelinisation. A spine MRI and lumbar puncture to study your cerebrospinal liquor is essential to rule out demyelinisation.
Once you perform these procedures, you will be sure there is no demyelinisation. Until then it is difficult to say for sure it demyelinisation or white matter disease. If you had no sensory involvement then the situation would lead towards a white matter disease. But since the whole history began with pain in the arm I recommend continue with spine MRI and LP.
Hope this helps.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Yes, I had a follow up phone call with the assistant (follow up appointment with doc to go more in depth is next week), and more details were 15-20 small white matter lesions that are non-specific and scattered. Could be due to microvascular disease, migraine headaches (though I've never really had any during my adult life), prior traumatic head injury (I was in a car accident in 1989 when my head hit the back of the front car seat on impact), and in her words "less likely" demyelination.
Likely tests to be ordered are a hypercoag panel, Trans esophageal echocardiogram, MRI of neck and back, and a carotid doppler to check neck arteries for stenosis. (I did also do a treadmill stress test and echocardiogram to rule out heart issues, and they were normal.)
Also, during initial meeting, the doctor had me do several motor skill tests including walking in a straight line, balancing on one foot, following the motion of his gestures including counting the number of fingers in each hand in my periphery, and several other what I considered basic tests, and there were no issues.
Likely tests to be ordered are a hypercoag panel, Trans esophageal echocardiogram, MRI of neck and back, and a carotid doppler to check neck arteries for stenosis. (I did also do a treadmill stress test and echocardiogram to rule out heart issues, and they were normal.)
Also, during initial meeting, the doctor had me do several motor skill tests including walking in a straight line, balancing on one foot, following the motion of his gestures including counting the number of fingers in each hand in my periphery, and several other what I considered basic tests, and there were no issues.
Brief Answer:
Perform the scheduled exam plus lumbar puncture
Detailed Answer:
Hello again.
The test you are scheduled to perform are for stroke screening and the MRI of the spine is the only exam to see for demyelinisation. I still insist for a lumbar puncture to rule out demyelinisation. Still, it is a good sign the doctor did not notice any neurologic problem, which leads to white to white matter disease which I said is a benign condition. Basically, perform the scheduled examinations and ask for the lumbar puncture.
Hope this helps. Please feel free for further questions.
Perform the scheduled exam plus lumbar puncture
Detailed Answer:
Hello again.
The test you are scheduled to perform are for stroke screening and the MRI of the spine is the only exam to see for demyelinisation. I still insist for a lumbar puncture to rule out demyelinisation. Still, it is a good sign the doctor did not notice any neurologic problem, which leads to white to white matter disease which I said is a benign condition. Basically, perform the scheduled examinations and ask for the lumbar puncture.
Hope this helps. Please feel free for further questions.
Above answer was peer-reviewed by :
Dr. Raju A.T
Yes, it looks like I forgot to add that a lumbar puncture is another likely test to be ordered.
Brief Answer:
Wish you the best health
Detailed Answer:
Anyway, it seems like this is a benign situation.
Wish you the best
Wish you the best health
Detailed Answer:
Anyway, it seems like this is a benign situation.
Wish you the best
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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