Brief Answer: You should keep hypertension in controlled level. Detailed Answer: Hello XXXX Thanks for writing to HCM In MRI,FLAIR or T2 weighted hyper intensities less than five in number in deep white matter of brain can be ignored. Mostly it is due to ischemic changes(decreased blood supply) that involves small blood vessels.However demyelination,Lyme's disease should also be ruled out with follow up scans.Diabetes mellitus also aggravates the situation. Hyper intensities more than five in number should be the cause of concern and it need investigations. You need monitoring of conditions that leads to ischemic changes like hypertension,altered lipid profile,diabetes mellitus. You need investigations like routine hemogram,RBS,LFT,RFT,Lipid profile,ultrasound of abdomen. If there is any more physical problems then it should be treated also. In your case chronic microvascular ischaemic disease is most likely it is due to hypertension and altered lipid profile.You should try to keep hypertension and cholesterol level in accepted values. You should take limited amount of salt in your diet and increase your physical activity in the form of exercise,walking etc. You should avoid fatty and fried food. You need proper examination of your eyes by ophthalmologist. Loss of quadrant vision may be due to many reasons like Glaucoma,systemic disorders like hypertension,Diabetes mellitus etc. Fundoscopy,direct and indirect ophthamoscopy should be done to find out the cause and treat accordingly. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

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