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What Does " Multiple Flair Hyperintensities Within The Deep White Matter" Mean?

Posted on Fri, 28 Feb 2014

Question: Mri brain Technique Axial flair, dwi,adc,tl, swl Coronal T2 Sagittal T1, T2 flair Findings Minimal change in the appearance of the multiple flair hyperintensities within the deep white matter. No interval increase in size of lesions however there is a new very small lesion within the insular lobe of the right side measuring 2mm. As previous there is signal abnormality within the callososeptal interface, No area of restricted diffusion to suggest recent infarct or acute demyelinating plaques. Ventricles, basal cisterns and cortical suici are patent and symmetrical. Normal flow voids within the dominant intracerebral arrpteries and dural' venous sinuses. Normal appearance of the orbits, pituitary gland and craniocervical junction. Conclusion Stable appearance of the non-specific white matter change. The involvement of the callososeptal interface remains concerning for demyelination. My question is what does all this mean

Answered by Dr. Vivek Chail (21 minutes later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi, Thanks for writing in to us. Your MRI brain report starts with findings of a previously done MRI which showed some white areas on FLAIR sequence in the deep white matter region of brain. There is no significant change in the size of these lesions. However, your scan shows a small (2 mm) area which is in the insular cortex (an area in the brain) and this is a new development. The callososeptal area shows the previously seen abnormality. This means that the MRI brain scan findings is largely stable. The callososeptal area draws attention to any disorder due to loss of myelin covering in the nerves of the brain. This can cause significant symptoms related to the nervous system. This necessitates discussion and detailed clinical examination by your neurologist. Hope your query is answered. Please write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (4 minutes later)

Thank you. What could be causing these lesions and signal abnormality. Is thenew small lesion a tumour

Answered by Dr. Vivek Chail (17 minutes later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX Thanks for writing in with an update. Continuing with queries raised by you, the new lesion is less likely to be a tumor unless you have a strong family history of cancer or have been treated for a cancer earlier. By the description of the lesions, it is most likely due to possible decreased blood flow in small arteries in the brain. This is technically termed as microvascular ischemic changes and occurs in many conditions like hypertension, diabetes and also with advancing age. Please note that this is only a possibility. The other possibility causing these changes is entirely related to loss of the covering of nerves in the brain (demyelination). This is caused by auto immune conditions, exposure to harmful chemicals and as a side effect to some medications. It can rarely include multiple sclerosis as one of the differential diagnosis. MS is to be diagnosed only if certain criteria are fulfilled and this is done only after detailed assessment. Hope your query is answered. Please write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (6 minutes later)

Thank you for your help my mums dad had lung cancer, my mums mum died of a ruptured aorta, my dads mum died of a stroke, she also had breast cancer, ive only had pre cancerous cells before. Was curious to why a new lesion had formed on the opposite side. I do appologise was keep on writing.

Answered by Dr. Vivek Chail (31 minutes later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX Thanks for writing in with an update. It is of note that the is a history of cancer in your grand parents, however, with current medical developments it is easy to diagnose and treat cancers in early stages itself. As you have mentioned about you having pre cancerous cells, it is important to know in which location and when did you get tested for it and any other clinical details. I have myself worked in a cancer institute for three years and have seen all kinds of tumors including those in the brain. The appearance of the new lesion on the opposite side could signify continuing minimal decrease in blood supply to your brain. In most cases of tumor lesions, the MRI scan will pick up the findings should there be a tumor. Still, any minor stroke or MS like symptoms need to be reported to your doctor immediately. Hope your query is answered. Please write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (3 minutes later)

I had pre cancerous cells on my cervical smear test results .

Answered by Dr. Vivek Chail (18 minutes later)

Brief Answer: Brain lesion unlikely to be malignancy Detailed Answer: Hi XXXX Thanks for writing in with an update. Precancerous cells on pap smear are seen in many women, it needs to be followed up closely with monitoring of any menstrual bleeding or vaginal discharge related symptoms. If advised by your gynecologist, you might discuss about any surgical techniques to treat you for the pre cancerous cells. Pre cancerous cells causing tumors in the brain is less likely. It is of note that some of the lesions are dormant. This signifies that there is no real malignant activity going on. Should it have been malignancy, the imaging features would have been drastically different from what is seen in your present and previous scans. Hope your query is answered. Please write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar