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What Does "several Focal T2 Signal Abnormalities Within The Subcortial White Matter" Mean?
Question: XXXXXXX 12, 2014
HISTORY White matter changes based on prior MRI
PRIOR MRI performed 8/15/2013
Findings:
There are several focal T2 signal abnormalities within the subcortial white matter of the frontal lobes. These finds are unchanged. No acute infarct hemorrhage or extra-axial fluid collections seen.
The posterior fossa and brain stem are unremarkable
The basilar artery and internal carotid artery flow voids are patent.
The paranasal sinuses are well-aerated
Impression:
Several focal T2 Signal abnormalities within the subcortical white matter of the frontal lobes. These findings are unchanged since the prior exam and of uncertain clinical significance. Differential diagnosis would include Lyme disease, migraine headaches, or other demyelinating processes.
What does this mean? What follow up should I have?
HISTORY White matter changes based on prior MRI
PRIOR MRI performed 8/15/2013
Findings:
There are several focal T2 signal abnormalities within the subcortial white matter of the frontal lobes. These finds are unchanged. No acute infarct hemorrhage or extra-axial fluid collections seen.
The posterior fossa and brain stem are unremarkable
The basilar artery and internal carotid artery flow voids are patent.
The paranasal sinuses are well-aerated
Impression:
Several focal T2 Signal abnormalities within the subcortical white matter of the frontal lobes. These findings are unchanged since the prior exam and of uncertain clinical significance. Differential diagnosis would include Lyme disease, migraine headaches, or other demyelinating processes.
What does this mean? What follow up should I have?
Brief Answer:
Repeat imaging after clinical examination
Detailed Answer:
Hi XXXX
Thanks for writing in.
I have read through your query in detail.
Your Brain MRI (dated 08-15-13) report indicates that the white matter in the front part of brain is showing small abnormal areas. These are not an emergency but can be due to an infection or degenerative disease condition which is affecting the nerve bundles. Infections of the nerve bundles can give this picture. Also, the nerves in the brain are covered by a sheath called myelin. In certain conditions the myelin can get destroyed and this can appear as in your scan. Sometimes this kind of picture may be benign and of no particular clinical significance, but considering your age this needs to be dealt with carefully.
You must discuss the findings with your neurologist and be alert to inform them about any new neurological symptoms that you might be experiencing.
Follow up imaging is necessary to know any new findings which may relate to any new symptoms that you may have. Follow up essentially means consulting your neurologist and getting another MRI scan done as felt necessary after complete neurological examination
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
Repeat imaging after clinical examination
Detailed Answer:
Hi XXXX
Thanks for writing in.
I have read through your query in detail.
Your Brain MRI (dated 08-15-13) report indicates that the white matter in the front part of brain is showing small abnormal areas. These are not an emergency but can be due to an infection or degenerative disease condition which is affecting the nerve bundles. Infections of the nerve bundles can give this picture. Also, the nerves in the brain are covered by a sheath called myelin. In certain conditions the myelin can get destroyed and this can appear as in your scan. Sometimes this kind of picture may be benign and of no particular clinical significance, but considering your age this needs to be dealt with carefully.
You must discuss the findings with your neurologist and be alert to inform them about any new neurological symptoms that you might be experiencing.
Follow up imaging is necessary to know any new findings which may relate to any new symptoms that you may have. Follow up essentially means consulting your neurologist and getting another MRI scan done as felt necessary after complete neurological examination
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I went to the neurologist who said my neurological exam was normal and blew me off and tested me for Lyme which was negative. My primary ordered another MRI ten months later which is the report you are reading. I don't know what to do. Should I see another specialist. What testing would you recommend? I have TMJ jaw popping but no other symptoms really at all. Primary recently did blood work CBC CMP Lipids TSH all normal. Lyme was done after first scan negative. Neuro physical exam was normal by neurologist. I just have jaw popping and they ache could it be related? I don't know if I should just ignore this and wait until I have symptoms or should I have further testing done. Also could this be a disease like MS? Should I seek opinion of different neurologist.
Brief Answer:
MS is less likely with current presentation
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
A diagnosis of MS requires certain criteria to be fulfilled. There has to be new lesions in temporal ans spatial distribution with neurological correlation. Since you do not have these feature, a diagnosis of MS is least likely.
The jaw popping might just be a coincidential event. You may wait for specific symptoms to appear before further testing although following up regularly with your doctor is advisable.
It is important to know if your alcohol intake is excessive as I have come across similar findings in people who have a higher than normal alcohol intake.
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
MS is less likely with current presentation
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
A diagnosis of MS requires certain criteria to be fulfilled. There has to be new lesions in temporal ans spatial distribution with neurological correlation. Since you do not have these feature, a diagnosis of MS is least likely.
The jaw popping might just be a coincidential event. You may wait for specific symptoms to appear before further testing although following up regularly with your doctor is advisable.
It is important to know if your alcohol intake is excessive as I have come across similar findings in people who have a higher than normal alcohol intake.
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Okay well is it good news that August 2013 and XXXXXXX 2014 MRI's remain unchanged according to report? Also, what blood tests do you recommend I have? I will see my primary this week. Do you think I should have another MRI done down the line? Thanks for your advice. I wouldn't consider my alcohol intake to be excessive at all. I have been bitten by a couple ticks (I have a dog who I play with regularly and I live in a very high number of Lyme Disease cases area) in my life but I never have enough antibodies to be diagnosed with Lyme disease- I usually only have one or two.
To get down to the bottom- Do you think I will suffer from something significant in the future or is this just incidental as MRI's are a superior technology that can detect very minute changes in our body. Thanks for all the answers. I appreciate it.
To get down to the bottom- Do you think I will suffer from something significant in the future or is this just incidental as MRI's are a superior technology that can detect very minute changes in our body. Thanks for all the answers. I appreciate it.
Brief Answer:
No change in findings is good news
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Its good news that there is no change in appearance between the two scans which means MS is surely ruled out by criteria. The other diagnosis which may be considered in you is migraine and if you have the typical headaches then this diagnosis may be accepted. I do recommend an EEG (electroencephalography) test which will record any abnormal brain electrical activity should it be present.
Certain disorders associated with Lymes disease, alcohol intake and encephalitis is ruled out.
Though another MRI may be done after a year or two years, I stress upon the need to evaluate any neurocognitive symptoms which you may develop in the future though most of the conditions run a benign course.
Lastly, MRI scanners have improved with time and they are picking up even small non specific areas which may not be indicative of disease but may be explained by the general health condition of the individual. MRI findings should always be considered in the context of each individual person. Rather than just focusing on these white matter signal changes, it is probably best to consider what risk factors might need addressing.
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
No change in findings is good news
Detailed Answer:
Hi XXXX
Thanks for writing back with an update.
Its good news that there is no change in appearance between the two scans which means MS is surely ruled out by criteria. The other diagnosis which may be considered in you is migraine and if you have the typical headaches then this diagnosis may be accepted. I do recommend an EEG (electroencephalography) test which will record any abnormal brain electrical activity should it be present.
Certain disorders associated with Lymes disease, alcohol intake and encephalitis is ruled out.
Though another MRI may be done after a year or two years, I stress upon the need to evaluate any neurocognitive symptoms which you may develop in the future though most of the conditions run a benign course.
Lastly, MRI scanners have improved with time and they are picking up even small non specific areas which may not be indicative of disease but may be explained by the general health condition of the individual. MRI findings should always be considered in the context of each individual person. Rather than just focusing on these white matter signal changes, it is probably best to consider what risk factors might need addressing.
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer. I will go back to the doctor and request an EEG and some blood work to rule out tick borne related diseases. I hope this is something old and benign that won't change.
I would like to mention a few years back I had a Head CT Scan non contrast for headaches I was getting then (which weren't really that bad but doctor wanted to rule out serious causes) and it came back completely normal with no findings. Is it possible that I had the spots then but a ct scan couldn't of picked it up?
The MRI in August was due to a minor head injury. The XXXXXXX 2014 was a follow up for the white matter spots.
I would like to mention a few years back I had a Head CT Scan non contrast for headaches I was getting then (which weren't really that bad but doctor wanted to rule out serious causes) and it came back completely normal with no findings. Is it possible that I had the spots then but a ct scan couldn't of picked it up?
The MRI in August was due to a minor head injury. The XXXXXXX 2014 was a follow up for the white matter spots.
Brief Answer:
CT scan may not pick MRI findings
Detailed Answer:
Hi XXXX
You are welcome and thanks for writing back with an update.
I am sure your doctors will help you out with the EEG and other blood work.
CT scan brain may not pick up the white matter spots and these are noticeable only on MRI scans.
Please do not worry much if you are not having any head related symptoms. The XXXXXXX 2014 scan has shown that there is no change and hence most of the serious conditions are ruled out on MRI scanning.
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
CT scan may not pick MRI findings
Detailed Answer:
Hi XXXX
You are welcome and thanks for writing back with an update.
I am sure your doctors will help you out with the EEG and other blood work.
CT scan brain may not pick up the white matter spots and these are noticeable only on MRI scans.
Please do not worry much if you are not having any head related symptoms. The XXXXXXX 2014 scan has shown that there is no change and hence most of the serious conditions are ruled out on MRI scanning.
Hope your query is answered.
Do write back if you have any further doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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