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What Does The Following Brain MRI Report Indicate?
Question: 32 years old male, had a brain MRI at the age 30, what prompt me to get it was constant bad headaches, and a not very good short term memory. I had braces at the time so the imaging wasn't very clear, however in the report it said "there are at least six scattered foci of the juxtacortical white matter hyperintensity invoking the left acceptable, left frontal parietal and right frontoparietal regions" and followed by "these are more than expected for the patient's age, however remain nonspecific". Overall iam a healthy guy, but I do smoke, and I'm taking 50mg of Amitriptyline a night. This was given to me after the MRI results to help with my headaches.
Brief Answer:
No active lesion, not related to headache.
Detailed Answer:
I read your question carefully and I understand your concern.
That MRI report doesn't show an active lesion, a condition which is causing continuing damage. It does show some minuscule hyperintensities. These are too little to cause any symptoms, they are not related with your headache, haven't played any role in starting amitriptyline. Their origin unfortunately can not be determined, they are sort of like small scars, remnants of a past process. Might have been anything like trauma, hypoxia during birth, infections etc, it can't be determined by the MRI. They are commonly found in many patients, the older one gets the likelier it is to find some, if you were older it would be normal. For your age though they are not expected, however that doesn't mean that they need any treatment. At most I would advise a repeat MRI after 1-2 years to check for the appearance of new foci which might raise the suspicion of multiple sclerosis. So scheduling a control MRI may be considered.
As for amitriptyline it is a common first line treatment for headache prevention, so its prescription makes sense. Only if not effective may other medications for headache prevention be considered.
I remain at your disposal for other questions.
No active lesion, not related to headache.
Detailed Answer:
I read your question carefully and I understand your concern.
That MRI report doesn't show an active lesion, a condition which is causing continuing damage. It does show some minuscule hyperintensities. These are too little to cause any symptoms, they are not related with your headache, haven't played any role in starting amitriptyline. Their origin unfortunately can not be determined, they are sort of like small scars, remnants of a past process. Might have been anything like trauma, hypoxia during birth, infections etc, it can't be determined by the MRI. They are commonly found in many patients, the older one gets the likelier it is to find some, if you were older it would be normal. For your age though they are not expected, however that doesn't mean that they need any treatment. At most I would advise a repeat MRI after 1-2 years to check for the appearance of new foci which might raise the suspicion of multiple sclerosis. So scheduling a control MRI may be considered.
As for amitriptyline it is a common first line treatment for headache prevention, so its prescription makes sense. Only if not effective may other medications for headache prevention be considered.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor for your quick response, as you can see iam worried with the term "more than expected with the patient's age". I never really thought of MS as a possible diagnosis, I think based on what i researched online, I don't have suggestive symptoms of MS, but maybe I'm wrong. Its hard to describe but I don't feel like I'm "ok", I honestly have the worst memory, and it causes a lot of frustration, which I did bring up to my doctor who didn't seem concerned about it. We did do a general blood test and we found out i have low levels of Anemia. He did suggest a second MRI once my braces come off, which should be sometime this year. Is it possible that MRI was maybe somewhat "misleading" due to my braces? how reliable that test could have been? When I was chatting with my doctor about this he told me "this is absolutely normal to have in your brain, I even have it", he didn't seem concerned at all. but i really can't get over the fact my MRI results said "more than expected" and they even highlighted that part. Could this possibly be due to smoking? or migraines? Thank you again for your time.
Brief Answer:
Read below
Detailed Answer:
Thank you for the additional information.
If you have no other neurological symptoms MS is unlikely, those foci are not in a typical location for MS either.
It is good that you are doing a second MRI. It is hard to give an opinion on whether braces have misled the MRI without being able to view the images, without seeing how much of an influence the braces had on the image quality. I am inclined to think it was reliable though since they describe the precise number and location of the foci.
I understand your anxiety about that more than expected term, it is true they are more than expected for your age, however you should remember that they do not represent any threat. You might have had them since childhood, the fact you had an MRI only evidenced that. The important thing is they are not too many to cause any change in brain function and they are not an active evolving process. So your doctor is right in trying to calm you down.
Smoking does not cause them. Migraine on the other hand is often associated with such non specific changes which do not affect functioning. However it is not exactly typical for migraine as usually the changes there are in the posterior part of the brain. It remains a possibility though.
Let me know if I can further assist you.
Read below
Detailed Answer:
Thank you for the additional information.
If you have no other neurological symptoms MS is unlikely, those foci are not in a typical location for MS either.
It is good that you are doing a second MRI. It is hard to give an opinion on whether braces have misled the MRI without being able to view the images, without seeing how much of an influence the braces had on the image quality. I am inclined to think it was reliable though since they describe the precise number and location of the foci.
I understand your anxiety about that more than expected term, it is true they are more than expected for your age, however you should remember that they do not represent any threat. You might have had them since childhood, the fact you had an MRI only evidenced that. The important thing is they are not too many to cause any change in brain function and they are not an active evolving process. So your doctor is right in trying to calm you down.
Smoking does not cause them. Migraine on the other hand is often associated with such non specific changes which do not affect functioning. However it is not exactly typical for migraine as usually the changes there are in the posterior part of the brain. It remains a possibility though.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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