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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suffered From Headaches

Because of increased noise in my left ear, tinny sounds and small muscular spasms through the left side of my face and head, I had an MRI to rule out any problems with my ears. Nothing showed up except for and I quote, a number of small foci of increased T2 signal in the hemispheric white matter bilaterally, probably due to chronic small vessels ischemia. My doctor told me not to worry about it. It s usually seen in people with hypertension, diabetes, etc. But I don t have hypertension, or high cholesterol, or high blood pressure, and I never have, I have always been low-normal. I don t have diabetes. I am 50 yrs. old. I m healthy and fit. But over the last 5 years have had lots of tiny spasms throughout my head and sometimes feels like everything is tightening and have had very low grade headaches that last for days. Could this be a result of the ischemia. thank you.
Tue, 16 Jul 2019
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Neurologist 's  Response
Hi,

First of all- the "tinny sounds" you describe are referred to as tinnitus. An MRI of the ears? is probably not exactly what was sent but rather of the brain. I don't know that I would've done that particular study first without doing some other things first but at any rate.....You could likely benefit from an audiogram and tinnitus evaluation which an audiologist can do.

This will help identify important features of what you're describing so that an MRI (if necessary) could be better focused on specific areas of the brain (or in the ears if that's where the audiogram shows the problem). If an MRI were obtained I would do it with gadolinium contrast and ask the radiologist to rule out the presence of an acoustic neuroma at the cerebellopontine angle.

There are many reasons for white matter disease and while hypertension, diabetes, high cholesterol, and hypertension are some of the more talked about risk factors they are by far not the only ones...and in fact, the most important risk factor for this problem is something that none of us can control....age....After the age of about 35-40 years a good radiologist will identify small lesions of white matter degeneration, perfectly expected, perfectly benign, and perfectly harmless.

Headaches are really associated with areas of white matter degeneration typically referred to as UBO (Unidentified Bright Objects). There is no known cause/effect between their presence and headaches and they are usually in association with migraine headaches...not tension-type or low-grade headaches. Your symptoms of tightness in the head/face are not due to ischemic phenomenon or white matter brain changes as you've described.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Dariush Saghafi, Neurologist

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Suffered From Headaches

Hi, First of all- the tinny sounds you describe are referred to as tinnitus. An MRI of the ears? is probably not exactly what was sent but rather of the brain. I don t know that I would ve done that particular study first without doing some other things first but at any rate.....You could likely benefit from an audiogram and tinnitus evaluation which an audiologist can do. This will help identify important features of what you re describing so that an MRI (if necessary) could be better focused on specific areas of the brain (or in the ears if that s where the audiogram shows the problem). If an MRI were obtained I would do it with gadolinium contrast and ask the radiologist to rule out the presence of an acoustic neuroma at the cerebellopontine angle. There are many reasons for white matter disease and while hypertension, diabetes, high cholesterol, and hypertension are some of the more talked about risk factors they are by far not the only ones...and in fact, the most important risk factor for this problem is something that none of us can control....age....After the age of about 35-40 years a good radiologist will identify small lesions of white matter degeneration, perfectly expected, perfectly benign, and perfectly harmless. Headaches are really associated with areas of white matter degeneration typically referred to as UBO (Unidentified Bright Objects). There is no known cause/effect between their presence and headaches and they are usually in association with migraine headaches...not tension-type or low-grade headaches. Your symptoms of tightness in the head/face are not due to ischemic phenomenon or white matter brain changes as you ve described. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Dariush Saghafi, Neurologist