Need answer on white matter lesions MRI wish could be of chronic ischemic change

[Justwanttoknow1948]

I recently had a MRI with and without contrast due to my recent complaint of headaches which I thought were due to stress (work) but since I was not 60 almost 61 they wanted to test to rule other things out.
The MRI of the Brain without contrast said most areas were fine except for:
White Matter:  There are multiple focal and confluent subcortical and periventricular white matter lesions present.  Most of the lesions are located at the mid-convexity.  None of the lesions are associated with intralesional hemmorhage, diffusion abnormality or enhancement.
Conclusion:
1.  There is global atrophy, which is pattern nonspecific  and within normal limits for patient's age.
2.  There is multiple nonspecific white matter lesions present.  -Either due to headaches or could be areas of chronic ischemic change.
The conclusion of the MRI with contrast said that there are normal variatios to the intracranial cirulation. No flow limiting stenosis, vascular anomalies or aneurysms are seen. Although, the findings were that the Codominant vertebral arteries are seen.  The left posterior cerebral artery is fed primarily via fetal origin from the anterior circulation. There is a diminuitve vessel which likely represents a hypoplastic left P1 segment.  A hypoplastic or absent right posterior communicating artery is seen.  There is a patent anterior communicating artery.  No flow limiting stenoses, vascular anommalics or aneurysms are seen.

Any comments would be appreciated.  Justwanttoknow1948

Please explain the white matter lesions - and if I should follow up with another doctor?

[Addie2U]

A NEUROLOGIST NEEDS TO DO EXTENSIVE WORK UP AND A NEURO EXAM SHOULD TAKE A GOOD HALF HOUR PLUS, IF NOT FIND A DIFFERENT ONE.

I UNDERSTAND WANTING ANSWERS AND WAITING IS THE HARDEST, SOMETIMES IN RETROSPECT IT IS BEST TO GET THE REPORTS AFTER SEEING A NEURO BECAUSE WE HAVE ATTENDANCY TO GET ON THE INTERNET TO RESEARCH THE WORDING OF THE MRI'S.

A GOOD NEURO WILL READ THE MRI'S THEMSELVES AND NOT RELY ON THE RADIOLOGIST REPORT. <<<TLYNN

In regards to the above . . . after noticing more forgetfulness than usual, I spoke with my neuro and he ordered an MRI of the brain w/out contrast.  My MRI showed white matter that my doctor brushed off as me having either migraines, high blood pressure or diabetes.  I don't have any of those things . . . so I'm sitting her scratching my head wondering . ..  what are those things.  He got off the MRI subject by saying my B12 was borderline, and because my memory stinks, I forgot to ask him.

My neuro s*cks . . . can't stand the guy; I wait for an hour to see him, and he takes all of 10 minutes with me and calls it a "comprehensive" exam.  BS!  I have been looking for another neuro, and spoke to my Family Doctor about it, but he said, "unfortunately, he's the best in this area".  So what's a person to do.  (BTW, I have had epilepsy for 40 years; been seizure free for 20 of them; take Mysoline)
Addie

[young at heart]

JUST WANT TO KNOW;

WELCOME TO OUR FORUM FAMILY; THE RADIOLOGIST THAT READ YOUR MRI , LEFT NO STONE UNTURNED HE OR SHE WAS VERY DETAILED ON THEIR FINDINGS THAT IS A TRUE BLESSING.

IN MANY CASES THE MRI IMPRESSION REPORT ARE ALL TO VAGUE. THE WAY YOURS IS WORDED WAS IT READ BY A NEURO RADIOLOGIST,USUALLY IT WILL STATE THE RADIOLOGIST CREDENTIALS AFTER THEIR NAME.

I RECENTLY HAD A MRI AND IT WAS READ BY A NEURORADIOLOGIST AND LORDY YOU WOULD OF THOUGHT SHE WAS WRITING A NOVEL, I HAVE A GREAT DEAL OF ATROPHY FOR MY AGE, WHICH IS NOT UNCOMMON FOR SOME MS PATIENTS ESPECIALLY WHEN THE ATROPHY IS MORE THEN IT SHOULD BE FOR ONES AGE.

APPARENTLY ACCORDING TO THE MRI, I HAVE HAD A STROKE AT SOME POINT,WHEN I HAVE NO CLUE IT WAS NOT ON THE LAST IMAGES.

I WILL FORWARD THESE TO MY DOCTOR AT THE CLEVELAND CLINIC AND LET THEM HAVE FUN WITH THIS SET, THEY HAVE ALOT GOING ON.

A NEUROLOGIST NEEDS TO DO EXTENSIVE WORK UP AND A NEURO EXAM SHOULD TAKE A GOOD HALF HOUR PLUS, IF NOT FIND A DIFFERENT ONE.

I UNDERSTAND WANTING ANSWERS AND WAITING IS THE HARDEST, SOMETIMES IN RETROSPECT IT IS BEST TO GET THE REPORTS AFTER SEEING A NEURO BECAUSE WE HAVE ATTENDANCY TO GET ON THE INTERNET TO RESEARCH THE WORDING OF THE MRI'S.

A GOOD NEURO WILL READ THE MRI'S THEMSELVES AND NOT RELY ON THE RADIOLOGIST REPORT.

BEST WISHES

T-LYNN

[essdipity]

Thank you for the lovely compliment. I still have a great deal to learn, but most of what I know thus far has come from this forum, especially our headliner Quix. She's the expert and I'm still a novice.

To answer your question, you've got it right. It's never a bad idea to ask a neuroradiologist for a second opinion.

ess

[MsWobbles]

I understand justwantoknow's frustration.  Sheesh, I can't glean much from her description of her MRI results.  How could a layperson ever make anything of it?  We have to rely on the experts.  

My question to you is this:  Some people here, dissatisfied with their neuro's interpretations of their MRIs, have taken their MRIs to some other kind of radiology specialist - I forget the name - was it a neuroradiology interpreter??  What is the term for that person who reads MRIs with a flair for neurology interpretation??
And how do we go about finding a good one?  You're so informed on everything related to MS!!  It's a joy to read your responses!

Thanks!

WAF

[essdipity]

Hello and welcome.

The radiologist is describing what he/she sees and mentally is comparing that with the thousands of other MRIs he's looked at, including many older brains. That doctor does not know you or your medical history, symptoms, and so on, and therefore cannot make any sort of diagnosis. That's the job of your neurologist, after runnning many tests, including a lengthy physical exam.

You have numerous white matter lesions, but whether these represent MS or something else needs to be determined. If you have no MS symptoms or other abnormalities, it's highly unlikely you have MS. The suggested ischemia is often seen in older brains, but it's also often mistaken for MS and vice versa. Your neurologist should be looking at the MRI independently of the radiologist, as interpretation can almost be an art form. Make sure this happens.

A certain amount of atrophy is also normal with aging, so the question is, how much is too much? MS can and does cause atrophy. Another issue, of course, is headaches. MS can cause headaches, and there are lots of discussions here about that. Headaches can certainly happen without MS, as well. Usually brain lesions caused by migraines are described as punctate, meaning very small, unlike MS lesions. However, I've never heard of lesions that could result from either ischemia or migraines, as your radiologist suggests, because to the best of my unprofessional knowledge, these lesions look quite different.

I know you want your MRI to mean something relatively harmless, and I sure don't blame you. But no one here can tell you that. You have much more work to do with your neurologist to pin down what is causing your headaches and why your MRI looks as it does.

Please let us know what happens.

ess