What is FLAIR signal hyperintensity

[Ked5001]

After experiencing some minor numbness on my left side, I had 2 MRI on my head and brain.  The report I received says, in part:

"Several sulci of T2 and FLAIR hyperintensity within the white matter of both cerebral hemispheres"  "Primary diferential considerations include sequela of chronic small-vessel ischemic disease.  No evidence of acute infarction."

My Intenet searches have turned up a plethora of discussions of FLAIR hyperintensity in connection with conditions that range from Lyme disease to MS, but I haven't found a specific explanation of T2, FLAIR, or hyperintensity as they apply in this context.

Can you give me a fairly complete explanation of the terms and the significance of the phrase "sulci of T2 and FLAIR hyperintensity within the white matter" as well as any other insight into what this finding implies?

[Quixotic1]

Hi, Welcome to the forum!

The wording in the MRI report is a little faulty, I suspect.  Sounds like the radiologist mispoke.  The first sentence would only make sense if the word "sulci" ( which is one of the deep fold that is seen on the outside of the brain) was actually meant to be the more common word "foci".  Then it would be stating that there were several "spot" of increased signal on the two imaging techniques.

These white matter lesions appear mostly to be the result of microvascular disease which is seen in normal aging (40"s +), migraines, hypertension, and possibly some of the clotting disorders which can result in tiny, ministroke events, (eg. Huges Syndrome)

Do you have a history of high BP or of migraines?  And how old are you?

For the "fairly" complete explanation (it needs some tweaking) please read our thread called "MRI, Lesions, and Symptoms."  There is a section in it explaining (in laymans terms) what the terms, T1, T2 and FLAIR mean.  I will find this thread and make sure it is on the first page, if you are viewing the forum by "Last post".  

Let us know if you don't find it.

Quix, MD

[Ked5001]

Thanks for the very clear response.

I am 67 years old.  I have "elevated" blood pressure or what is often called pre-hypertension, I believe.  My BP runs in the 145 to 150 over 78 to 82 range.

No migraines or or known clotting problems.

When I discussed the MRI with my internist, he pretty well blew it off, exept that he has scheduled a carotid scan at my request.

Ked

[joparo]

Hi,
I just finished reading my wifes MRI what follows is copied and pasted from the cd. The information is totally alien to me and I could you some insite... We will be speaking with her dr later this week.
Thank you for your time.
John
************************
There are multiple foci of bright T-2 and FLAIR signal in
the periventricular white matter bilaterally. Several similar foci
are also noted in the brainstem and in the pons. These findings
suggest multiple sclerosis or vasculitis. There is no abnormal
enhancement. No mass or mass effect is present. There is no evidence of infarct or hemorrhage.
*************************

[jensequitur]

Hi, joparo!

I recommend starting a new thread with this information.  What sort of questions do you have about this information?  Take a look at the Health Pages section (the link is in the upper right corner) for more information about a diagnosis of MS, and how to interpret your MRI.

[aish1357]

My child had a febrile seizure at 3 and a half years.last month when he is 5 and a half months,he had another seizure.The MRI brain and EEG have been reported to be normal.However today,another seizure took place.The MRI report states that:
"Evidence of a few discrete areas of T2 flair hyperintensity in billateral periventricular deep white matter"
IS there a need to worry?
AT the time of seizure the child has mild fever.Its been observed that on all occasions the seizures have occured after intense physical activities(exertion).
Please advice on d precautions as well as care to be taken while/post seizures

Thanking you
Yours truely
aishwarya

[pjctn]

MRI w/wo contrast reads: Patchy, rounded and punctate foci of increased T2 and FLAIR signal in the periventricular and deep cortical white matter.  A patchy focus of increased T2 and FLAIR signal is seen in the leftward pons as well.  These findings are non specific. Differential considerations include small vessel disease, gliosis, demyelinating pathology and Lyme Disease.
Past history of MS 40 + years ago.  At that time only one small patch was noted.  Repeat Lymes testing - negative.  Recent history of
diplopia and blurred vision.  Burning, numbness on left side of body.
Patchy focus on Pons could be correlated with diplopia.  Could other
findings be age related - age 61.  
What is involved with further investigation for potential MS diagnosis?
Waiting for your reply.          Pam Cress

[ATMCoord2]

Hi could you please provide some insight as to what my recent MRI finding could mean:

"There are at least 20 T2 and FLAIR hyperintense FOCI within the periventicular and subcortical white matter of both cerebral hemispheres".

Also, I had a recent ANA test and the results were: Positive/Titre 80/patteren speckled.

Thanks.  Of note I've suffered migraines for 15 years.  I'm 50 years old.

[Quixotic1]

This forum does not have an official physician answering questions.  I am a physician here with MS, but I am not official and I was NOT a neurologist.

Unofficially, you have many lesions found with the T2 and FLAIR techniques in places that MS lesions are frequently found.  However, a long history of migraine disease can also cause this type of lesion, as can many other disease processes.

Why was the MRI ordered?  No one can even guess at what an MRI means without knowing what symptoms the person has and what abnormalities they might have on neurologic exam.

The positive ANA is very weakly positive.  At the titre of 1:80 it could well mean nothing.  Real autoimmune immune disease is typically associated with higher titers than that.

So, no one here can say what your MRI might mean.  Much more information is needed.  What kind of symptoms have you had and for how long?  Is MS suspected?

Quix

[ATMCoord2]

Many thanks for your thoughts/input!  MRI was ordered for severe headaches.  I've suffered migraines for years.  My sister has similar ANA readings and had massive stroke at 43 yrs.

Again, many thanks!

[Quixotic1]

With a history like that of a family history of early severe stroke, you would need to be worked up for disorders of the clotting system like are seen in Hughes Syndrome, AntiPhospholipid Syndrome, etc.  This is very concerning.  Please make sure your doc or cardiologist sends the blood word for the blotting factors and the antibodies anti-pospholipid and antiCardiolipin, along with Factor Leiden V, etc.  There are more than those, but a good internist, neurologist or cardiologist would know the whole workup.

Quix

[ATMCoord2]

Thanks!  Of interest I had DVT in my right leg (calf) at 25 years old!!   They never could determine why...they even though I had lupus.  Kind of makes sense looking back at things.

Best regards and many thanks for your thoughts on the matter.

Steve