15 month old- brain MRI results

We recently took my 15 month old to the Dr. because he was off balance and falling a lot (almost like his knees were giving out and he couldn't support himself).  He also had some intermittent vomiting during this time.  His symptoms lasted for about 2 days.  Our Dr. did a physical exam to rule out infections, and did blood work as well.  The only thing that came back abnormal (to my knowledge) was an elevated alkaline phosphatase level.  He sent us on to have an MRI of the brain to rule out a tumor.

We had the MRI last week and have received the radiologists report.  They did not find any tumors, and we were very relieved!  I was not expecting that they would find something else though.  The radiologist's report noted that there was slightly greater than expected for age scattered white matter and an increased T2 signal.  He said there were no OBVIOUS signs of leukodystrophies.  He was suspecting delayed myelination and said that this MRI may serve as an important baseline.  Our Dr. has referred us on to a pediatric neurologist to have someone more specialized in this area read the MRI and evaluate my son.  We are currently in the waiting process to get an appointment.  I wish we could go tomorrow!  The waiting is the hardest part.  

I was wondering (without seeing the MRI scan) if you could tell me what those results/report may indicate?  I know MS and leukodystrophies are possibilities, but seem unlikely at this point.  He doesn't have any signs of delayed development regarding speech, motor skills, etc.  So far, we have only had the 2 days when he seemed really "off".  (He also woke up from a nap during one of the days of symptoms....screaming and shaking.  He never does that!)

Thank you!  

-Worried Mom

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine your child, I can not comment on a formal diagnosis.  However, I will try to provide you with some information regarding this matter.

There are different types of leukodystrophies, e.g., to name a few they include adrenoleukodystrophy, metachromatic leukodystrophy, Krabbe, Canavan, vanishing white matter, and Pelizaeus-Merzbache. As you are probably aware by now, some of them have peculiar MRI findings and examination findings. Two disorders of demyelination include multiple sclerosis and acute disseminated encephalomyelitis.  Without knowing the exact location of the white matter changes and your child’s current examination, it is difficult to comment on them. Myelination of the nervous does continue after the birth of a child. Some parts of the nervous may continue to be myelinated into the second decade of life. It is good that your child will be seen by a pediatric neurologist. A thorough history, including developmental milestones, and examination is needed to adequately comment on the MRI findings. The examination should include ophthalmoscope (to assess the back of the eye for a finding called cherry red spot and to evaluate for optic atrophy), head circumference, muscle tone (to assess if appropriate or if your child is hypotonic), and palpation of the visceral organs, particularly the liver and spleen, to assess for any enlargement. Depending on what the pediatric neurologist finds on the MRI and clinical history/examination, he/she may wish to do nothing or work up your child further with perhaps repeat neuroimaging in the future.

Thank you for using the forum, I hope you find this information useful, good luck.