7 year old MRI results awaiting blood tests

My son had an MRI last week due to 6-7 severe headaches with vomiting in the last 8 months.  Can you help me understand the findings?  

Long TR hyperintensities are identified in the peratrial white matter bilaterally in a symmetrical manner.  There are focal punctate long TR hyperintensities in the right frontal deep white matter as well.  There is no evidence of abnormal postcontrast enhancement.  The rest of the brain parencyma is of normal signal intensity and morphology.  The cerebellar tonsils are in a normal position and the remaining midline structures appear unremarkable.  The bilateral hippocampal formations are symmetrical without evidence of volume loss or signal abnormalities.  The brainstem and cerebellum appear unremarkable.  

Thre is no evidence of intracranial hemorrhage, hydrocephalus or midline shift.  No subural fluid collections are present.  There are no focal areas of restricted diffusion.  Normal flow voids are seen in the major intrcranial vessels.  There is complete opacification of the left maxillary sinus. scattered mucosal thickening is noted elsewhere in the paranasal sinuses.  The mastoid air cells are clear.  

My son has shown no physical developmental delays and we are currently awaiting blood test results.

We do have a family history on my husbands side for a familial tremor.  My husband and his father both have this condition.  I mentioned this to the doctor, but he seemed unfamiliar.

I am very scared particularly because it seems like anything with these symptoms is truly dire.  This is a highly active happy 7 year old boy.  he does have some difficulties in school, but physically he is my most agile and skilled boy. (I have 3).  Is there any chance that this is not going to be debilitating for him?

I appreciate any insights you may offer.

Thanks

[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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are multiple reasons for a person to have T2 prolongation (or hyperintensities) on MRI. Since your son is young, most are excluded (for example long standing hypertension, smoking abuse, etc). Given your son’s history of headache, it is impossible that the lesions on the brain MRI are related. The significance of these lesions is unclear.

However, other causes of hyperintensities on MRI can usually be distinguished based on history and symptoms, such as symptoms of neurologic deficit (for example arm weakness or difficulty walking etc). These can also be distinguished based on the MRI appearance of the various sequences used to acquire the image(s). These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.

I would suggest that your son be followed by a pediatric neurologist who specializes in migraines, but to also follow him long-term given your concerns.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.