Burning sensation in the brain

MRI report of my 72 year old mum stated thus:

Multiple tiny FLAIR high signal confluent areas in bilateral deep and periventricular white matter suggestive of small vessel ischemic changes.
Bilateral cerebral hemispheres show prominence of sulci, ventricles and cisternal spaces suggestive of age related atrophic changes. Rest of the cerebral hemispheres show normal grey white discrimination. No obvious demonstrable hemorrhage or SOL in brain parenchyma.
Mild atrophic changes seen in bilateral cerebellar hemispheres as evidenced by prominent folia.
- normal signal intensity of cerebellum
B- both cp angles clear
- medulla,  pons & mid brain show normal signals in all sequences
- No miline shift noted; orbits and their contents appear normal.

In addition, it seems that she has lost her sense of taste. The burning sensation from the brain affects her sleep pattern. She suffers from acute insomnia

Please can anyon explain in a layman's  language what is going on with her and what all this mean?

[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 causes for so called plaques in the brain. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented.

Other causes of plaques in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance.

Other causes of plaques 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. These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.

The different causes can be determined to some extent by interpretation of various sequences of the MRI. It sounds like your neurologist does not think the pattern of white spots in your brain are typical of multiple sclerosis. Other investigations are sometimes necessary to distinguish the various causes of white matter lesions. A lumbar puncture is sometimes necessary, in which fluid from around the spine and brain is taken out and analyzed with various tests.

Given your mother’s age, one potential cause for the “burning sensation” could be from a condition called giant cell arteritis or temporal arteritis. These are due to inflammation in the temporal artery and other arteries in the body. Symptoms include one sided headache pain in the temple and jaw that may be triggered by chewing. This condition can be diagnosed by a blood test called an ESR and a biopsy of the artery. It is very important to rule this diagnosis out as it is highly treatable and if left untreated it can lead to vision loss. It is exceedingly rare in people younger than 55, and is more common in even older age groups.

Another potential cause of temple pain is inflammation or arthritis of the temporo-mandiublar joint, commonly called the TMJ. This can sometimes occur due to bruxism, biting down at night or during the day, and other stresses to the joint. This is best diagnosed/managed by an orthodontist or an ENT, and treatment includes braces and other dental fixtures and sometimes muscle relaxants, depending on the exact cause.

These are potential differentials. There are more. I would suggest you have your mother follow up with her physician.

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