Concussion repercussions?

I had a recent MRI of my  brain (without contrast) after I experienced 10 seconds of nausea, light-headedness and a frontal headache. The MRI showed no large vessel stenosis or aneurysm but patchy areas of signal abnormality in subcortical and periventricular white matter of both cerebral hemispheres, mainly in the frontal lobes & periatrial regions. No evidence of infract. Nonspecific white matter lesion. No bleeding. I don't smoke, normal weight and blood pressure, no diabetes, exercise regularly, have eaten a low-fat diet for years. I am 70, female, and have had five concussions in my active life, the last one 20 years ago. Could these be responsible for the findings since no cardiovascular disease seems present and tests for peripheral blood vessel problems in my legs are normal?  If it is a result of concussions, is this condition likely to progress? No current symptoms. Doctor put me on low-dose Zocor and Plavix. What is the most likely explanation for these findings and what advice, if any, do you have? More generally, what are the usual long-term effects of multiple concussions. Thanks.

[Joanna Fong, MD]

Hi Akela,

There is a certain pattern of MRI white matter lesions for multiple sclerosis.  The typical location of MS lesions are:  periventricular region, corpus callosum, centrum semiovale, and, to a lesser extent, deep white matter structures and basal ganglia. MS plaques usually have an ovoid appearance, and lesions are arranged at right angles to the corpus callosum as if radiating from this area. The plaques appear hyperintense on proton density and T2-weighted studies, and they are hypointense (if visible at all) on T1-weighted images.  

Post-concussion MRI images are less specific.  You can see abnormalities from atrophy to white matter disease for axonal damages.  However, the white matter lesions don't have same distribution and characteristics as MS lesions.

Post-concussion syndrome (PCS) is controversial, especially in its protracted form. The symptoms are vague, subjective, and common in the general population. The affected patient population is heterogeneous with varying degrees of injury to the head and brain. Individual patient characteristics may alter the expression of the injury. The underlying pathophysiology is undefined. Test results may or may not be abnormal; when present, test abnormalities do not follow a consistently defined pattern.  The most common complaints in postconcussion syndrome (PCS) are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory, and noise sensitivity.

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