MRI findings...normal variant with age?

I am 42 yo female with hx of migraine beginning at 8 yrs. Over the years my migraines have changed in symptoms from migraine without aura to migraine with aura. I have had my "normal" visual aura several times without migraine. My trigger is stress and this past year has been VERY stressful. Over the last year I've had symptoms I didn't relate to migraine including numbness and tingling in the lower half of my face bilaterally, numbness and tingling in my forearms and hands bilaterally, sensation of being "off", dizzy,and lightheaded and feeling like "crap". There were no visual symptoms or muscular symptoms. These symptoms would last anywhere from 4 to 7 days. The thought was migraine aura without headache. Ophthalmology exam, cranial nerve, reflexes and babinski all normal. MRI has revealed minor foci of high signal in the white matter bilaterally, more numerous than would be typically expected in a patient of this age. Ddx is between early microanglopathic disease and other causes of demyelination. My question...with my history of migraine and age could these MRI findings be a noraml variant?

[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.

In your case, the most likely cause of these plaques is due to migraines.

Other possible causes include 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 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.

I would suggest that you discuss your MRI findings with your ordering physician.  

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