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Possible causes of White Matter Lesions?
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Possible causes of White Matter Lesions?

Hi, I am a 26 year old female, and was diagosed with mild temporal lobe epilepsy in 2004. This is now controlled fully by medication. Recently, I had my yearly check up with my consultant. I explained everything was fine and I was given the news that my MRI scan (from May 2008 - 10 months ago!) was actually abnormal! I am still angry at the fact that it took 10 months for me to be given this information!
Anyway, I asked about possible causes and one of the first things mentioned was MS. Naturally, I was rather shocked, even more so as I was on my own. However, I am now not so concerned it is MS, as I have no symptoms . I have had a visual evoked potential eye test and i'm waiting for a lumbar puncture, which seems to be taking ages.
I know that medically, you cannot give me any diagnosis, but i just wanted to ask what the other potential causes could be? Or is it remotely possible that lesions could be MS, without me ever having any symptoms? I have heard that high cholestrol could be a possible cause also. My dad has this, and although he does not have a high fat diet, I have been told that genetically, this is quite typical in the west of scotland.

Also, would it be worth trying to push further for my Lumbar Puncture, in view of what seems like a lapse in professionalism by the hosptial in question? Any help on this matter would be greatly appreciated.
Thanks
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Avatar_dr_f_tn
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 examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

There are multiple causes for so-called "white matter lesions" in the brain. MS is a demyelinating disease, in which the nerves lose their coating which is called myelin. Demyelination could be silent, meaning occurring without clinical symptoms, but there are specific MRI criteria and clinical criteria to diagnosing MS.

Most often, white matter lesions 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. However, unless you smoke or have other vascular risk factors such as diabetes, this would be unlikely at your age.

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.

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.

As you can see, there are many potential causes of white matter plaques, some more serious than others. The different causes can be determined to some extent by interpretation of various sequences of the MRI, in addition to history and physical examination. Sometimes, the MRI is simply repeated (with IV contrast) in 6-12 months to see if new lesions appear, which would suggested a cause that needs to be further investigates. A lumbar puncture is sometimes indicated in the evaluation of white matter lesions, particularly when there are unexplained clinical symptoms occurring. It is important to discuss with your physician your concerns about the delay in receiving your MRI results, the implications of your MRI findings, and whether or not further testing is necessary.

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





Also, would it be worth trying to push further for my Lumbar Puncture, in view of what seems like a lapse in professionalism by the hosptial in question? Any help on this matter would be greatly appreciated.
Thanks
3 Comments
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Avatar_f_tn
Hi, i was wondering, I also have white matter on my MRI and get bad migraine headaches, did you get a diagnoses "Cadasil" did you.
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562511_tn?1285907760
Thank you for the information you give in response to the questions asked in this forum.  I am finding that you give concise and easily understood replies.  
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