White matter on the brain

[Pam]

Hi, actually I have lot's of questions,but this is the main one.I suffer from a lot of things-vertigo,chronic pain through out my body,double vision,muscle weakness,to name a few.I've had 3 MRI'S of the brain,each 2 yrs. apart.All show white matter in area's of the brain.Had a lumbar puncture,MS was ruled out.I was told it's FMS.But, I can't get a clear answer about the spots on my brain.Why ar they there and will they affect me some how?I sure would appreciate any info. you can give me.Many Thanks

[CCF Neuro[P] MD, RPS]

Dear Pam:

I am not sure what you mean by white matter.  White matter is normal, it is the myelin surround axons in the axonal tracts of the brain.  There is a difference with white matter and hyperintensities on MRI scan.  Probably you mean the latter.  Sometimes the hyperintensities are part of the aging process and can be seen in even younger people (late twenties).  They are usually of no consequence.  We often see them routinely on MRI scans of people who are getting scans for reasons not necessarily to MS.  If hyperintensities are in areas that we question about MS, such as the temporal horns or periventricular regions then they may be a harbinger of MS, IF the clinical symptoms fit.  They have come to have the name of unidentified bright objects or UBOs if they are just a nonspecific finding.

I hope this helps.

Sincerely,

CCF Neuro MD

[Pam]

Hi,thanks for your fast reply.I'm sending you the findings on the MRI resultes,which I should have done in the first place.(sorry)It says-There are a few foci of increasad signal in the cerebral white matter,which are not normal at age 33,These are nonspecific and of uncertain significance.They do not have the typical location of areas of demyelinating plaques,and might be some minor post-ischemic/inflammatory changes.Could you explain this to me?Thank you very much for your time.

[CCF Neuro[P] MD, RPS]

Dear Pam:

It is difficult to tell you what they may be.  I would say, the the most likely scenerio is that they are just a finding of no consequence.  However, if you have high blood pressure, they might represent small infarct (unlikely as these are usually in the basal ganglion region.  But based on what you give me, I would think that they are just UBOs (see your previous posting).

Sincerely,

CCF Neuro MD

[kathie]

Hi, I have had migains for as long as I can remember. I had felt very sick after my daughter in 1991 and the doctors put me on birthcontrol pills. as weeks went by I had lose of visson on the left side of both eyes my head was going to explode at lest it felt like it. had some numbness on the left side of my top lip and some of my cheak. then everything started going away, back to normal. I went to the doctor and he wrote it as a minie stroke. I got off the birthcontrol. Everything seemed to be fine. Had my son in 1996 things went bad again. They found endemetreosis (sorry about the spelling) Had sugury full historactomy. I still have problems with migrains and at time I will either feel weak or alittle shaky and I also have  ADHD and Dyslexica the computer bothers me and the sunlight. could these be conected together or different problems.

[CCF Neuro[P] MD, RPS]

Dear Kathie:

It is difficult to tell you whether your stroke and migraine headaches after the birth of your first child are related.  There are many reasons for stroke after birth and I am sure that these possibilities were investigated thoroughly at that time.  There is a small percentage of people who have migraines who are more prone to stroke, and this might fit you.  However, before making this conclusion, you need to be evaluated by a good neurologist.  As far as ADHD and dyslexia, likely migraine is not an associated.  The reasons for each are alittle different and the exact etiology is currently unknown.  However, far more people have migraine than either of these two entities as addults and the cross-over or people having both or all three is very uncommon.  

Sincerely,

CCF Neuro MD

[Skip Chang]

Hi Doc.  Love the service you all provide here.  I have a question for you.

I'm posting on behalf of my wife.  Whe is 37 year old white female.  We have two children age 3 1/2 and 1 1/2.  Here is a cronology of events:

1.  Two months ago, while recovering from a nasty flu, my wife was getting back onto our bed at night, and she missed the bed and hit her lower back and her head on our wood bed frame.  She was knocked out for approximately 15 seconds.  She has no memory of being knocked out.  We did not know she had a concussion until several weeks went by and we discussed the events of that night.  In mean time, we took our kids to a amusment park and my wife rode in a roller-coaster which jostled her around a lot.  After the roller-coaster ride is when her symptoms started appearing.

2.  About a month after the concussion, she started getting tingling and numbness in her left hand and left foot.  Getting worried about her condition, she saw her GP.  Her GP indicated that the symptoms may be a start of MS.  Needless to say, my wife was frightened!

3.  Had an MRI of the head done on 12/4/99.  The results indicated that she had slight deterioration of the "white matters" on her right lumbor (sp?).  Her GP said this could very well be an indication of MS and referred her to a Neurologist (the earliest appointment with the Neurologist we can get is almost a month away!).  In mean time, my wife is so scared her symptoms are getting worse when she thinks about them.  

4.  Now the tingling and numbness is flip-flopping between her right side and her left side.  However, the symptoms does not appear all of the time.  Somedays, she does not have any of the symptoms all day long.  Other times, it only lasts for couple of minutes or longer.

Sorry for being long winded.  My questions to you are:
a.  Can the concussion she suffered two months ago cause the symptoms she is currently having?
b.  Can the deterioration of the "white matter" be normal?  How can they say the "white matter" has deteriorated when there is no baseline to measure against?
c.  If her diagnosis is MS (understanding that MS is a clinical diagnosis), is there anyway to determine the severity of MS?

The unknown is the worst affliction that we have now.  Due to the uncertainty, both my wife and I are very very scared.  Any information/advise on my wife's affliction will greatly help us.

Thank You so much for your service,
Skip Chang (Worried husband in Colorado Springs)

[CCF Neuro[P] MD, RPS]

Dear Skip Chang:

Sorry to hear about your wife's symptoms.  I am not sure where the lesion you are indicating in the brain, "lumbor"?  White matter changes do not have to be related to MS.  Many other things including the ageing (aging) process can give us white matter changes.  There are particular areas of the brain that are affected by MS, such as the periventricular white matter, corpus callosum, temporal lobes, etc.  Post-traumatic head problems could give your wife these symptoms, but over the internet I can't tell.  There is no way to determine whether MS will be malignant or the usual relapsing remitting type.  Time will tell, I wish there was a way of diagnosing.  There some hints such as concentric types of demyelination etc. but obviously your wife does not have this.  

Be sure and take the brain films with you to the neurologist.  Depending on where the lesions are, there may be a correlation with the numbness and tingling.  

I would venture to say that it is unlikely that your wife has MS.  If her MRI looked worrisome for MS, your GP would have acted immediately and did a spinal tap with other lab work.  The fact that your wife lost consciousness for over 15 minutes suggest that she had a pretty bad concussion.  Most likely, this is post traumatic damage and should resolve.  But, go to the neurologist and make sure.

Sincerely,

CCF Neuro MD

[Skip Chang]

Update to my previous post:

After reading the responses from the doctors to the other posts, I have additional questions:

1.  My wife's symptoms seems to get worsen when the weather gets cold.  Does this bode well that it may NOT be MS?  (I hope so)

2.  My wife does not have any feeling of weakness, just tingling and some fatigue.  Is this another data point indicating that it may NOT be MS?

3.  What other situations can cause the slight deterioration of the "white matter"?

Thank you in advance for your advise,

Worried husband in Colorado Springs.

[Skip Chang]

THANK YOU!  Your response has given us some needed hope.  We do realize that you cannot diagnose my wife's condition over the net.  However, your insight was extremely valuable for our peace of mind.

Follow up to the follow up.

Sorry for the redundant question.  I guess my bookmarks were stale and did not get your answer before I posted my second set of questions.  

Thanks again for your feedback.

LESS Worried husband in Colorado Springs

[CCF Neuro[P] MD, RPS]

you are welcome.  Let us know how things turn out.

CCF Neuro MD

[Terri Eder]

My father-in-law has had headaches, neck pain and syncopal episodes.  An MRI was done to the brain and he was told he has a mild periventricular white matter disease.  He is 59, was born in Germany during WWII, he is Jewish.  He has also been told the cisterna magna is somewhat prominent.  The third ventricle is slightly enlarged.
An MRI was done to the cervical spine and he was told there is evidence of multi-level spondylltic degenerative changes, degenerative end plate changes and degenerative marrow signal.  The most prominent spondylltic change is noted at C6-7 in which there appears to be a disc osteophyte complex.

I cannot understand what this means.  Any way I can have an english (and simplified) version of what is wrong with him?
Thank you!
Terri

[CCF Neuro[P] MD, RPS]

Dear Terri Elder"

It is difficult for me to tell you exactly what is going on as I have not seen the films.  But, I am guessing that the white matter changes are age related.  As we age and undergo the diseases of life and our lifestyle our brain changes.  We loose neurons and the cells that myelinate the neuronal axons that travel down the brain into our bodies also die.  On an MRI, this would be indicated by white matter changes in the periventricular region of the brain.  The loss of neurons and brain cells would cause the ventricles to slightly enlarge to compensate for the loss of brain matter. The enlarged cisterna magna is likely a normal variant and nothing to be worried about.  The changes in his spinal column are also likely lifestyle or trauma related and they just mean that the boney structures are degenerating and the vertebrae are sliding out of alignment. The marrow changes are age-related and signal vertebral degeneration.

I hope this helps.

Sincerely,

CCF Neuro MD

[Betty]

I, 65 yr old female, have breast cancer and after chemotherapy had headaches.  I thought caused by being taken off caffiene & premarin.  The oncologist said by length of time that was not cause & ordered MRI of brain.  Finding: small focus of abnormal hyperintense signal in the right suprasylvian region likely representing a small area of gliosis/encephalomalomalacia related to microvasculopathy.  Minimal periventricular white matter disease present.  In layman's terms what does this mean?  No evidence of metastic disease was found.   Thank you.

[CCF Neuro[P] MD, RPS]

Dear Betty:

As we age, we have some brain degeneration that is part of the aging process and the life styles we live.  Alcoholics, smokeres, people with high blood pressure, diabetes, etc all have brain white matter changes.  People who live clean lives and have no vices also get white matter changes.  My neuroradiology friend who is 41 has one spot on his MRI that indicates white matter changes.  I would just try and live your life and not pay too much attention to it.  Of course, if you do any thing that would hasten aging, then I would recommend changing your habit(s).  

Sincerely,

CCF Neuro MD

[Todd]

My girlfriend is 24 years old and has a baby of 16 months. She has hypothyroidism and is on medication for that. She started to get tingling and numbness in her left leg mostly and sometimes in her hands and arms. She has been complaining of this ever since they had sprayed to kill mosquitos here in Westchester NY. If you dont know, there is this viral mosquito thing going around here. Anyway, she started to feel these symptoms when they sprayed since she was outside at the time of spraying and actually felt the chemicals hit her skin. I dont know if it can be related but you never know. After seeing a doctor about this numbness and tingling and later worsening effects like, "earthquake in the brain", or a "feeling of being on drugs, no control", and fatigue and other little things, the doctor said we should do an MRI and the results found that she has, "white lesions on the white matter of the brain". Well this was just told to us 2 days ago. Needless to say we are very very scared as to what it is that is causing lesions on the brain. Furthermore she doesnt have any insurance, however nothing has been diagnosed yet. The doctor said the next step is to schedule a spinal tap. This is unreal that we are going through this and it just scares the hell out of us. I guess my question is do you have any advice knowing all the circumstances that were previously explained. I have read about the MS theory and I just cant believe that she would have it, knowing however that it effects anyone. I was wondering first, what else it could possibly besides MS? You know her statistics do you need any other information? Cant a stroke cause lesions on the brain? Is the demyelination process the only thing that causes these lesions? Help for we are scared and information hungry. Thanks....................................

[Todd]

My girlfriend is 24 years old and has a baby of 16 months. She has hypothyroidism and is on medication for that. She started to get tingling and numbness in her left leg mostly and sometimes in her hands and arms. She has been complaining of this ever since they had sprayed to kill mosquitos here in Westchester NY. If you dont know, there is this viral mosquito thing going around here. Anyway, she started to feel these symptoms when they sprayed since she was outside at the time of spraying and actually felt the chemicals hit her skin. I dont know if it can be related but you never know. After seeing a doctor about this numbness and tingling and later worsening effects like, "earthquake in the brain", or a "feeling of being on drugs, no control", and fatigue and other little things, the doctor said we should do an MRI and the results found that she has, "white lesions on the white matter of the brain". Well this was just told to us 2 days ago. Needless to say we are very very scared as to what it is that is causing lesions on the brain. Furthermore she doesnt have any insurance, however nothing has been diagnosed yet. The doctor said the next step is to schedule a spinal tap. This is unreal that we are going through this and it just scares the hell out of us. I guess my question is do you have any advice knowing all the circumstances that were previously explained. I have read about the MS theory and I just cant believe that she would have it, knowing however that it effects anyone. I was wondering first, what else it could possibly besides MS? You know her statistics do you need any other information? Cant a stroke cause lesions on the brain? Is the demyelination process the only thing that causes these lesions? Help for we are scared and information hungry. Thanks....................................

[Enhanced Lesions on White Matter]

I had an MRI done to rule out blocked carotid artery and that ended up fine but found scattered white matter plaques and one enhanced (first mri was 6 months earlier and no enhancements) So now we are in the dx stage to see if I have MS.  I consider myself lucky to have had this noticed so soon as I have no MS symtpoms.  

My question is, based onthe location of the plaques (periventricular right semi ovale) I was told this is typical area for MS lesions/plaques. If it is MS, is that area where mobility will be problem?  Could the lesions be from chronic sinusitis? as I have constant nose,chest,throat infections.

I will not be terrified if I have MS. It is actually the best thing to have rather than stroke, ALS, etc..  I just want to get an idea on what MAY happen in 15 years or so. You know, maybe save a little money now instead of later LOl

Thanks for your time and please don't get discouraged with the bad element in some of the replys. People will be people.

[Sheree Kazi]

My grandmother suffered a stroke this week.  It was evidently mild, but was shown in a cat scan.  The dr. has said that he would like to have a MRI done because he detected a malignancy within the white matter.  Reading what I can about white matter, I'm not sure how he would know this from a cat scan.  What would your insight be?  Thank you.

[Sheree Kazi]

I did forget to mention that Grandma fell a day or two before the cat scan, but the dr. has stated that the fall had nothing to do with the stroke.  Since the fall, she has not been able to hear very well at all, but each day it gets better.  The dr. also said that there is no bleeding in the brain.

Thanks again.

[Cathy McDonald ([e-mail]]

I am a 47 year old female. I don't smoke or drink but have a family history of heart problems, diabetes and cancer.  I began not feeling well several years ago - it started with tiredness in my legs, especially when walking or climbing stairs.  Then it got to the place where my muscles were sore and achy and I had severe fatique. I had blood work, a stress test, an echogram, and all of that was normal.  About a year ago my family doctor diagnosed me with fibromyalgia.  I've read quite a bit about fibromyalgia and I have most of the symptoms but my doctor never performed the pressure point test.  

In February of this year I was in an accident and suffered an injury to my head.  A CT scan was performed to check for bleeding.  The CT scan showed I might have a pineal cyst so I was told to have an MRI.  In April I had an MRI without contrast which showed some white matter disease, nonspecific finding, could not rule out demyelinating.  I was sent to a neurologist.  The neurological exam was normal and both the visual evoked response and the auditory revoked response tests were normal.  The neurologist suspected that I may have MS but was somewhat baffled.  I then had an MRI with contrast and followed up with the neurologist.  The MRI with contrast report reads "there is no evidence for enhancing mass, mass effect or midline shift.  The ventricles are normal in size and location.  There are periventricular white matter hypertensities identified within the right frontal region, stable from previous examination.  No areas of acute hemorrhage.  Impression:  Stable periventricular white matter hypertensities found predominently in the region of the right frontal white matter tracts.  The finding is nonspecific and is likely secondary to chronic small vessel disease.  Demyelinating process however is considered less likely."  The neurologist says that if the white matter hypertensities were only in the white matter it would more likely suggest MS but he said I also have hypertensities in the gray matter, which does not occur with MS.  He says it is "mysterious" and he can't tell me what is wrong.  Can you help?

[Judy]

My sisters little boy has shown signs of white brain matter loss
such as doing poorly in school, he was diagnosised with very mild
siezers and is controlled with med., they said he has lost some of the white brain matter but they wont tell her how much or what the different stages are to help prepare for the out come which they did inform her that it would be death. Is there any way of informing her of the different stages to look for?

[debmcdonald]

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[Jenna]

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