Would appreciate feedback on these head MRI results...

[Chloe1498]

Hello,
I am a 49F, former smoker, cholesterol bit elevated, bit overweight.   Mid-Dec my tinnitus spiked and I presented with pulsatile tinnitus, lightheadedness, very minor pressure type headaches sporadically....   ENT ordered MRI of head, MRA of head and neck.   In the meantime for the past week, I've been getting almost like tingling sensations on lkeft side of face, and arms and legs etc...   I also have Rosacea, along with health anxiety.  When I google these together. a bunch off results said indicative of MS.   So I am scared.  All results from imaging seem good per ENT however this freaked me out....  

Few small frontal predominant periventricular and subcortical white
matter foci of T2/FLAIR hyperintensity

ENT said they see that a lot with people my age and not to worry, and that iff the radiologist suspected MS they would of written that etc...

Any advice?
Thanks!

[Red_Star]

The white matter hyperintensities are probably due to smoking. “WMHs have been associated with the presence of various vascular risk factors, such as hypertension, diabetes, and smoking (Dickie et al., 2016, Habes et al., 2016, Wardlaw et al., 2015).”

You might want to see an optometrist to have your eyes checked for papilledema (swelling of the optic disc due to elevated intracranial pressure) because all those symptoms you mention are listed under a condition called Idiopathic Intracranial Hypertension (IIH).

[Chloe1498]

Thanks for responding.   I thought about IIH, but have no vision issues, and no bad headaches.  Plus I figured the MRI/MRA would of caught that.   And yes, they probably are from the past smoking, but I get very anxious and my mind goes places.   I already have appointments with my cardiologist and a neurologist.  

[Red_Star]

Ok. Papilledema may be asymptotic (no symptoms). Of course there are many other causes of pulsation tinnitus but with the pressure headaches it wouldn’t hurt to have an eye test done. Eye tests are recommended every 2 years anyway after age 40. Weight loss is an effective treatment for IIH.  Studies report that weight reduction of 11%–15% leads to clinical remission.

Harvard article on IIH…

“ A diagnosis of definite IIH is reached if the patient has:

•  Either papilledema or a sixth nerve palsy

•  Normal MRI/MRV imaging of the head

•  And a lumbar puncture showing an elevated opening pressure (>25 cm H2O in adults or >28 cm H2O in sedated children) with normal spinal fluid constituents

A minority (5-10%) of patients with IIH may have no papilledema.

The presence of multiple MRI features of raised intracranial pressure can assist in making an accurate diagnosis of IIH in those patients without evidence of papilledema or a sixth nerve palsy.”