help with MRI results

[mama8]

I was wondering if you could help me interpret results from an MRI report, as I await a doctor's appointment.  A few weeks ago I started having tingling on one side of my body and then a couple of days later a massive headache hit.  That headache has been with me for two weeks now.  The parts of the MRI that were "abnormal" read as follows:

"There are a few small scattered white matter plaques consistent with small vessel insults.  These are best seen on the FLAIR images and to a lesser degree on the T2 images. Note made that there appears to be a mucous retention cyst or polyp along the posterior inferior aspect of teh sphenoid sinus.  

Conclusion: Scattered white matter plaques suggest small vessel disease.  Atherosclerosis, hypertension and diabetes are the most likely etiology.  MS plaques would look the same.  There is no perventricular predilection as might be seen with the latter process, however.  "

I do have hypertension ( on four meds, it still runs 130's/80 and 140's/90's) and diabetes.  I have also had a couple of other episodes in that past that might suggest MS, though.  

At this point my main questions are these:

1) Could my headaches be related to these MRI results?  It started out as a right sided headache in the back of the head between the ear and spine.  At it's worst it spreads to above my ear and the left side.  Yesterday I started getting a pain on the left side, same place (behind ear).  It feels like my head is going to explode and I am concerned about strokes, etc.

2) What is likely to be done about the sphenoid cyst?  
Thanks!

[CCF-Neuro-M.D.-JT]

Please keep in mind that I have never personally reviewed your films and an accurate answer is very difficult. Having said that:

1.Bit of a loaded question.  Although they may be related, yes, it's unlikely that the changes on the MRI are causing your symptoms.  Rather the headaches and longstanding history of hypertension are the more likely cause of the white matter abnormalities (if they aren't MS). The headaches in themselves may be from uncontrolled blood pressure. You do have multiple stroke risk factors and I can understand your concerns.  The best thing to do is to control your sugars and BP to the best of your ability. Check your cholesterol, stop smoking if you do, and get regular exercise. An Aspirin a day will be helpful if your kidneys are ok and there's no other reason why you shouldn't take aspirin.
2.Wouldn't worry too much about it as this is likely an incidental finding that doesn't mean anything clinically.

Good luck.

[The Crusader]

WHAT EVER YOU DO, NEVER LET THEM INJECT YOU EPIDURALLY WITH DEPO-MEDROL STEROIDS.  GO TO:  http://groups.msn.com/DepoMedrolDidItHarmYou/depomedroldiditharmyou.msnw

[dizz]

I would wait for your Neuro's diagnosis and not worry too much about it till then.  But here is what little I know about the topic: First I would not read too much into the Radiologist's findings of Small Vessel Disease. This appears to be a "broad" finding while research shows its rare, its quite common from what I've found (I have been diagnosed with it). The cause of Small Vessel Disease is unknown, but generally is associated with smoking. However, I know a lady who has never smoked a day in her life and she too was diagnosed with Small Vessel Disease (i.e. they don't know, there's a lot about the brain they don't know, but a brain surgeon is not supposed to say "I don't know").  Now if you smoke you MUST stop immediately as nicotine will make this condition worse by "constricting" blood vessels even further and increasing your risk for stroke. My SVD of the brain was diagnosed by UCSF Neurology Dept after suffering a stroke back in May 2002.  In laymen's terms SVD is your blood vessels in the brain are shown on MRI's smaller than normal and some of these vessels in the brain have very tiny capularies that are already the smallest in the body, some so tiny a single red blood cell can have difficulty traversing. It's important to ask your doctor about this if you've had/have stroke like symptoms (numbness to one side, lips etc.), more specifically prevention medications or anti-coagulant such as Plavix with asprin therapy. At a minumum a 81mg of ecotrin coated asprin a day wouldn't hurt if you can take it. Ask your doctor about your last blood test results specifically for a high platelet count as this could increase risk of thrombus.  Hypertension seems to make Small Vessel Disease worse, so its very important to keep your PB under control (because of my stroke,  I was told to keep mine below 135/85). My stroke left a
acorn size lacunar infarct of the basal ganglia right caudate head.  This is typically the area of the brain that suffers from hypertension effects with small infarcts as the capularies here are very tiny. If you go to Google.com and search for Small Vessel Disease you'll find a very few pages on the topic. Next, the avg person couldn't identify plaques on MRI's.  Plaques are the result of Atherosclerosis or fatty deposits lining the walls of your blood vessels. For example, a blocked artery which causes a heart attack is the same. It is important to note that if you have plaques in the vessels of the brain you most likely have them throughout your body. So keeping your chloresterol under control would be just as important. What can you do? Exercise, keeping PB undercontrol and lowering chloresterol. Some studies have shown A deficiency of folate, vitamin B12, or vitamin B6 may increase your level of homocysteine, an amino acid normally found in your blood. There is evidence that an elevated homocysteine level is an independent risk factor for heart disease and stroke (source NIH). The evidence suggests that high levels of homocysteine may damage coronary arteries or make it easier for blood clotting cells called platelets to clump together and form a clot. However, there is currently no evidence available to suggest that lowering homocysteine with vitamins will reduce your risk of heart disease. Clinical intervention trials are needed to determine whether supplementation with folic acid, vitamin B12 or vitamin B6 can lower your risk of developing coronary heart disease. Despite the supporting studies, UCSF put me on 1mg of Folate (Folic Acid), Vitamin B-6 and B-12 for this very reason.  Note: Folate will mask deficientcy of B-12 so its important to take them together. sphenoid sinus: another item to ask your doctor about, but it can sometimes be examined with a non-evasive endoscopic telescope through a nasal passage, click here for more info:
http://www.ghorayeb.com/SphenoidMucocele.html

[mama8]

Thanks very much for that informative post.  The more research I do, the less concerned I am, actually.  I have never smoked, but I do have hard to control HTN and also type II diabetes.  I am on four meds for HTN and it still runs over 130/80 that is recommend for diabetics, though.  The main thing right now is the headache that has been present for over two weeks, but I go to see a H/A specialist on Monday.  

Again, thanks for your input.

And, if the "Crusader" is still around, I would tell him to stop flooding forums like this with his propaganda.  Many of the posts that he responded to had nothing whatsoever to do with his subject matter.  I am sure there is a place for that warning, but it is not at all necessary to take up that much forum space for it.  

Ramona