mri scan

[ladycaro]

I had a brain mri scan for recurrent 'auras' thought to be due to migraine. The result of the scan came back normal except for a few spots of plaques. I am 50, is this normal? I am concerned that it is indicative of early degeneration associated with dementia.

[Lama Chahine, MD]

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 provide with an explanation for your particular MRI findings, however I will try to provide you with some information.

There are multiple causes for so called plaques in the brain. Most often, these 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.

While the presence of small vessel disease does not predict dementia per se, it may increase risk of a type of dementia called vascular dementia, and likely increases the risk of Alzheimer's disease though research regarding the latter is ongoing.

What most predicts a future risk of dementia is not plaques but is atrophy: shrinkage of the brain. Other factors that increase risk for dementia including age, a family history, a history of heavy alcohol consumption, head trauma, and others.

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.

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.

In your case, the most likely causes are that the plaques are due to either the migraines, and are therefore likely inconsequential, or they are due to chronic small vessel disease if you smoke, have high blood pressure, high cholesterol, or diabetes. In that case it is imperative that you stop smoking, take medication to control your blood pressure, cholesterol, and diabetes, eat a healthy diet, and exercise.

It is important for you to further address your questions and concerns with your doctor. Further evaluation by your neurologist as necessary.

Thank you for using the forum, I hope you find this information useful, good luck.

[ladycaro]

The information you gave me was very helpful indeed. I indeed have suffered from auras and migraine and now feel a lot less worried about the presence of plaques on the mri scan of my brain. Thank you for being very helpful.