neurology

[palermo]

Back in 2005 I had a brain scan with 2 spots of white matter in the frontal lobe, I was 35 years old.  Now I am 38 and there are 20 spots of white matter in the same area.  I was a migraine sufferer in my 20's and early 30's but they have gone into remission ever since.  I am type 2 diabetic, my c-reactive protein is high and sed rate too.  My a1c is at 7.0. I have pains in my extremities.  I was diagnosed with fibromyalgia in my early twenties.  I have been in pain since I was 9 years old.  These last 2 months though I have had a different type of "pain" in my feet and hands a sharp pain.  I have these lumps deep in my upper thighs that are very painful but seem to lessen in size or go away when massaged.   I've had a ct scan of the abdomen which was clear.  The mri of my thighs showed a normal scan.   My ca-125 was a bit elevated at 40 but my obgyn doesn't suspect that it's ovarian cancer.  I was very concerned when he told me I had twenty spots of white matter.  I'm going to see the neurologist but was hoping for some encouragement in the meanwhile. Thanks

[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 white matter lesions 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.

Other causes of white matter lesions in the brain can be migraine. People with migraine often have white matter lesions on their MRI that are of unclear cause or significance.

Other causes of white matter lesions 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, cancer metastesis, infection, and inflammatory processes such as vasculitis.

In your case, if the white matter lesions are due to either the migraines, they are likely inconsequential. If they are due to chronic small vessel disease, it is imperative that you stop smoking if you do, take medication to control your blood pressure, cholesterol, and diabetes, eat a healthy diet, and exercise. If other causes are diagnosed, there are treatments for some of them depending on the process occurring.

The different causes can be determined to some extent by interpretation of various sequences of the MRI. In addition, other imaging techniques such as MRA (to look at the blood vessels) and administration of contrast to see if any where enhances (lights up) can help your neurologist distinguish these various causes. It is important for you to further address your questions and concerns with your neurologist.

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