please can you help me understand this mri

please can anyone tell me what this means.  my relative has dysphagia, loss control of limbs, he is 57 lost his memory, first he had symptoms of getting angry and within 1 year he is bed bound unable to do anything doesnt recognise anything with a catheter naso gastric tube etc etc    and he is abroad they sent me report after mri but ive had no explanation what it is and what is treatment for it

MULTIPLE SMALL, FINE NON-ENHANCING FOCI OF ABNORMAL SIGNAL INTENSITY, APPEARING HYPOINTENSE ON T1W AND HYPERINTENSE ON T2W SEQUENCES ARE SEEN HIGH UP IN THE DEEP CEREBRAL WHITE MATTER

[CCF Neuro, M.D.]

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 a doctor.

Without the ability to examine and obtain a history, I cannot tell you what the exact cause of your relative’s symptoms may be. Also, without the ability to examine the MRI myself, I cannot be sure what the interpretation you provided actually is referring to. However I will try to provide you with some useful information.

I am sorry to hear about your relative’s condition. Certainly it sounds like he or she had a very dramatic and progressive course, affecting first behavior, and then overall brain function.  This sounds like he or she may have had what is referred to as a neurodegenerative disease. Many illnesses can cause this type of deterioration, and determining the cause usually requires gathering information about your relative’s past medical health, and the health of your family members, as well as multiple diagnostic tests, of which MRI is just one.

The MRI can be helpful to identify injuries or abnormal structures in the brain. The findings you describe are somewhat non-specific, and without looking at the images I am not sure how much more information I can provide. Broadly speaking, “foci of abnormal signal intensity” means a specific area that looks abnormal; in your relative’s case there were multiple, small areas (foci) that appear abnormal on MRI.  “Non-enhancing” means a contrast material was given to your relative, but none of these abnormal areas became brighter (enhanced) on MRI after the contrast was given.  Typically, contrast-enhancing lesions are areas of active inflammation, such as a tumor, an infection, or an area where the immune system is causing destruction, such as happens in multiple sclerosis. T1- and T2-weighted images refer to how the magnet is used to obtain the MRI picture, and different things will appear dark or bright on T1 and T2 depending on how much water is in that tissue. The “deep cerebral white matter,” are the connections between different parts of the brain that carry the electrical signals between brain cells (neurons).

Taken together, the report you provide means that within the deep connections of the brain, there were multiple small areas that appear abnormal, and appear to contain slightly more water than the surrounding areas. Sometimes this happens after an old injury or insult, the normal tissue dies, leaving a small hole that fills with fluid.  However, I am unable to determine what caused these abnormal foci, and how they fit in with the larger picture of your relative’s illness I am also unsure. Some neurodegenerative diseases will have characteristic MRI abnormalities that provide further clues to a diagnosis. Other investigations are sometimes necessary to distinguish the various causes of white matter lesions. A lumbar puncture is sometimes necessary, in which fluid from around the spine and brain is taken out and analyzed with various tests.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[haz201]

  

  Thank you so so much for helping me understand the report. my brother went to many doctors in pakistan and they couldnt tell him much.
this means alot to me. thanks for taking time to explain.
  Allah guide you light.

[haz201]

Please doctor i have just one more question the other part of the report read that right mastoid shows abnormal intensity.
  
i will copy and past all  report below. there is no family history of any disease and he was healthy. the CSF lumbar puncture  report was all normal.
He did have an ear infection last year and was hit on the back of the head 7 months back and thats when he started getting angry and quiet.  
my question is please is this caused by the blow on head or the ear infection.
A big please what is your opinion id appreciate it if you could know the answer.  also what is the treatment,  I know youre probable busy doc but it would mean alot to get youre opinion.thank you

[haz201]

Please doctor i have just one more question the other part of the report read that right mastoid shows abnormal intensity.
  
i will copy and past all  report below. there is no family history of any disease and he was healthy. the CSF lumbar puncture  report was all normal.
He did have an ear infection last year and was hit on the back of the head 7 months back and thats when he started getting angry and quiet.  
my question is please is this caused by the blow on head or the ear infection.

A big please what is your opinion id appreciate it if you could know the answer.  also what is the treatment,  I know youre probable busy doc but it would mean alot to get youre opinion.thank you

MULTIPLE SMALL, FINE NON-ENHANCING FOCI OF ABNORMAL SIGNAL INTENSITY, APPEARING HYPOINTENSE ON T1W AND HYPERINTENSE ON T2W SEQUENCES ARE SEEN HIGH UP IN THE DEEP CEREBRAL WHITE MATTER OF BOTH CEREBRAL HEMISPHERES.
Right mastoid shows areas of abnormal signal intesity appearing is to hypointense on T1W and hyperintense on T2W sequences, not showing any significant anhancement (?chronic inflammatory process ?)
-Intra-cerebral and extra-cerebral CSF spaces are within normal limits
Pons, mid-braqin and medulla oblongata appear normal
no evidence of intra-cerebral, sub-dural extra- dural bleed
no evidence of dural sinu thrombosis is seen.
pituary gland is normal in size with central infundibulum
The vestibulo-cochlear nerve complexes appear normal on both sides
Impression
small vessel cerebral ischaemic foci
?chronic inflammatory