question for a doctor regarding my most recent MRI

MRI.I had another MRI in July and one the other day because in July a plaque showed up in the left parietal region and she wanted to give it three months. Anyone want to tell me what they think of this?

.i recently had an mri in june and now a follow up last week. can someone tell me what they feel about these findings.

Again seen are numerous T2-hyperintense foci in the cerebral white matter. There is also a prominent lesion, about 6-7 mm size, in the left basal ganglia area in or adjacent to the posterior limb of th einternal capsule. Of note, there are no periventricular lesions, and in the corpus callosum, only a single small lesion is noted along the far left lateral aspect of the anterior part of the corpus callosal body. Also, there are no visible lesions in the brainstem or cerebellum. Typical features of multiple sclerosis are lacking. Prominent perivascular spaces are noted in the left cerebral peduncle of the midbrain.


There is no pathologic enhancement in any area. There are no areas of restricted diffusion on DWI. The ventricles are normal. The major vascular flow voids are unremarkable. The orbits and paranasal sinuses are unremarkable.

Any ideas? I'm open to listen to anyone

[Shazia Alam, DO]

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 obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

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.

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.

You may be under evaluation for Multiple sclerosis.  Multiple sclerosis is a disease that primarily affects the central nervous system (brain, spinal cord, nerves from the eye, the optic nerves). Symptoms may be mild to severe, ranging from tingling and numbness to paralysis. There is not one test alone or one symptom that can diagnose MS, but there are well-established criteria that help neurologists make the diagnosis. These include taking a thorough history, doing a thorough physical exam, conducting an MRI of the brain with gadolinium (contrast, similar to dye) and sometimes MRI of the spine, and sometimes ancillary testing such as lumbar puncture and evoked potentials. If an MRI of the brain and spine is normal, the diagnosis of MS becomes highly unlikely.

In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and needed as it helps determining the presence of white matter lesions in 2 or more locations, however there are multiple conditions producing MRI changes that could be mistaken for MS, and the MRI should be reviewed properly and correlated to the symptoms. If someone has several lesions on the brain MRI, but they have not had distinct episodes of neurologic symptoms, or they have specific findings on neurologic examination, then a diagnosis of MS can not be made.

When a neurologist is considering the diagnosis of MS, the criteria he/she may use include (1) evidence of damage in at least two separate parts of the central nervous system (CNS) (2) lack of another explanation for the damage (3) specific MRI findings (4) specific findings on CSF (fluid taken from around the brain/spine through a procedure called lumbar puncture) (4) results of visual evoked potentials (a test of how the nerve from the eye, the optic nerve, is functioning.

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.

I hope this information is helpful.  I would recommend discussing your results with your neurologist.  

[Missy1018]

Thank you for your answer.