questions about MRI study

Hello,

I have a basic question about an MRI study my father has results from - I ask in part to help him understand how to ask questions, of his doctor.

First, my father has had lung cancer for 5 years. Standard (I suppose) chemo and radiation. All is in remission.

More recently, a complaint of dizzyness led his doc to order an MRI Brain W and W/O Contrast.

The findings that concern me are "Worsening Chronic Microvascular Ischemic Disease". This is accompanied by mild to moderate number of high T2 signal lesions of chronic ischemia in both cerebral hemispheres, increased in size and number. (Everything else is normal)

Not sure what this might indicate, but I do know that with my father's dizzyness, he also has quite increased mood disorder (sudden anger), memory issues. Lung cancer was tough for him, he became depressed, but now is better. Though his has worried about the dizzyness.

I told my father to ask the doc. about cognition (he does suffer mood disorder, distraction, hearing loss which may be more cognitive than physical (?) ..

He also has had blockage of his arteries (bad diet for so long), and is on meds for that.

I ask how to quickly assess, or guide, the MRI result because my father is not one to ask, he has trouble asking questions in English.

His mother had two strokes, and later Alzheimer's.

Any thoughts or advice on how to understand this MRI report? Or guidance to as his doc what how to understand the findings?

Thanks so much,
Frank

[Dr Sharma]

Hi there. It is important to make note that white matter lesions on a brain mri does not necessarily mean Multiple sclerosis. White matter lesions can be seen in various conditions. These represent micro vascular ischemic changes in the brain hence these white matter abnormalities on mri are common in patients who have microvascular and macro vascular risk factors like history of hypertension, diabetes and high cholesterol. White matter signal changes on MRI are seen in infectious and other inflammatory conditions and migraine headaches. These white matter signal changes on brain mri need to be correlated to the history, clinical examination and other ancillary investigations. Your doctor needs to check cerebral degeneration as a part of paraneoplastic syndrome related to lung cancer. Your doctor will also need to investigate your dad for multiple sclerosis where the disease phase is characterized by active phase and remissions. It has multiple symptoms and signs and is a diagnosis of exclusion. The symptoms of multiple sclerosis are loss of balance, muscle spasms, numbness in any area, problems with walking and coordination, tremors in one or more arms and legs. Bowel and bladder symptoms include frequency of micturition, urine leakage, eye symptoms like double vision uncontrollable rapid eye movements, facial pain, painful muscle spasms, tingling, burning in arms or legs, depression, dizziness, hearing loss, fatigue etc. The treatment is essentially limited to symptomatic therapy so the course of action would not change much whether MS has been diagnosed or not. Apart from clinical neurological examination, MRI shows MS as paler areas of demyelination, two different episodes of demyelination separated by one month in at least two different brain locations. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons, transmit nerve signals slower than non-demyelinated ones and can be detected with EP tests. These are visual evoked potentials, brain stem auditory evoked response, and somatosensory evoked potential. Slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI in addition, a spinal tap. Therefore, it would be prudent to consult your neurologist with these concerns. Hope this helps. Take care.

[frankier]

Dr. Sharma,

Thank you for your thoughts. I'd not thought this was MS-related at all, though his sister had and a son has MS .. I had thought that what his MRI findings were possibly related to age (he is 74), to his lung cancer (diagnosed at 69) or to its treatment (radio and chemo).

If anything, I had thought these findings might indicate a heightened propensity to stroke? He does have pretty clogged arteries.

Thanks, Frank