MTBI

[dodo60]

How do you differentiate between white spots on an MRI scan a year post injury caused by moderate traumatic brain injury and those possibly caused by arteriosclerosis?

[dodo60]

Thanks for your response regarding differentiating between causes of white spots in brain scan. Nearly 4 years ago when I was thankfully a fit and physically and intellectually active 56 yr old I was lucky to survive when I was felled by a large falling branch hitting me on the top of my head. It felled me straight onto the back of my head knocking me out. The second blow probably the more serious. I changed in an instant from being very healthy to what feels like 20/30 years older.
I have had classic mtbi symptoms since then plus daily debilitating fatigue relieved only by sleep. Very thorough assessment by a neuorologist and ENT specialist has resulted in a diagnosis of vestibular reflex impairment probably with diffuse axonal injury.
However a neuropsychologist who tested me cognitively for a second time two years after the first test (my basic intelligence etc is intact and I am quite articulate if not fatigued) and found a slight increase in slowing down of processing, suggests that this is due to a pre-existing brain disease. I do not suffer from depression nor am I on any medication. He thinks this  because the first MRI scan I had one year after the accident showed a scattering of small white lesions which a specialist suggested might be arteriosclerosis. However the neurologist felt that because I was very fit before the accident these were most likely normal for my older brain. Although I had a second and more powerful scan two years after the first and this showed no deterioration or increase in the tiny spots the neuro psych is having difficulty explaining my slower processing observed in his second test two years later. I have tried to point out to him that the first test he did was mid-morning when I am relatively bright but the second cognitive test was mid-afternoon when I was suffering from the fatigue and when everything, on a daily basis, slows down and all the symptoms worsen. He never once asked me about fatigue. I do not smoke, nor drink, I eat a wholefood diet and I have exemplary blood pressure. I passed a tightly-timed written exam with distinction 5 months before the accident, was working as a secondary school teacher and had no symptoms of ischemia, MS, Alzheimer's etc. From my own research, and as confirmed by yourself, white spots can be scars from the micro-haemorrhaging of fine blood vessels caused by a blow to the head. None of the specialists I have seen has mentioned this.
As far as the psychologist is concerned, could this be a case of "if the only tool you have is a hammer, all problems look like nails"?
Thank you as just needed to get this off my chest.

[dodo60]

Thanks for your response regarding differentiating between causes of white spots in brain scan. Nearly 4 years ago when I was thankfully a fit and physically and intellectually active 56 yr old I was lucky to survive when I was felled by a large falling branch hitting me on the top of my head. It felled me straight onto the back of my head knocking me out. The second blow probably the more serious. I changed in an instant from being very healthy to what feels like 20/30 years older.
I have had classic mtbi symptoms since then plus daily debilitating fatigue relieved only by sleep. Very thorough assessment by a neuorologist and ENT specialist has resulted in a diagnosis of vestibular reflex impairment probably with diffuse axonal injury.
However a neuropsychologist who tested me cognitively for a second time two years after the first test (my basic intelligence etc is intact and I am quite articulate if not fatigued) and found a slight increase in slowing down of processing, suggests that this is due to a pre-existing brain disease. I do not suffer from depression nor am I on any medication. He thinks this  because the first MRI scan I had one year after the accident showed a scattering of small white lesions which a specialist suggested might be arteriosclerosis. However the neurologist felt that because I was very fit before the accident these were most likely normal for my older brain. Although I had a second and more powerful scan two years after the first and this showed no deterioration or increase in the tiny spots the neuro psych is having difficulty explaining my slower processing observed in his second test two years later. I have tried to point out to him that the first test he did was mid-morning when I am relatively bright but the second cognitive test was mid-afternoon when I was suffering from the fatigue and when everything, on a daily basis, slows down and all the symptoms worsen. He never once asked me about fatigue. I do not smoke, nor drink, I eat a wholefood diet and I have exemplary blood pressure. I passed a tightly-timed written exam with distinction 5 months before the accident, was working as a secondary school teacher and had no symptoms of ischemia, MS, Alzheimer's etc. From my own research, and as confirmed by yourself, white spots can be scars from the micro-haemorrhaging of fine blood vessels caused by a blow to the head. None of the specialists I have seen has mentioned this.
As far as the psychologist is concerned, could this be a case of "if the only tool you have is a hammer, all problems look like nails"?
Thank you as just needed to get this off my chest.

[dicee9]

Hi about 6 years ago I had a MRI done they found white spots on my brain and told me to have another MRI 6 months later. but I lost my insurance and cannot go to a Doctor should I be really worried and what could it be

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
White spots on MRI are seen in MS, microvascular disease (arteriosclerosis as you mention), some types of headaches, Alzhiemer’s disease, old age and even due to TBI. It is difficult to differentiate the white spots due to one disease from the white spots due to another. Patient history and other parameters are taken into consideration and co related with the MRI picture. Please discuss with your neurologist. Please let me know if there is any thing else and do keep me posted. Take care!