Hi Cindy and welcome,
Matching lesions to symptoms is not always clear cut, some types of symptoms are easier than others to pin down to the most likely location, for example structural spinal issues as well as spinal cord lesions are more commonly associated with all the issues you've specifically mentioned "Lhermitte's, foot drop, painful tingling and weakness in legs, peripheral neuropathy in the legs" so a spinal MRI is most likely needed to help rule in and out condition causation's....
Scattered foci of T2 and FLAIR signal within the periventricular white matter 'and or' the subcortical white matter are very common MRI findings and are typically non specific microvascular ischemic changes.
Mild cerebral cortical atrophy when mild could be interrelated to chronic ischemic changes but there are different specific atrophy patterns that have been associated with different types of medical conditions eg dementia, stroke, traumatic brain injury, Alzheimer's, hereditary diseases, neurosyphilis, encephalitis, MS, AID's, Cerebral palsy, frontal lobe dementia etc etc etc I honestly can't tell you what each specific atrophy pattern is suggestive-consistent with what but from my understanding up the MS associated brain atrophy pattern is suppose to involve grey brain matter...
The types of symptoms associated with cerebral cortical atrophy are memory and cognitive functions eg executive functions, visual-spacial perception, sequencing etc, seizures, and aphasia eg speaking and understanding language etc
In regards to IF neurological conditions like MS can be the cause of these types of findings......generally these types of common non specific brain MRI findings wouldn't put neurological conditions like MS at the top of anyone's causation's list.
With your 30 year history of symptoms there is typically a lot more lesion evidence suggestive-consistent with demyelinating lesions and in more than just the periventricular area of the brain. Try to keep in mind there are hardly any symptoms associated with MS that are unique to MS, and if after a 30yr time frame the classic MRI evidence and or correlating clinical signs of MS haven't shown up, it's more likely the diagnostic evidence is pointing away from neurological conditions like MS and it's highly possible you have been dealing with one of the conditions that mimics MS instead and you've got a lot more testing ahead of you to work it out.
hope that helps......JJ
It's in your best interest to try to be open minded, whilst there are specific types of symptoms connected to cerebral atrophy, it's very possible what was found on your brain MRI is not actually neurologically abnormal and hasn't caused any type of neurologically associated symptoms because your report states "There are foci of T2 and FLAIR signal within the periventricular white matter that are not uncommon for the patient's age....typically representing changes associated with chronic ischemia. "
That doesn't mean in anyway that what you have been experiencing doesn't have a cognitive or verbal component to it, just that the primary causation is less likely to be from a neurological related disease or brain abnormality....
hmmmm how to explain what i'm meaning, lol bare with me here, okay for example think of what happens when someone drinks too much alcohol ie a drunk night out, they experience a temporary disruption in speech quality, cognitive and memory issue, imbalanced motor skills, visual clarity etc etc but weeks, months, years later there wouldn't be any evidence expected to be showing up on an MRI from there drunk night out because those symptoms are a side effect of alcohol. Alcohol like medications, migraine, sleep deprivation, mental health issues, infections etc etc can cause temporary episodes of aphasia like symptoms but it's not really the same as primary brain damage related aphasia. (lol did that make sense?)
hope that helps.....JJ