Non Specific White Matter Changes

[roe1]

I amwriting to find out some info about my daughters health issues.....  She has beenjust been diagnosised with Hodgkins Lymphoma, she has not started any treatment as of yet.
She had severe anemia for a while, due to a small bleed in her stomach, that the docs did not pick up on.  
She has had a headaches for several months now, it is a constant headache.   Her hematogist/oncologist just did a mri of her brain.  He called last night and said the finds were...... non specific white matter changs, toxic metabolic changes, small venus angomias.   He did not say what he was thinking, just for her to have spinal tap done ASAP.  
My question is, could this be CNS Lymphoma?

[roe1]

Thank you for your response.  I have a question. You said that a malignancy would light up.  I am did not that, that is what happened when she had the MRI of her lymph.  But, if it did light up, would the report still read, Non specific white matter changs, toxic metaboltic change, and angianomas.  Or would they have been able to tell that it was a cancerous brain tumor?  She is having a pet scan this week, and a spinal tap next.  They want to do an MRI of her spine first.  

[Neuro Forum]

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 and review the imaging, I can not tell you what the exact cause of the symptoms is or what the implications of the imaging findings are. However I will try to provide you with some useful information.

In general (in someone without lymphoma), white matter changes can have various causes, that is what makes them non-specific. 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: age (>50), 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 white matter hyperintensities include migraine in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance. Other causes 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.

CNS lymphoma is of 2 types: primary and secondary. If your daughter's lymphoma was involving the brain, this type would be called secondary. Primary CNS lymphoma arises from within the brain and does not involve other organs (it is not systemic); primary CNS lymphoma can appear as nonspecific white matter hyperintensities. In both types of lymphoma (whether primary or metastatic), enhancement ("lighting up" when a type of dye, the IV contrast agent gadolinium) and specific features on specific imaging sequences, raise suspicion for this. When there is concern for malignancy in or around the brain, lumbar puncture is useful to assess for this.

Continued follow-up with your daughters physicians is recommended.

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