periventricular small vessel ischemic changes

[Deb2136]

My mother recently had an MRI and it showed periventricular small vessel ischemic changes in her brain. Could you please explain what this means in layman's terms. She is 81 years old and has been experiencing tingling and numbness episodes on the right side of her face, hand and foot.

Thank yoiu,

Debbie Zabor

[Prash1234]

Periventricular ischaemic changes are common findings in old age on ct and Mri. Causes mostly could be ischaemic changes ie. Decreased cerebral blood flow. And sometimes due to age related cerebral atrophy which you often attribute to these findings on Mri. Most patients will be elderly and asymptomatic. Very rarely hydrocephalus can also be a cause and symptoms of hydrocephalus can clarify/correlate the findings on Mri.

[Holmfield]

What does moderate atrophy of the temporal lobes bilaterally predominantly involving the medial portions of both temporal lobes.Suspicion of possible mesial temporal sclerosis.MRI findings suggestive for patchy chronic post ischemic white matter demyelination are identified in frontal and partial lobes bilaterally. My husband is 82 yrs old and they say it's Alzeimers ?
Also says mild cerebellar vermin atrophy.

[seawherry]

Hi Ya,  I went to the doctors in England 7 years ago for numbness in my hands , they brushed it off stating probably a pinch nerve I worked hard , walked 8 to 16 miles a day as post lady, and 17 hour shifts so didnt think anything of it as just simply i am a work aholic. I am 48 now , went to the US doctors as moved here and started having numbness in my legs and tingling and incompetency problems. so they did spinal MRI found 5 disc collapse so 9 weeks ago had spinal fusion.  mean time my legs weakness , fatigue and ordination to walk still continued to get worse so they did a Brain MRI Here are my results , I don't have a clue one what they mean as the doctor who ordered the results have not called me in for a consultation. As i find very disturbing. Radiologist states this in his findings.  " EXAMINATION: MRI Brain without and with Contrast

HISTORY: Bilateral leg numbness, signal change in cervical cord, evaluate
for demyelinating disease.

TECHNIQUE: Sagittal and axial T1. Axial T2, FLAIR, gradient-echo and
diffusion weighted sequences obtained before contrast. Axial, coronal, and
sagittal T1 repeated after intravenous gadolinium contrast. Contrast: 13 mL
MULTIHANCE
FINDINGS:
There is a moderate degree of bilateral symmetric T2 and FLAIR signal
hyperintensity in each cerebral hemisphere. This is seen around the
periventricular regions and extending up into the corona radiata white
matter. There is some involvement of the right posterior-lateral corpus
callosum. There is a similar single small focus of signal abnormality in the
right posterior pons, near the junction with the midbrain, but no other
involvement of the posterior fossa is seen. No lesion with mass effect,
abnormal enhancement or restriction of diffusion signal. However, a few small
periventricular foci of moderate T1 signal hypointensity are also present,
fairly well-circumscribed. The appearance is suggestive of chronic "black
hole" plaque of multiple sclerosis.

No hemorrhage, infarct, mass or brain edema. Meninges are within normal
limits, there are normal flow voids in the large arteries and dural venous
sinuses. Orbital and skull base soft tissues look normal. Incidentally, there
is moderate opacification of the mastoid air cells on the right side but
there is no obstructing lesion seen in the region of the nasopharynx. There
is also no inflammation seen in the soft tissues around the right mastoid
bone. The mastoid air cells moderately enhance.

Impression
IMPRESSION:
1. Moderate degree of periventricular and deep bilateral cerebral white
matter demyelination, without enhancement or significant atrophy. The pattern
is most consistent with multiple sclerosis.
2. There is one small focus in the right brainstem as well, and another
within the corpus callosum.. I can handle anything good bad or ugly news , I just cant handle not knowing what it means. Can someone explain in simple terms please i cant get into a neurologist for 3 months. Cheers, Lisa

[india79]

Hi,i am 36yrs old male.. Recently i hv done my mri for brain and the report says( MULTIPLE SMALL FOCAL ISCHEMIC CHANGES AT PERIVENTRICULAR AND SUBCORTICAL WHITE MATTER OF BILATERAL FRONTOPARIETAL LOBES)..also my homocysteine levels are elevated(18.99)...i am experiencing pain in left side of my head and dizziness...sometimes tingling in my left leg...kindly confirm what treatment i hv to go thru is it something serious..pls confirm..thanx

[india79]

Hi,i am 36yrs old male.. Recently i hv done my mri for brain and the report says( MULTIPLE SMALL FOCAL ISCHEMIC CHANGES AT PERIVENTRICULAR AND SUBCORTICAL WHITE MATTER OF BILATERAL FRONTOPARIETAL LOBES)..also my homocysteine levels are elevated(18.99)...i am experiencing pain in left side of my head and dizziness...sometimes tingling in my left leg...kindly confirm what treatment i hv to go thru is it something serious..pls confirm..rhanxthanx

[india79]

Hi,i am 36yrs old male.. Recently i hv done my mri for brain and the report says( MULTIPLE SMALL FOCAL ISCHEMIC CHANGES AT PERIVENTRICULAR AND SUBCORTICAL WHITE MATTER OF BILATERAL FRONTOPARIETAL LOBES)..also my homocysteine levels are elevated(18.99)...i am experiencing pain in left side of my head and dizziness...sometimes tingling in my left leg...kindly confirm what treatment i hv to go thru is it something serious..pls confirm..rhanxthanx

[tybusiness43]

I apologize, my Cholesterol reading was 206, the LDL was 140 and my HDL was 47. My doctor said that I needed to bring the LDL down a bit. The FLAIR Hypertensities were T2. I do not drink or smoke.

[tybusiness43]

Good Morning, I am a 46 year old female in good health as far as my yearly exams are concerned. I experienced an episode on 12/22/2010 of a sharp pain traveling up my right arm and down into the left side of my chest, a weird sensation across the back of my eyes and mild numbness on the top of my right arm in the center between my hand and elbow. I took an Alieve and went to bed. The next morning I felt a little staggery when I walked to the bathroom. I noticed that the vision in my left eye was a little more blurry than before. (I wear glasses and my left eye is weaker than the right) I do not have high blood pressure or diabetes.  My lab work was described by the ER doctor as "Like a 20 year old" My weight is 150. During the last physical exam, my Cholesterol reading was.  I try to stay on a regimen of juicing my fruits and veggies. I try to keep a diet of talapia and ground turkey for meats and Pecans for snacks. I do use Protein Powder shakes with vitamins from A to Z that have 25 grams of protein per serving but it's not on a daily basis. I do, however, have a lot of stress in my marriage and I'm dealing with my grown daughters and their life issues. It's been a lot of stress over the past 7 years.

I took a visit to the ER by paramedics on 12/22/2010 just to be safe. I had an MRI of my head and neck that read the following:

Nonspecific white matter, FLAIR hyperintensities in the subcortical left frontal lobe and right corona radiata statistically related to small vessel ischemic changes. Otherwise, unremarkable MRI the brain.

Can you please tell me what this reading means?  I have not seen a doctor since the incident on 12/22/2010, but I'm scheduling an appointment with my primary care and a Neurologist ASAP. The ER doctor said that my symptoms were not "A Specific" to a  Stroke so he released me from the hospital visit with no medication. He instructed a follow-up though. I've been tested, in the past, for Lupus on 2 occasions by my primary care doctor and the tests were negative. I am very concerned about the vision in my left eye because I have to wear my glasses to see properly since the incident. In the past, I was instructed by my ENT doctor to use a nasal rinse, which has given me some relief from the sinus pressure that I experience. The last MRI I had about 7 years ago was normal, but there was a lot of swelling in my sinuses. My last CT Scan did not show a stroke either.

Thank you in advance for your advice

[mms556]

I am 39 and healthy, run 20mins on the running machine and does excersise 3 times a week min including swimming. I had 2 MRIs within 4 years which showed minimal changes regarding the load in the brain but the neuros seem to be "excited" about these lessions and suggested MS. They cannot however, distinguish " Dawsons fingers or any spots present within the Circle of WIll's. I have been suffering from chronic sinusitis and have recently been on antibiotics for a month. My ENT doctor was convinced that the presence of the polyp in the nasal cavity resulted in intracranial pressure and cause ON (caused 2 months before the ENT diagnosis. However, the neuro would not have it, despite my cervical cord being clean and refused to discuss the possible diagnosis. I declined the offer of CSF and suggested that the lessions could be from difficulties at birth and the migraine caused by sinusis. I have not told that I have a rare form of platelets HPA-1b homozygous (present in 1% of the population) which is important for blood clotting.  Would that make a difference? I feel a bit annoyed and that the neuros overinterpretation of data for just a T2 flair MRI! We are biological systems and abnormal should be replaced by atypical, meaning that everybody is an individual!  I have no other physical symptoms as such and I feel a bit let down.

[Cheryl1057]

I had an MRI recently and my GP tells me I have an acute infarc with ischemic change of vessels and stroke-like lesion.  What the heck does this mean?  Have I had a stroke?  I've had a headache for 7 weeks now and am 52 years old.  What do I do now?

[Lorim119]

I had an mri done I am 42 years old  foci of high signal in the deep white matter consistent with small vessel ischemic change and or gliosis. also the left side of the pituitary is larger than the right . Foot notes: There is evidence of small vessel ischemic change with several foci of high siganl within the deep white matter.  I dont have high blood pressure.  I was referred to a endoconologist. Can you tell me what this means please.
Tnanks

[CCFNeuroMD JT, MD]

I am happy to address the questions that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a substitute for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.

This “periventricular small vessel ischemic change” identified in the MRI report is a very common finding in the aged brain, strongly associated with hypertension.  This finding is generally a manifestation of atherosclerosis (AKA “hardening of the arteries”) related to high blood pressure.  The word “ischemic” indicates a loss of blood supply to a particular region of the body.  In this particular case, the very small blood vessels that supply some of the deep white matter in the brain are affected.  Oftentimes, these small vessel changes are incidental findings without clinical correlate (i.e. asymptomatic).  People with an extensive burden of small vessel disease may have manifestations of cognitive decline, AKA vascular dementia.  

It is unlikely that the tingling and numbness of the right side of her face, hand, and foot are related to the small vessel disease evident on her MRI.  However, given that she has evidence of diseased white matter, she likely has risk factors for stroke, the major ones being high blood pressure, high cholesterol, cigarette smoking, diabetes, cardiac arrhythmia (especially atrial fibrillation), and blood clotting disorders.  The numbness you mention may be a sign of a small stroke involving the very small, deep penetrating arteries of the brain.  These types of stroke, also called lacunar strokes (from the Latin root lacuna meaning “empty space”), may be so small that they are not always apparent on an MRI.  In your mother’s case, it sounds like her symptoms are purely sensory, perhaps suggesting a small “lacune” in the thalamus, which is the relay center for the brain.  

At this point, the best way to proceed is to see a neurologist who can examine your mother and provide you with a plan of care specific to your mother.  For most patients in her condition, the best treatment is prevention, meaning risk factor modification.  I hope I’ve answered some of your questions.  Best of luck!