MRI white matter lesions
Many times I get consulted by patients or their relatives when their MRI brain report reads multiple scattered white matter lesions seen. The radiologist’s report usually further reads that these can be seen in primary demyelinating conditions like multiple sclerosis or in vascular disorders. Patient’s and caregivers are naturally worried when they get this MRI report and do not know what to do and how to proceed further. So I thought that here I shall talk about these white matter abnormalities seen on the MRI. What is their significance? Do they represent evidence of multiple sclerosis?
White matter signal changes on the MRI essentially means that on the MRI, the white matter showed some scattered bright spots. White matter in the brain refers to the fiber tracts that carry information to and fro from the brain.
My first question when somebody asks me what next and what does this mean is to ask them why was the MRI done in the first place. If the MRI was done because there was a clinical suspicion of multiple sclerosis then these white matter lesions may indeed have significance and may represent radiological evidence of MS plaques. Let me explain this with an example. You go to your doctor, you have signs and symptoms that suggest MS (example you may have had an attack of optic neuritis), when the doctor examines you he is able to elict signs in the examination compatible with a diagnosis of MS, then he orders an MRI to see if you do have evidence of white matter lesions in the brain. In a case like this the presence of white matter lesions/ signal changes in the MRI is obviously important. Here it likely does suggest the presence of MS. That said and done I again want to re-emphasize that the diagnosis of MS is made on the basis of clinical history of previous attacks, CSF (spinal fluid) examination and MRI, not just on the basis of the MRI alone. Also there are certain criteria which have to be satisfied on MRI to make a definite diagnosis of MS. These radiological criteria for MS include the number of lesions on the MRI, their location and their size.
Thus it is important to remember that a person who is noted to have white matter lesions on a brain MRI does not necessarily have MS. White matter lesions can be seen in numerous other conditions and they are more commonly seen as we grow older. The thinking behind this is that they represent microvascular ischemic changes in the brain (the smaller caliber blood vessels in the brain showing signs of ischemia or decreased blood flow). Hence these white matter abnormalities on MRI are more commonly seen in patients who have microvascular and macrovascular risk factors such as a history of hypertension, diabetes and high cholesterol (dyslipidemia/ bad lipid profile).
White matter signal changes on MRI may also be seen in patients who have infectious and other inflammatory conditions. They have been reported in the MRI of patients with a history of migraine headaches (migraine too is a vascular disorder and that may explain the connection).
So I want to end by saying that the presence of these white matter signal changes on brain MRI has to be correlated to the history, clinical examination and other ancillary investigations. Your doctor shall help you in going about this in a methodical manner. I repeat these white matter lesions do not suggest MS in each and every case they are found.
White matter signal changes on the MRI essentially means that on the MRI, the white matter showed some scattered bright spots. White matter in the brain refers to the fiber tracts that carry information to and fro from the brain.
My first question when somebody asks me what next and what does this mean is to ask them why was the MRI done in the first place. If the MRI was done because there was a clinical suspicion of multiple sclerosis then these white matter lesions may indeed have significance and may represent radiological evidence of MS plaques. Let me explain this with an example. You go to your doctor, you have signs and symptoms that suggest MS (example you may have had an attack of optic neuritis), when the doctor examines you he is able to elict signs in the examination compatible with a diagnosis of MS, then he orders an MRI to see if you do have evidence of white matter lesions in the brain. In a case like this the presence of white matter lesions/ signal changes in the MRI is obviously important. Here it likely does suggest the presence of MS. That said and done I again want to re-emphasize that the diagnosis of MS is made on the basis of clinical history of previous attacks, CSF (spinal fluid) examination and MRI, not just on the basis of the MRI alone. Also there are certain criteria which have to be satisfied on MRI to make a definite diagnosis of MS. These radiological criteria for MS include the number of lesions on the MRI, their location and their size.
Thus it is important to remember that a person who is noted to have white matter lesions on a brain MRI does not necessarily have MS. White matter lesions can be seen in numerous other conditions and they are more commonly seen as we grow older. The thinking behind this is that they represent microvascular ischemic changes in the brain (the smaller caliber blood vessels in the brain showing signs of ischemia or decreased blood flow). Hence these white matter abnormalities on MRI are more commonly seen in patients who have microvascular and macrovascular risk factors such as a history of hypertension, diabetes and high cholesterol (dyslipidemia/ bad lipid profile).
White matter signal changes on MRI may also be seen in patients who have infectious and other inflammatory conditions. They have been reported in the MRI of patients with a history of migraine headaches (migraine too is a vascular disorder and that may explain the connection).
So I want to end by saying that the presence of these white matter signal changes on brain MRI has to be correlated to the history, clinical examination and other ancillary investigations. Your doctor shall help you in going about this in a methodical manner. I repeat these white matter lesions do not suggest MS in each and every case they are found.
Dr. Sethi
Visit and participitate in my blog:
http://braindiseases.wordpress.com
Visit the brain care foundation website at:
www.braincarefoundation.com
THIS IS VERY INTERESTING, SINCE I DO HAVE WHITE MATTER ALL IN MY MRI BRAIN SCAN. IT IS A TERRIBLE PLACE TO BE, WHEN NOT TAKEN SERIOUSLY AND A PERSON HAS TO FIGHT TO GET AN ANSWER TO WHAT IS GOING ON.
I RECENTLY WENT TO A NEUROLOGIST THAT DIDN'T TAKE ME SERIOUSLY, FOR APPARENTLY WAS MOCKING ME AT MY LAST VISIT. IF IT ISN'T HARD ENOUGH TO MAKE IT THERE AND STAY IN THE LOBBY FOR 2 HOURS, THEN ANOTHER HOUR IN HIS ROOM, THEN WHEN HE FINALLY DOES COME IN, HE IS RUSHING AND GETTING THROUGH WITH THE OFFICE VISIT SO THAT HE CAN RUSH OVER TO ANOTHER ROOM. I KNOW, I HAVE BEEN THERE AND I AM TIRED OF THESE SO CALLED DOCTORS...WHO, ARE SUPPOSE TO HAVE OUR BEST INTEREST AT HEART. INSTEAD, THEY RIDICULE YOU AND SEND YOU OUT OF THEIR OFFICE WITH MORE QUESTIONS THAN, ANSWERS.
I JUST WANTED TO POST MY BRAIN MRI HERE, SO THAT WHEN I DO GET DIAGNOSED, I WILL HAVE EVIDENCE THAT THIS DOCTOR FOUND, WHAT HE SAW ON MY MRI, AS INSIGNIFICANT. IT IS WRONG AND BAD ENOUGH FOR A DOCTOR TO SEEM NOT TO CARE, BUT WHEN THEY ACTUALLY MAKE COMMENTS THAT ARE CONDESCENDING AND OFFENDING, THEN SOMETHING HAS TO BE DONE. THIS DOCTOR, THE LAST TIME, I WAS THERE, TOLD ME THIS, "YOU DON'T HAVE LEPROSY DO YOU?" AND "DO YOU HAVE A PROSTATE PROBLEM, DO YOU?" I TOLD HIM, AFTER HE SAID THAT, THAT "I DON'T KNOW, HAVE YOU CHECKED?"..HE SAID, "WOMEN DON'T HAVE PROSTATES.". THEN, I REPLIED, "I DO KNOW THAT!"
THIS OFFICE VISIT WAS UNREAL. I HAVE NEVER HEARD ANY DOCTOR TALK TO ME, THE WAY THAT HE DID. HE WAS VERY CONDESCENDING AND IT WAS VERY OFFESSIVE AND HURTFUL, TO ME, SINCE I DEAL WITH A GREAT AMOUNT OF PAIN. I STRUGGLE TO GET THROUGH EVERYDAY, AS IT IS AND I DON'T NEED SOMEONE WHO IS SUPPOSED TO BE PROFESSIONAL TREATS YOU LIKE YOU DON'T MATTER.
HE WAS TELLING ME THAT I HAD TOO MANY SYMPTOMS AND I TOLD HIM THAT I KNEW THAT I HAD A LOT AND ALL OF THE SYMPTOMS, AFTER A WHILE WILL MAKE ANY PERSON DEPRESSED. IF I DIDN'T HAVE ALL OF THIS PAIN AND SUFFERING AS I DO, EACH AND EVERYDAY...I WOULD NOT BE DEPRESSED, AT ALL. I WOULD BE TO BUSY LIVING MY LIFE, TO BE THAT WAY.
THE LAST TIME I WAS THERE HE GAVE ME A PRESCRIPTION FOR CYMBALTA, BUT I DID TAKE ONE AND MY SYMPTOMS INCREASED. IT SAID ON THE INSTRUCTIONS NOT TO CONTINUE, IF SYMPTOMS WORSENED. I TOLD HIM THAT. HE ACTUALLY GAVE ME ANOTHER PRESCRIPTION TO TRY AND I TOLD HIM THAT I DIDN'T WANT IT AND HE ASKED ME WHAT IT WAS THAT I WANTED. I TOLD HIM THAT ALL I WANTED WAS TO FIND OUT WHAT IT IS THAT FEELS LIKE IT'S KILLING ME.
SOMETHING HAS TO BE DONE AND THE ANSWERS HAVE TO BE FOUND. IF, WE...THE PATIENTS, DON'T PUSH TO FIND THE ANSWERS, TO WHAT IT IS THAT IS PLAGUING US, THEN WE ARE VERY POSSIBLY TAKING THE CHANCE ON BEING A STATISTIC. I DON'T KNOW @ YOU, BUT I DON'T WANT TO BE ONE...I JUST WANT MY LIFE BACK.
I AM SO TIRED, OF HOW SOME PEOPLE TREAT THOSE WHO ARE SUFFERING, JUST BECAUSE THEY DON'T UNDERSTAND OR WANT TO UNDERSTAND, DOESN'T GIVE THEM THE RIGHT TO PUNISH THE PERSON ANY FURTHER. WHY DO THEY RIDICULE THE PERSON WHO IS ALREADY HAVING SUCH A HARD TIME TRYING TO LIVE THEIR LIFE? LIFE IS HARD ENOUGH, BESIDES HAVING TO DEAL WITH AN "ASS"..(sorry, it is sad, but true)
I AM PRETTY SURE THAT THE MRI'S THAT I HAVE POSTED SHOW EVIDENCE ENOUGH OF WHITE MATTER. DO DOCTORS EVEN LOOK AT THESE THINGS???? I DO HAVE MORE THAT SHOW EVEN MORE THAT I FOUND AFTER I POSTED THESE, SO I DON'T UNDERSTAND WHY IS IT SO HARD TO EVEN GET INTO SEE A DOCTOR THAT CAN HELP YOU. I HAVE BEEN TRYING AND IT IS LIKE PULLING TEETH...NO, WORSE.
GOD BLESS EVERYONE AND I PRAY THAT IF THERE IS ANYONE ELSE LOOKING FOR ANSWERS, DON'T GIVE UP. WE HAVE TO FIGHT TO STAY ALIVE THESE DAYS.:)))<3 Karen
http://braindiseases.wordpress.com
Visit the brain care foundation website at:
www.braincarefoundation.com
THIS IS VERY INTERESTING, SINCE I DO HAVE WHITE MATTER ALL IN MY MRI BRAIN SCAN. IT IS A TERRIBLE PLACE TO BE, WHEN NOT TAKEN SERIOUSLY AND A PERSON HAS TO FIGHT TO GET AN ANSWER TO WHAT IS GOING ON.
I RECENTLY WENT TO A NEUROLOGIST THAT DIDN'T TAKE ME SERIOUSLY, FOR APPARENTLY WAS MOCKING ME AT MY LAST VISIT. IF IT ISN'T HARD ENOUGH TO MAKE IT THERE AND STAY IN THE LOBBY FOR 2 HOURS, THEN ANOTHER HOUR IN HIS ROOM, THEN WHEN HE FINALLY DOES COME IN, HE IS RUSHING AND GETTING THROUGH WITH THE OFFICE VISIT SO THAT HE CAN RUSH OVER TO ANOTHER ROOM. I KNOW, I HAVE BEEN THERE AND I AM TIRED OF THESE SO CALLED DOCTORS...WHO, ARE SUPPOSE TO HAVE OUR BEST INTEREST AT HEART. INSTEAD, THEY RIDICULE YOU AND SEND YOU OUT OF THEIR OFFICE WITH MORE QUESTIONS THAN, ANSWERS.
I JUST WANTED TO POST MY BRAIN MRI HERE, SO THAT WHEN I DO GET DIAGNOSED, I WILL HAVE EVIDENCE THAT THIS DOCTOR FOUND, WHAT HE SAW ON MY MRI, AS INSIGNIFICANT. IT IS WRONG AND BAD ENOUGH FOR A DOCTOR TO SEEM NOT TO CARE, BUT WHEN THEY ACTUALLY MAKE COMMENTS THAT ARE CONDESCENDING AND OFFENDING, THEN SOMETHING HAS TO BE DONE. THIS DOCTOR, THE LAST TIME, I WAS THERE, TOLD ME THIS, "YOU DON'T HAVE LEPROSY DO YOU?" AND "DO YOU HAVE A PROSTATE PROBLEM, DO YOU?" I TOLD HIM, AFTER HE SAID THAT, THAT "I DON'T KNOW, HAVE YOU CHECKED?"..HE SAID, "WOMEN DON'T HAVE PROSTATES.". THEN, I REPLIED, "I DO KNOW THAT!"
THIS OFFICE VISIT WAS UNREAL. I HAVE NEVER HEARD ANY DOCTOR TALK TO ME, THE WAY THAT HE DID. HE WAS VERY CONDESCENDING AND IT WAS VERY OFFESSIVE AND HURTFUL, TO ME, SINCE I DEAL WITH A GREAT AMOUNT OF PAIN. I STRUGGLE TO GET THROUGH EVERYDAY, AS IT IS AND I DON'T NEED SOMEONE WHO IS SUPPOSED TO BE PROFESSIONAL TREATS YOU LIKE YOU DON'T MATTER.
HE WAS TELLING ME THAT I HAD TOO MANY SYMPTOMS AND I TOLD HIM THAT I KNEW THAT I HAD A LOT AND ALL OF THE SYMPTOMS, AFTER A WHILE WILL MAKE ANY PERSON DEPRESSED. IF I DIDN'T HAVE ALL OF THIS PAIN AND SUFFERING AS I DO, EACH AND EVERYDAY...I WOULD NOT BE DEPRESSED, AT ALL. I WOULD BE TO BUSY LIVING MY LIFE, TO BE THAT WAY.
THE LAST TIME I WAS THERE HE GAVE ME A PRESCRIPTION FOR CYMBALTA, BUT I DID TAKE ONE AND MY SYMPTOMS INCREASED. IT SAID ON THE INSTRUCTIONS NOT TO CONTINUE, IF SYMPTOMS WORSENED. I TOLD HIM THAT. HE ACTUALLY GAVE ME ANOTHER PRESCRIPTION TO TRY AND I TOLD HIM THAT I DIDN'T WANT IT AND HE ASKED ME WHAT IT WAS THAT I WANTED. I TOLD HIM THAT ALL I WANTED WAS TO FIND OUT WHAT IT IS THAT FEELS LIKE IT'S KILLING ME.
SOMETHING HAS TO BE DONE AND THE ANSWERS HAVE TO BE FOUND. IF, WE...THE PATIENTS, DON'T PUSH TO FIND THE ANSWERS, TO WHAT IT IS THAT IS PLAGUING US, THEN WE ARE VERY POSSIBLY TAKING THE CHANCE ON BEING A STATISTIC. I DON'T KNOW @ YOU, BUT I DON'T WANT TO BE ONE...I JUST WANT MY LIFE BACK.
I AM SO TIRED, OF HOW SOME PEOPLE TREAT THOSE WHO ARE SUFFERING, JUST BECAUSE THEY DON'T UNDERSTAND OR WANT TO UNDERSTAND, DOESN'T GIVE THEM THE RIGHT TO PUNISH THE PERSON ANY FURTHER. WHY DO THEY RIDICULE THE PERSON WHO IS ALREADY HAVING SUCH A HARD TIME TRYING TO LIVE THEIR LIFE? LIFE IS HARD ENOUGH, BESIDES HAVING TO DEAL WITH AN "ASS"..(sorry, it is sad, but true)
I AM PRETTY SURE THAT THE MRI'S THAT I HAVE POSTED SHOW EVIDENCE ENOUGH OF WHITE MATTER. DO DOCTORS EVEN LOOK AT THESE THINGS???? I DO HAVE MORE THAT SHOW EVEN MORE THAT I FOUND AFTER I POSTED THESE, SO I DON'T UNDERSTAND WHY IS IT SO HARD TO EVEN GET INTO SEE A DOCTOR THAT CAN HELP YOU. I HAVE BEEN TRYING AND IT IS LIKE PULLING TEETH...NO, WORSE.
GOD BLESS EVERYONE AND I PRAY THAT IF THERE IS ANYONE ELSE LOOKING FOR ANSWERS, DON'T GIVE UP. WE HAVE TO FIGHT TO STAY ALIVE THESE DAYS.:)))<3 Karen
No comments:
Post a Comment