Brain Talk or How to Make Sense of your MRI

The first time I read this I was like, "What???" 

Okay first of all I want to tell you about lesions.  When they talk about "white matter signal abnormalities" generally they are talking about the plaque surrounding myelin sheath or the protective covering on our nerves.  On the MRI these plaques or lesions are going to show up as white spots.  To the untrained eye, however, it is sometimes difficult to figure out what is a lesion and what is not just by looking at the scan.  It is helpful for your neurologist to look over your scan with you so he or she can point out where the lesions exist. 

Doctor Sethi explains the terminology on his Brain Diseases web log: 

"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 from from the brain.

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"

I also want to point out that white matter signal abnormalities are not always indicative of MS.  We all get some plaques or lesions especially when we age.  This is why they noted on my report that my lesions were more than what would be expected for my age. 

Some other reasons for the finding of lesions are noted in this article where the author states: 

"Although white-matter lesions are viewed as a normal part of aging, and are found in people with no dementia or other neurocognitive disorders, they are linked with other health problems. In this study, hypertension accounted for a small but significant amount of variance both in white-matter lesion scores and in general cognitive scores in old age. This finding builds on other recent evidence that white-matter abnormalities may be related to circulatory problems (including hypertension, diabetes, heart disease and cardiovascular risk factors)."

In scanning the literature there can be many reasons other than MS for having brain lesions including:  Migraines, schizophrenia, epilepsy, hypertension, diabetes, cancer. heart disease, dementia, and old age. 

When they talk about the small focus of enhancement on my MRI, they are showing evidence that one of my lesions was active and causing me trouble recently.  And this was certainly true for me.  I was experiencing some visual disturbances including seeing bright flashing lights in my periphery.  I was sent to an eye doctor who was unable to detect anything wrong.  Just goes to show you that the MRI is quite often able to detect things that the doctors are unable to. 

IMPRESSION:  FINDINGS MOST CONSISTENT WITH DEMYEINATING DISEASE WITH NUMEROUS SUBCORTICAL AND PERIVENTRICULAR WHITE MATTER SIGNAL ABNORMALITIES.  THERE ALSO APPEARS TO BE SUBTLE ENHANCEMENT ALONG THE LEFT OPTIC NERVE