Okay, ....big breath.....By doing MRIs on large numbers of people who were "normal," that is, they were without neurologic symptoms they have found that many "older" people have small T2 hyperintense white matter lesions. A few studies some years back reported that numerous people over 60 had these lesions, some over 45 or so had them, an occasional person over 30 had a couple and rarely they found 1 or 2 such lesions in people in their twenties.
It seems that the more lazy and mediocre of neurologists jumped on this to conclude that any lesions seen at any age with or without symptoms could be said to be secondary to aging. We have had people here on the forum in their twenties and thirties dismissed as having aging-brains. This is patently ridiculous.
I have a nice study in the journal Brain, from October, 2006 that reports that 30% of elderly people have these small asymptomatic white matter lesions. Given the vague numbers of earlier studies it is clear that the percentage will drop the younger the patient is. The number will be less than 30% in ones 50's and FAR less than 30% as you drop into the 40's and below. That is just lesions in normal people.
In my mind all bets are off when you are dealing with a person with neurologic symptoms. I don't accept the thinking of ANY neurologist that is willing to look at someone with symptoms and immediately judge that all small lesions are just from being alive and can be dismissed. They are not even playing the odds! I feel that all lesions must be acknowledged and kept in mind that they may pertain to the symptoms. Close to 3/4 of all people in their 50's would NOT be expected to have lesions! Keep taking the percentages down and you see that by the 30's we are getting into an age with a very low chance of having them and of having very few if they are there.
A person goes to a neurologist with neurologic symptoms. The neurologist thinks, "I should do an MRI to see if this patient has any lesions. Chances are, at his/her age they do not." So they do an MRI and , Lo and Behold!, there are lesions!!! So, after finding the lesions he was looking for, the neurologist then says, "Oh, those things. Everybody your age has those!" Then why did he look? How does he know that "those" lesions are normal? True, a minority might have them. But, what if "some" of the lesions are not normal? It's not like the neuro can tell the difference.
I know I have said this before, but I AM going to say it again. It's like the police are called to a business and the owner says, "I had a burglary. I came in this morning and my expensive watches are gone." The detectives decide to look at all the windows and doors to see if there is any sign of forced entry. They find a window that has been jimmied and forced open. Their reaction is to say, "This window has been jimmied open, but that was not what happened. Every shop has a window that doesn't lock securely. We don't think you had a burglary. Maybe you took the watches."
Bottom line is that a minority of people get white matter lesions as they age. These lesions can appear in mainly in the 50's, but even by age 60 less than 30% have them. Much younger people are not likely to have them. Even if they do have some, not all lesions can automatically be attributed to aging. They must, if they are not classic for a specific disease, be kept in mind as all of the data is collected. Beings that only a small percentage of people get them when they are young, it is only prudent to begin with the assumption that these lesions are RELATED to the patients neurologic complaints.
Older patients may well run into this, but should still remember that less than 30% at age 60 will have these age-related lesions. Run from the neuro that jumps to the conclusion that all lesions can be dismissed due to age. They cannot think critically enough to be treating you anyhow.
Factors that contribute to having "age-related white matter lesions." Far and away the strongest factor is untreated or inadequately treated high blood pressure. Another big factor is impaired pulmonary function as is seen in emphsema and COPD (specificalled the FEV1 - Forced expiratory Volume in the first second). High cholesterol was not generally found to be a factor in the studies I read. Diabetes played a role but was more minor than high blood pressure.
Two studies mentioned smoking as a cause, but stated that it was statistically significant, but really very minor. Obesity is not a risk factor for these lesions, nor is "stress," or having children. Migraine were not mentioned, but I have seen several studies mentioning long-standing migraine disease as a facotr in having small white matter lesions.
The fewer of these risk factor you have the less likely your lesions can be attributed to "age."
Does that clear up any of the uestions?
Didn't see your wicked brilliant post, either, somehow. I didn't know your doc had attributed your lesions to aging. Hmmmmm!
And then to find out it was MS. How very interesting. (And devastating, I know) I wonder how often this happens. And, like Elaine says...perhaps there are NO lesions due to normal aging.
Feel well, all!
Elaine, I think you're right about this. My take is that many older people have tiny little strokes (strokelets?) that in the absence of other negative indicators such as high BP are essentially meaningless. The individual is not aware of this and no basic harm is done if he or she is otherwise healthy. Such lesions or ischemic incidents are found only on autopsy or because an MRI has been done for some other purpose. So they indeed are silent.
Where I might differ with you is in regard to the seriousness of these lesions. I do think they occur in 'normal' people, as well as those in danger of cardiovascular illness.
I'm guessing that Challengecase is asking this because she may have lesions that are attributed to aging. That happened to me, multiple times. The radiologist sees something he's not sure about and looks at the patient's age, then whammo. Ischemic disease. Without knowing a single thing else about the person. I have no indicators whatever for ischemic problems other than my age. Sometimes they suggest this even for someone still in their 30s. That seems very far-fetched to me.
The big thing is that people with this disease do not have symptoms. People with MS do. Neuros are supposed to be abelt to tell the difference based on their comprehensive evaluation of the patient. Often they drop the ball. My old neuro even sent me for a Doppler Ultrasound of my carotids, and I guess he was perplexed when it came out fine. Talk about zebras and horses.
I just read though many of your posted . I have a difficult time remembering who has( and has had) what. Seems like you haven't gotten up the courage to say what you had wanted to .
I get the frustration part . Being told after all this time that your lesions are from aging . I got that from my first neuro , the little sh*t that he is. Said to discount all lesions . NOT ms, he alluded to my age ,57 then Jan. 08, sent me off for sleep study and would not do any more testing .
New neuro and MS specialist both say its ms. I had a couple more tests that did show abnormalities. BTW dizziness can be caused by a lesion , that's what the VNG proved for me.
I don't have the answer to your question . I never bought into it ( well , maybe for a second ) so I didn't research much in that area. Brain fog letting up wait a minute its getting clearer :) I do remember a few articles on 'white matter disease' , I think there are many sx.s...( Google it ) Soooo whats causing the white matter disease , aging ???? I don't think so. Sorry I can be any more help
Please don't let this or them take your humor. ( see I did read your posts) :) :) :)
Yes, excellent question, and I think Elaine is on the right track.
We have discussed many times here how doctors will dismiss lesions as the normal aging process, and how this just isn't right, if the patient is having neurologic symptoms. Lesions just can't be whisked under the rug IF someone is having symptoms.
When someone has lesions AND symptoms...it should be assumed the lesions are causing the symptoms, or are related to the symptoms and more investigation needs to be done in order to determine WHY the patient is having symptoms.
If EVERYONE got lesions due to aging that would be one thing. But we don't. It happens, but not to everyone. I really think this excuse of 'normal aging' when a patient is having neuro symptoms or signs is assinine and lazy.
And Elaine makes good sense about the silent lesions.
Did your doc attribute lesions you have to aging? How old are you? (See how I worked that sneaky question in?)
I didn't see your post. Amen, Sista.
I'm 29. Quoting my 1st neuro, my MRI was "slightly abnormal," with ~8 lesions.
I've posted about this before and am not repeating it to hijack the post, but it seems relevant here. I don't know the details of challengecase's situation, but I am guessing it is similar to mine: I've had all of the standard tests (blood, EMG, EKG, full eye exam) and all are normal. I've not had an LP or any evoked potentials.
Symptoms + normal tests + "slightly" abnormal MRI = confused patient, with no treatment.
Atleast that's me in a nutshell.
Thank you Ess & Elaine for your enlightening remarks, and challengecase, I hope you are well.
thanks also to Zilla and Jo, and in advance to all other replies! Guess lots of us were pondering this one at the same time!
I hope someone else can jump in, because I have never heard of normal brain lesions from aging. In Alzheimers Disease, there are plaques in the brain.
In people with Metabolic Syndrome (high fasting blood sugar, uncontrolled high blood pressure, and high cholesterol ), people can develop "silent" brain lesions which are also called ischemic brain lesions.
In Metaboloic Syndrome, lesions are in the periventricular white matter, and subcortical area. They are also usually larger than 3mm. However, they are called "silent" because the patient with these lesions has no neurological impairment. The neuro exam is normal.
In progressive migraines, there are also brain lesions. But again, no neuro abnormailities.
Ischemic brain lesions especially in Metabolic Syndrome are a proposed future indicator of risk for stroke and cognitive impairment.
So I guess the short answer is that certain people can have "silent" brain lesions which cause no neuro abnormalities, but can put the person at risk for problems down the line.
Thank you for all the helpful insight. I am 55 yrs old and my problems began in 1996, but looking back there were many signs something wasn't quite right even in my 20's.
The short of this is, I saw a new neurologist (again) earlier this year....new MRI....numerous new lesions, larger and oval in shape. She ordered an LP and evoked potentials. Those tests came back negative for MS.
Decided to see a MS Specialist in May. Took my MRI films, but nothing else. I think she called the neuro I had seen because we heard a nurse telling someone (almost positive it was the doctor) "she hasn't returned the call yet." The Specialist would have got her name from the MRI films....didn't think about that happening. Anyway, we waited in the exam room for an hour and twenty minutes before she came in. She spent about 15 minutes (exam and all) with me and then told me the lesions were from aging. She wrote a prescription for PT and told me it wouldn't be necessary to make another appointment since I didn't have MS.
Obviously, I am not going to get help from a doctor, so I am going to wing it from now on and learn what I can here.
Oh dear, what a disaster. I can really see why you feel this way, and in your shoes I'd sure be taking a breather.
But it's not true that no doctor will help you. You just haven't found the right one yet. I know this sounds awful, but when your symptoms once again come on strong and really intrude in your life, you'll be ready to search for answers again, maybe putting up with more uncaring and downright rude medical care once again. Eventually things will work out.
Meanwhile, please hang out here. I've learned a huge amount here and it's helped me so much in dealing with the process. You're not alone.
Ess is right. You just haven't found the right doctor yet. In the meantime, have you ever had a vitamin D3 blood level done? Bringing the level up to 50 in the blood is a good place to start.
So you don't have any abnormal neuro tests? Do you have any activity limitations?
I have a whole lot to say on this, but I am tapped out today. The short answer is that people indeed do get white matter T2 hyperintense lesions just from "aging." That, is they are found in otherwise asymptomatic individuals. The older you are, specifically over 50, the more they are "likely" to appear. I have read a ton of stuff about these. They are called "Age-Related MRI Lesions" or Age-Related White Matter Lesions. You can Google that and find lots of articles. But, tomorrow I'll try to let you know what I learned when I spent a lot of time looking at the phenomenon last fall.
Not everyone will get lesions, but they become more and more common after age 60.
This IS one of my favorite soapboxes, so I will fill in the blanks.
I'm looking forward to your comments
I'm bumping this up because I am so very interested in your thoughts. I did google "Age-Related White Matter Lesions"....just can't understand what I'm reading!!!!
Bumping this back up because it is a GREAT question.