Hi and welcome,
One of the problem with a neurological condition like MS that affects the central nervous system, most of the symptoms associated with MS are also commonly associated with hundreds of other types of conditions, some also neurological but most are not....
The term "punctate' typically means minute spots, so when the term punctate is mentioned in brain MRI reports, it basically means the spots showing up are very tiny, microscopic, 1mm or less and vascular related.
White matter hyperintensities (WMH’s) can get smaller or disappear and they are most commonly associated with vascular related medical conditions eg Diabetes, smoking, hypertension, migraine etc which is why WMH’s are considered to be part of small vessel disease.
I think it's only been in the last 4 or 5 years that research started making it clear that it's not true that WMH's are a normal part of ageing, yes they are more common in the older age groups 65+ but WMH are now being recognised as a clinically important marker though of what is not always evident....
Unfortunately the types of symptoms you've been experiencing could be a lot of different things, they're not the typical issues that would be specifically pointing towards a neurological condition like MS and because your brain MRI only found a small number of teeny tiny lesions in the periventricular, the diagnostic evidence typically suggestive and or consistent with MS as the cause of your symptoms just isn't there.
That doesn't in any way mean what you are experiencing isn't being caused by something, just that what that something else is, is highly unlikely to be a neurological condition like MS. You are 'only' 55 so what ever is happening can 'not' be passed off as old age!
I would suggest you consider looking up the side effects of any prescribed or over the counter medication, and if you take more than one, look up if there any known combined side effects. You might also consider if there could be an environmental cause eg mold, carbon monoxide etc etc previous chemical exposure, or tick bite...
It would be in your best interest to see your family GP and ask 1) If it's not a neurological condition, what else could explain all the symptoms i have? 2) What additional tests do you think i need to get to help rule in or out every other potential cause?
I hope that helps..........JJ
Elaine Hanson, I’m 64 and have had MS for 15 years. I have to say that all your symptoms are like that of MS. There’s another term listed for what you may have. It’s called “MS Lasiitude”. It’s the extreme fatigue common in MS. I take Nuvigil to stay awake. I must add though thatI also have Narcolepsy. Having both diseases is a double whammy on fatigue. I thought you may be unaware that the fatigue in MS has its own name. I’m unable to suggest answers about your MRI. But every symptom you mentioned, I have. Good Luck!
Feb 2019 information - Periventricular white matter lesions:
"Combining these three studies together, it is clear that small (punctate) white matter lesions are extremely common, they are found in roughly half of the otherwise healthy population in their 40's, and WML increase with age. In addition, as people age, they not only get more white matter lesions, but the WML start to merge together into bigger patches (confluent white matter lesions). People who have vascular risk factors (such as diabetes, smoking, hypertension), have more of these lesions.
Causes of periventricular white matter lesions:
Major causes of periventricular white matter (PWM) lesions include normal changes from aging (then they are called UBO's, for "unidentified bright objects), small strokes, and disorders related to multiple sclerosis (MS). PWM are also correlated with vitamin B6 (pyridoxine) deficiency. The phrase "normal changes from aging" is really a synonym for "we don't know".
Getting older: Age is certainly the single most common association of PWM. This is presumably a "wear and tear" phenomenon. You get older, and there is more water under the bridge. More fluctuations in blood pressure, more chance for small blood vessels to close, more chance of head injury, more chance for little emboli.
Nevertheless, while clinicians often suggest that changes in the brain that are similar to others of the same age are not important, and call them "incidental", data suggests that even a few of these PWM reduce cognitive performance (see below).
Small strokes: A period of hypertension is a common cause. In the authors experience, just a few days of extreme hypertension may be enough. This is the "stress is not good for you" connection. Progression of these lesions is associated with variability as well (Liu et al, 2016). This might suggest that small bleeds are the cause in some. There is a related disorder called "superficial siderosis" due to cerebral bleeds as well as cerebral microbleeds briefly discussed above.
Clinical studies of PWM also show association with diabetes, but not consistently with atherosclerosis. PWM are often reported in persons with migraine, and occur especially in women with migraine and aura. PWM are also more common in persons with frequent syncope and orthostatic intolerance (Kruit et al, 2013)
WM lesions are associated with retinal microvascular abnormalities. Persons with both WM lesions and retinopathy have a much higher risk of clinical stroke (20% vs 1.4%), (Wong et al, 2002).
MS and related conditions: Demyelinating disorders such as multiple sclerosis and relatives can cause PWM. These generally have a different look on MRI, as they often resemble "fingers" pointing towards the ventricles...."
Hope that helps......JJ
I didn’t want to sleep a lot until I began blood pressure medicine. Before, I spent up to 14 hours at times because of bladder weakness trying to get the 9-9 1/2 hours I needed. The b p medicine sometimes makes me crave falling asleep as if it were an illegal drug. My doctor is experimenting with new pressure meds to combat this.
I was told by one dr that I was too old at 50 to be diagnosed with MS, I think it may be in their textbooks somewhere. I wa just diagnosed at 58 finally! Btw I'd had quite a few symptoms prior to the vist at 50, find a new dr, current one looked at my MRIs from the past and basically said no sh$& it's MS! Like this new guy, he's weird and really smart LOL! All the best, Janet