Multiple Lesions of Hyperintensity on MRI

[Anyuka]

I am a 43 year old female. My MRI findings indicaate that everything is normal except for multiple ovoid foci of hyperintensity in the bilateral subcortical white matter, the bilateral centrum semiovale and the bilaterial periventricular white matter. No midline shift or herniation is present. On the diffusion-weighted sequences, no evidence for restricted diffusion is noted to suggest acute infarcts. All other readings were completely normal.  I've received a diagnosis and a differential diagnosis from the MRI department report and I'm waiting for my doctor to review it and get back to me.

I would like to know what kind of diagnosis a neurologist would make of such MRI findings without knowing my clinical history.  

Also, can these lesions eventually go away, are they dead brain cells and if so, can these brain cells regenerate?

Thank you

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.      
   The MRI findings that you describe are most commonly seen in multiple sclerosis, but other possibilites exist.  Multiple sclerosis (MS) is a disease were you bodies immune system attacks the insulation (myelin) that protects nerve processes (axons).  This causes signals the nerve was carrying to be slowed down, jumbled or lost altogther.  There are many clinical presentations of MS (becuase there are many sites in the brain that the lesions can affect).  Some of the more common include painful loss of vision in one eye (optic neuritis), numbness and/or weakness in one extremity that lasts for several weeks then improves, loss of balance, room spinning that improves over several weeks, and double vision that then improves.  As MS progresses the lesions in the brain accumulate and permanent damage is done.  There are many different levels of severity in MS.  Some patients are wheel chair bound by their 30's while others have only a little trouble walking in their 60s or 70s.  Some lesions do go away completely, while others leave a hole in the brain where the axons have all died and degenerated.  What causes some lesions to be worse than others is unknown.  Overtime MS can also lead to generalized brain atrophy.  Very few cells in the brain are able to regenerate, and there is no indication that the cells lost in MS can be replaced or regenerated at this time.  Our current MS therapies target the inflammation that is presumed to cause the leisons (no one knows what causes MS).  I would suggest a complete workup for CNS demyelinating disease (which includes MS).  This would include a MRI of the brain (which you have had) and cervical spine with contrast, a lumbar puncture (for signs of inflammation, tourtelotte panel/IgG index, oligoclonal bands) Visual evoked potentials (to look for past evidence of optic neuritis), somatosensory evoked potentials (to look for occult spinal cord lesions) and blood work including lyme antibodies, ANA, ESR, CRP, B12 and EBV/CMV antibody titers.  I would also suggest that you seek the opinion of a professional in CNS demyelination (a neurologist that has done a fellowship in neuro-immunology/MS).
I hope this has been helpful.

[Anyuka]

Thanks for the info regarding CFS, I am certainly fatigued physically and mentally on a regular basis, however; I've been eating much healthier, mostly raw foods and eliminating carbs and sugars as much as possible and I'm starting to feel more energetic.  

I have a referral to a neurologist and he will decide what kind of tests I need to have.

Thanks once again

[PlateletGal]

Many people who have CFS often have the MRI findings you had described. In addition... headaches, chronic fatigue and cognitive problems are all common symptoms in patients' with CFS. (I have CFS myself)

If you test negative for MS & lyme disease, please be sure to talk to your physician about CFS. CFS affects your nervous, immune and endocrine system.

[JCmcc]

In comparison to others; your symptom are more consistent with Lyme disease, though, they are non-specific and can be accounted for in general MS, and others.

Depending on locale or travel habits I would consider looking more into Lyme disease. You can find more information by going to www.lymenet.org where you will find a plethora of information, support and education beyond my scope of knowledge.

I am always available to look into your case.

Good Luck!
JCmcc.

[JCmcc]

I am not a doctor and I cannot advise you beyond my knowledge.

This could mean a diagnosis of Multiple Sclerosis, Lyme disease, Vasculitis-to name a few. The lesions are suspicious for MS/Lyme but are non-specific.

Have you had an LP? This is a good next step and blood tests to look for Lyme (request IGENEX LABS)

Good Luck!
JCmcc.

[Anyuka]

Thank you for the information, I'm thinking of going to a neurologist to figure things out.  I'm feeling okay, just used to get lots of headaches, chronic fatigue, and lately some cognitive and memory problems.  I have a hard time organizing my tasks and thoughts and have slowed down quite a bit.