Here are the first five possible causes your doctor may be considering for the changes seen in your brain MRI 1. Small blood vessel changes from diabetes or high blood pressure Diabetes and high blood pressure can damage the small blood vessels in the brain over time, leading to changes in the white matter. This is common in people with these conditions and can affect memory and thinking. Reference httpspubmed.ncbi.nlm.nih.gov33125468 2. Agerelated white matter changes As people get older, it is common to see some changes in the brains white matter, even without symptoms. These changes can be more noticeable if there are other risk factors like diabetes or high blood pressure. Reference httpspubmed.ncbi.nlm.nih.gov9744823 3. Migrainerelated changes People who have migraines, especially with aura, can develop small spots in the white matter of the brain. These are usually harmless but are seen more often in people with frequent migraines. Reference httpspubmed.ncbi.nlm.nih.gov33636178 4. Multiple sclerosis MS MS is a condition where the immune system attacks the protective covering of nerves in the brain and spinal cord. It can cause white matter changes, especially if there are symptoms like vision problems, numbness, or weakness. Reference httpsjamanetwork.comjournalsjamafullarticle10.1001jama.2020.26858 5. Vitamin B12 deficiency Low levels of vitamin B12 can affect the brain and spinal cord, sometimes causing white matter changes. This can lead to problems with memory, balance, or feeling in the arms and legs. Reference httpspubmed.ncbi.nlm.nih.gov24248213 Your doctor may order more tests to help find the exact cause and guide the best treatment. Milind Patel