Neurologist | Neurology Questions Radiologist

Brain MRI?

I had a brain MRI, my Dr said it revealed changes in my white area. He is now ordering an additional MRI with contrast of my brain as well as neck and spine. What could he be looking for?

Female | 51 years old
Conditions: diabetic type2

5 Answers

Neurologist|NeurologyRadiologist
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
He is looking for possible MS, Lime disease, or sarcoid or autoimmune brain disease.
They are looking for ischemia, early stroke, nonspecific inflammatory disorder, vasculitis, demyelinating disorder, etc...
Without having seen your MRI, it sounds like there are "white matter lesions." White matter lesions can be normal in a person, and you get more and more of them as you get older as part of the normal aging process. However, they can also be a sign of something bad going on. Certain disease cause white matter lesions that are very bad, like cancer and multiple sclerosis. What they sometimes do in these cases is repeat the MRI scan, but this time they do it with contrast to see if any of the white matter lesions "light up." Certain disease light up with contrast, like cancer, infections, and active multiple sclerosis lesions. They are repeating this scan WITH CONTRAST to make sure you don't have any lesions that "light up." If they don't light up, then that's good. But the only way to know for sure is to do the scan, so it is important to get the scan.
Likely leukoencephalopathy, possibly demyelinating process, but difficult to know without seeing the images.