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I'm Dr. Nissinen, a board certified neurologist. How may assist you today?
I can help you with that yes.
So the MRI is showing T2 and FLAIR hyperintensities which are two sequences on the MRI to show damage in the brain. They can signify many things however and their location aids in the diagnostic process of determining their etiology. They can be caused by high blood pressure, diabetes, strokes, multiple sclerosis among others.
Multiple sclerosis lesions tend to dominate in the region near the ventricles which are the normal fluid filled spaces in the brain. What we call "periventricular white matter lesions" are suggestive of multiple sclerosis but no necessarily diagnostic. To diagnose multiple sclerosis you need two points in time. Either a "clinical attack" which is one where you have neurological symptoms, or two MRI's showing new lesions in the second, or a single MRI showing old lesions and "active" lesions which would require contrast to see.
Have you had an MRI since 2008? Have you ever had symptoms?
My apologies, I misread the date of the MRI. Since the MRI has been stable since 2008 whatever process cause the T2/FLAIR hyperintensities is stable.
Without seeing the MRI it is a bit difficult to judge what the MRI looks like based on report. Again a clinical history is important.
Have you ever lost vision in one eye, or had your vision fade out in one eye? Have they ever performed a lumbar puncture on you? Is there any family history of multiple sclerosis?
Also, have they ever imaged your neck and thoracic spine with MRI?
A lumbar puncture can be used to gather supportive evidence for multiple sclerosis, but a negative result does not necessarily rule it out. An MRI of the thoracic and cervical spine can aid in diagnosis as if there are T2/FLAIR lesions there as well it is more suggestive of multiple sclerosis. A contrast MRI can help if multiple sclerosis is being rule out as it rules out any active disease at the time of the scan.
That all being said, again T2/FLAIR hyperintensities can be non-specific and related to blood pressure, diabetes, high cholesterol etc.
The second study you posted is an MRA or an MR-Angiogram which looks at blood vessels in the neck. It shows that your carotid arteries are open and without atherosclerotic disease which helps to say that the T2/FLAIR hyperintensities are not small strokes caused by plaque detaching from your carotid arteries
While it shows that you have mild degenerative disease in your low back, it does not unfortunately aid in diagnosing multiple sclerosis as the disease, when present, affects the brain, cervical spine and thoracic spine but not the lumbar spine.
CKD stage 3 is a definite contraindication to contrast.
Again though, since there has been no change in your MRI since 2008, even if you were to have multiple sclerosis it would be VERY slowly progressive and some physicians may not even start treatment for it. Unfortunately without actually seeing the MRI I cannot make a firm determination. Multiple sclerosis is more common in individuals in their late 20s and early 30s and in females more than men.
I hope that this information is helpful for you.
Let me know if you have further questions or concerns and I will get back to you as soon as possible.
If my answer has been helpful and to your satisfaction please remember to leave positive feedback. Thank you and Best Regards,
Kristoffer Nissinen, MD
If there are any other questions please let me know.
Kristoffer Nissinen MD