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RH, Board Certified Neurologist
Category: Neurology
Satisfied Customers: 1949
Experience:  Expert in various areas of Neurology
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What causes white matter(frontal lobe) hyperintensities There

Resolved Question:

What causes white matter(frontal lobe) hyperintensities?
There are two intensities about 4mm in size frontal lobe.
age is in 30's.
Recently had steroid injection that caused steroid myopathy(single dose), this led to depression.

Submitted: 5 years ago.
Category: Neurology
Expert:  RH replied 5 years ago.

They could be nonspecific findings but depends based on what symptoms was the MRI done so I can give you a differential diagnosis for those two lesions. Current symptoms besides depression?
Customer: replied 5 years ago.
Well I recieved a depo medrol 20 mg sho a few months ago and developed impotence. Im hoping this is reversible. Do u think it may be?
Also, I developed a steroid myopathy which started with upper and lower extremities muscle wasting the spread to central portion. Is this reversible?
So working up the impotence the endocrinologist decided to get an MRI to rule out hypogonadotropic hypogonadism. I have had occasional blurry vision since the depo shot but the optometrist said the exam was ok.
so essentially Im wondering if a steroid can cause these MRI findings.
Are nonspecific findings meaning that they may not be harmful?

Thank you
Expert:  RH replied 5 years ago.
Steroid myopathy and impotence due to steroids is reversible but we need to rule out if hyperglycemia (uncontrolled diabetes) is contributing to the impotence or not and it may not be just the steroids. Given your symptoms, those two lesions are nonspecific and dont have anything to do with myopathy or hypogonadism. They are likely harmless.
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Customer: replied 5 years ago.
Well they have checked my glucose levels and they were within normal.
But now it seems my testosterone dropped.
Would you have a rough estimate of how long the myopathy and impotence take to improve?
and are they reversible 100%?
Expert:  RH replied 5 years ago.
myopathy and impotence due to steroid use can take up to 6-8 months to recover depending on how long you had used the steroids - to see whether you diabetes is in control or not - better to check HgbA1c rather than a random or fasting glucose value. It your problems are purely due to steroids and not because of uncontrolled diabetes then yes it can be reversed 100%.
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Customer: replied 5 years ago.
The odd thing is that i received only one shot depo medrol 20 mg and that was it.
It was an Acute steroid myopathy which doesnt occur often I was told.
I hope things normalize because not only did i have a myopathy but also lipoatrophy generalized, and skin thinning.
Expert:  RH replied 5 years ago.
that is very unusual - rather rarely heard of - in that case you should be getting better already - this should not take months.
Customer: replied 5 years ago.
well the doctors told me that acute steroid myopathy may last longer than chronic steroid myopathy. They said it usually lasts over 6 months. But my hope is that it reverses.
Expert:  RH replied 5 years ago.
we can tell the prognosis based on EMG study - have you had this?
Customer: replied 5 years ago.
no, the neurologist told me it wasnt necessary even though i asked him to do one.
But if it was acute steroid myopathy would it resolve compltelt with time?
Expert:  RH replied 5 years ago.
Yes it should resolved; I just want to make sure that this is related to only the steroid use and we are not missing any other cause for this problem. You should definitely advocate about getting EMG.
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