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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5162
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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I had an MRI for pulsatile tinnitus and the an incidental finding

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I had an MRI for pulsatile tinnitus and the an incidental finding of 14 subcortical and periventricular focal white matter lesions present in the white matter. Impression is multifocal white matter disease without callosal or basal ganglion involvement presumably relating to small vessel white matter disease rather than non-ischemic white matter pathology. The rest of the MRI was normal.

I am a healthy normotensive 59 year old female with no significant health concerns. I am active, normal weight, no cognitive impairment and work in a science related field.

What is the incidence of WM lesions in the general population of people in my age group? Do I need to be worried?

Doctor-Bob :

This is a very common MRI finding over 40. The clinical significance can vary, but is often inconsequential. Do you have a history of migraine headaches?

Customer:

Yes I do; mostly through adulthood ( undiagnosed as migraines until my late 40's when I began to have the occasional headache with aura). I have had very few in the last 5-7 years.

Doctor-Bob :

These types of WM changes are associated with migraine headaches. The exact nature of this association has not bee worked out yet, but this would be the leading theory in your case.

Customer:

So would you recommend follow up? do they tend to progress? In a way I'm sorry I had the MRI! Incidental findings like this can be worrisome. I suppose I just need to assume they are inconsequential and not worry. I am going to see my family MD and request a referral to a neurologist for as well.

Customer:

Do you know how common these are in the general population? i.e. in healthy non-cognitively impaired middle aged to older adults?

Doctor-Bob :

This is a common occurrence and suggests the old adage "be careful what you look for" :-)

Doctor-Bob :

At any rate I think it is reasonable to follow up with a neurologist and pursue this to make sure there is not something else that is being missed otherwise.

Customer:

Yes - too late now though.

Customer:

What else? I have no family history of dementia, I'm not diabetic, hypertensive, overweight, eat well, no hyperlipidemia. I just have to figure out how not to obsess about it. Clinically I'm fine.

Doctor-Bob :

These types of changes increase with age. They are not only associated with migraines and HTN but also diabetes, rhematologic conditions, alcohol, tobacco and generalized aging of the neurons.

Customer:

OK so pretty non-specific. Brain health is what I'll work on!

Customer:

p.s. I don't smoke either.

Doctor-Bob :

Prevalence rates vary widely from 20% to as high as 90% by the 60s. While they are associated with a slightly higher risk of cognitive decline, many individuals with these types of lesions have no discernible atrophy or dementia.

Doctor-Bob :

Brain health is a great idea...and don't worry too much as this is usually counter-productive. :-)

Doctor-Bob :

In the meantime, monitor you blood pressure monthly and consider a baby aspirin daily to thin the blood in the tiny blood vessels supplying the neurons.

Customer:

Thanks. I will remain on the positive side. I suppose the are probably not any longtitudinal studies or data following a healthy population with these findings over 10 - 20 years to see how many with WMH progress to dementia or MCI and how many do not?

Doctor-Bob :

Here are a couple links you can review to prevalence studies. More longitudinal studies are needed. http://jnnp.bmj.com/content/70/1/9 http://www.ncbi.nlm.nih.gov/pubmed/11118240

Doctor-Bob :

Actually, those are both from the same study.

Customer:

I noticed. And it was published several years ago. That prevalence study show they are fairly common in the general population 60 - 90 years of age.

Customer:

If you have any other studies to pass along that would be great. I'm going out for a walk now!

Doctor-Bob :

Yes. We see this all the time, and it is difficult to tell patients what it means for them and what it portends because the clinical course is so variable.

Doctor-Bob :

If everyone was scanned over 40 there would be an absolute deluge of patients coming into neurology clinics all over the US! :-)

Customer:

That's good to know. It's like the rest of the body; things sag, joints change and energy declines with age. I will take one day at a time, enjoy my health and do what I can to stay healthy. And tuck this information away in a corner of my mind (maybe in one those white pockets) and not obsess too much. thanks for the information.

Doctor-Bob :

You're welcome. You have the right attitude towards this...it will not adversely affect your life...unless you let it. :-)

Doctor-Bob :

Hope you stay well for eons. Follow up anytime. God bless.

Dr. Bob and other Neurology Specialists are ready to help you
Customer: replied 3 years ago.

Hi dr. Bob. I found an artice in JAMA Nov. 2012 on Migraines and WML that was very reassuring. Since I don't have any sypmtoms of MS or vascular disease, I suspect my WML are related to either normal aging or migraines. The article link is


 


http://www.ncbi.nlm.nih.gov/pubmed/23150012

Thank you. This is a very interesting and evolving field of study. I suspect the next 10 years will bring a plethora of new information about the various etiologies, clinical consequences and prevention strategies of WMD. Unfortunately, this "progress" will likely be too late for those of us over 50. :-)