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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I am a normally healthy 59 year old female. I recently had

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I am a normally healthy 59 year old female. I recently had an admission from ER due to chest pain and dizziness. No heart/chest/lung problems, but a CT scan of the brain showed some “abnormalities”. I had a follow-up MRI and the report contains the following: “There are minimal FLAIR hyperintensities in the periventricular and frontoparietal subcortical white matter. These likely represent chronic microvascular ischemic changes. There are expected vascular flow voids at the skull base. Mild paranasal sinus mucosal thickening is seen.”
What does this mean, and do I need to worry about any of it? Should I follow up with a neurologist, or is all this age-related?
Thanks.

neuromd2012 :

Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.

neuromd2012 :

I am here to answer you question on chat if you are online

neuromd2012 :

hello

Customer:

I just need to know what these results mean, and if they need following up. Thanks.

neuromd2012 :

ok

neuromd2012 :

so this is a typical change seen in patients your age. the FLAIR hyperintensities are little areas of lipohyalinosis

neuromd2012 :

areas in the arterioles or small blood vessels, where there is a tiny accumulation of lipids

neuromd2012 :

that cause this change

neuromd2012 :

it is a non specific finding, and is seen in migraine headaches

neuromd2012 :

hypertension, diabetes, high cholesterol, smoking

neuromd2012 :

a family history or small vessel disease can also cause these to appear

neuromd2012 :

but this is the most common finding seen on MRI's in "normal" patients

Customer:

Thank you. I have been suffering from bad headaches and have put these down to the menopause. Also my mother (aged 84) has vascular disease, so is it possible that this is an "inherited" condition?

Customer:

Also, what steps, if any, should I take to prevent any further problems in this are?

neuromd2012 :

I would not say you need follow up with a neurologist, unless you are having neurological symptoms

neuromd2012 :

oh

neuromd2012 :

hi

neuromd2012 :

yes, this could be an inherited condition

neuromd2012 :

but it would usually be worse than what is described in this report

neuromd2012 :

in terms or prevention

neuromd2012 :

of

neuromd2012 :

you need to treat the underlying condition

neuromd2012 :

so if it is migraine, you treat that

neuromd2012 :

or any of the other issues I described above

neuromd2012 :

studies have shown

neuromd2012 :

that this type of change, although really not serious at this point

neuromd2012 :

has been linked to a higher risk of stroke or heart attack later in life

neuromd2012 :

so if your mother has vascular disease

neuromd2012 :

you may be following in her footprints, at least that is possible

neuromd2012 :

so you should consider aspirin therapy, or adding Plavix (clopidogrel)

neuromd2012 :

or if this is migraine, you need to aggressively treat your migraine problem

neuromd2012 :

we always think of migraine as benign, but the risk of stroke is higher in this group

neuromd2012 :

later in life

Customer:

Thanks - so maybe a follow-up in say 5 years?

neuromd2012 :

yes, I would say 1 to 2 years

neuromd2012 :

to see if this has progressed in terms of the number of UBO's (we call them unidentified bright objects)

neuromd2012 :

it the number is XXXXX going up

neuromd2012 :

you need to consider treatment like I mentioned

Customer:

Would any of this have caused the dizziness I've been experiencing?

neuromd2012 :

yes

neuromd2012 :

this is linked to dizziness, especially if your blood pressure is going up

neuromd2012 :

but I noted the sinus issue

neuromd2012 :

do you have sinusitis?

neuromd2012 :

that could be your dizziness

Customer:

Well my blood pressure is quite low, so I know that's not an issue.

neuromd2012 :

ok

Customer:

Not sure about the sinusitis.... my husband says I sound congested at night though (snoring).

neuromd2012 :

other conditions, like hypothyroidism

neuromd2012 :

has been linked to this as well, how is your thyroid?

Customer:

No - I'm normally very healthy - eat a good balanced diet and exercise daily.

neuromd2012 :

well I am guessing, but if you snore, and have headaches

neuromd2012 :

you need an evaluation for sleep apnea

neuromd2012 :

that also can cause this change in the brain MRI

Customer:

TSH 1.47

neuromd2012 :

great

Customer:

I did have a sleep study - it said no apnea, but restless legs. I have horrible insomnia though.

neuromd2012 :

I see

neuromd2012 :

well your MRI is no big deal

neuromd2012 :

but it indicative of what is going on

Customer:

OK - well I think I have enough information to go forward now. Thanks for your help!

neuromd2012 :

great

neuromd2012 :

good luck

neuromd2012 :

come back anytime

neuromd2012 :

bye

neuromd2012 :

Dr Frank T

Customer:

Thanks and goodbye.

neuromd2012 :

bye

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