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Feeling weakness, dizziness and shaky hands. MRI showed single subcortical hyperintense. Any suggestion?

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Orthopaedic Surgeon
Practicing since : 1994
Answered : 10363 Questions
Hello Dr. Grief, although your specialty is not neurology I have a question. My daughter had an MRI performed last week due to questionable S&S. Blank stares (2-3 sec.), followed by sharp temporal and frontal pains, weakness and dizziness/hand shaky at times. The test showed a single subcortical T2 hypertense focus in the posterior frontal lobe, along with non-specific trauma. An EEG was performed, but my daughter did not have any episodes during it, therefore a repeat 72 hr EEG will be done on Friday. What am I dealing with in terms of the MRI findings? My daughter is a new patient to the pediatric neurologist we are seeing, so she is not familiar with her. The neurologist suggested that her condition is bahvioral and not physical, she futher stated that my daughter's episodes could be similar to a tic due to the Asperger's as in Tourett's. If that is the case why is my child experiencing pain?
Posted Tue, 4 Dec 2012 in Brain and Spine
Answered by Dr. Praveen Tayal 3 hours later
Thanks for posting your query.
A single subcortical hyperintense focus on MRI may not be clinically significant.
"All white matter lesions do not represent a disease".
The lesion found in your daughter's case are likely to be non progressive. Thus is more indicative of a benign chance finding. The significance of such lesions is limited and is often seen in ischemic small vessel disease. These lesions are more commonly seen in the MRI of patients who have cerebrovascular risk factors like hypertension, diabetes and high cholesterol as well those that smoke. Their incidence increases with age.
These lesions are responsible for memory impairment (vascular dementia) in some individuals. A neurological examination to look for cognitive impairment is needed to diagnose the condition.

Hence I advise you to follow with your neurologist. He would be the best person to guide further diagnostic workup and treatment.
The behavioral symptoms are most commonly associated with a psychological pain. The symptoms of your daughter can be behavioral and a careful observation will help in differentiation.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
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