Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX, Thanks for writing in to us. I have read through your query in detail. Please find the explanation to your queries below. 1. A small restricted diffusion is noted in the right posterior corona radiata reflective of acute lacunar infarcts are seen in the left thalamus and left putamen/external capsule junction. No parenchymal hemorrhage is noted. There is a small area due to sudden deficient blood supply in the left thalamus and putamen. This conveys the message that a very small stroke like episode has occurred. If you take medication then there will not be any further such events. 2. There are T2 and Flair white matter bright signal in periventricular and deep whitr matter and pons reflective of microvascular ischemic white matter changes. Prominent pervascular spaces are seen in both basal ganglia. In many people, due to advancing age, the blood vessels get thin and the irrigation of brain tissue decreases. Very small areas which do not get enough blood supply may go in for irreversible changes. 3. Cerebro-cereballar volume loss noted. Another common feature seen with advancing age is that the brain volume decreases. This is technically called atrophy. It is a part of growing older. 4. Trace mucosal thickening is noted in both maxillary sinuses. The rest of the para nasal sinuses and mastoids are well aerated Very small areas of mucosal thickening are noted in your maxillary sinuses. These are located in the cheek regions. The mucosal thickening seen is not significant in you. It usually happens in the cold weather. Finally, you have got a condition making you prone to stoke like episodes along with the typical features of aging. Certain medications are being taken by you for coronary artery disease should prevent further brain injury among the other problems as mentioned in your query. I am sure you are regularly seeing your doctor for coronary artery disease, diabetes, dementia and peripheral artery disease. Wishing you good health. Do write back if you have any doubts. Regards, Dr.Vivek

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Brief Answer: Your MRI shows findings of vascular insufficiency Detailed Answer: Hi XXXX, Thanks for writing in with an update. Multiple sclerosis is an important condition which has got symptoms shared by many other conditions. There are clinical and imaging criteria by which multiple sclerosis is confirmed or ruled out in a person. According to the McDonald criteria for multiple sclerosis, the diagnosis requires objective evidence of lesions disseminated in time and space. As a consequence there is an important role for MRI in the diagnosis of multiple sclerosis, since MRI can show multiple lesions (dissemination in space), some of which can be clinically occult, and MRI can show new lesions on follow up scans (dissemination in time). Multiple sclerosis has a typical distribution of White Matter Lesions which occur mainly in corpus callosum, U-fibers, temporal lobes, brainstem, cerebellum and spinal cord. The closest condition similar to multiple sclerosis is vascular insufficiency and your MRI shows these findings. Please do not worry about multiple sclerosis. Wishing you good health. Do write back if you have any doubts. Regards, Dr.Vivek

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Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX, Thanks for writing in with an update. I have used the term cerebral vascular insufficiency to define insufficient blood flow to the brain. The most common cause of decreased blood flow is atherosclerosis of the arteries that supply blood to the brain. What I meant is that it's apparent from your MRI scan that you do have microvascular ischemic white matter changes. In other words it means that there is decrease in the blood flow through small vessels in the brain which have led to areas of ischemia (decreased perfusion). The acute lacunar infarct seen in left thalamus/ putamen also is due to decreased blood flow to that part of the brain. These areas of decreased blood supply (cerebral vascular insufficiency) have also caused vascular dementia or dementia due to decrease in blood supply to certain areas of the brain. Multiple sclerosis and cerebral vascular insufficiency may present with similar symptoms and are differentiated by MRI scan. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

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Brief Answer: Welcome Detailed Answer: Hi XXXX, You are welcome and it was a pleasure communicating with you. Wishing you good health. Should you have any new query to be answered by me, please quote query ID 85483 and I will be glad to answer at the earliest. Regards, Dr.Vivek

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Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX, Thanks for writing in with an update. The Doppler was an important investigation for you and if your internal carotids are showing 50% stenosis, you must start taking medications. A 50 % carotid stenosis is classified as mild. Carotid stenosis is a narrowing of the internal carotid arteries, the two major arteries that carry oxygen-rich blood from the heart to the brain. It is caused by a buildup of plaque inside the artery wall that reduces blood flow to the brain. The process of plaque buildup is called atherosclerosis. Carotid stenosis is a major risk factor for stroke and can lead to brain damage. The small vessel disease seen earlier on MRI could be due to this reason. Treatment aims to reduce the risk of stroke by controlling or removing plaque buildup and preventing blood clots. Medications include antiplatelets, cholesterol-lowering statins, and antihypertensives and I guess you are taking that regularly. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

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Brief Answer: Thanks and good health in the coming Year Detailed Answer: Hi XXXX, You are welcome and it was a great to reply to your query. Wishing you good health in the coming New Year. Should you have any new query to be answered by me, please quote query ID 85483 and I will be glad to answer at the earliest. Regards, Dr.Vivek

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