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    What do white patches in an MRI report indicate?

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Posted on Wed, 9 Aug 2017 in Brain and Spine
Question: Hello Doctor ,

I had antibiotic reaction to quinones 2 year back and after which I had headache and during MRI found some white patches and after some days grace reduced and all normal.

recently 6 months back I had vertigo with vomiting and went to doctor and MRI done again and report is attached. My vit B blood report shows deficiency.

according to my treating doc gave me shellcal and bit b capsules and getting tablet for 2 weeks. slowly symptoms improved and all normal.

I just want to know if this white patches or current report of brain has anything to do with my vertigo and headache ?

any suggestion to improve these white patches demyelinating impression or any cares to be taken.

Currently I don't have any major problems
but when I m tensed I feel little weak and vertigo feeling.
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Report has not been uploaded.

Detailed Answer:
I read your question carefully and I understand your concern.

I am afraid though that there is no MRI report attached as you say it should be. Perhaps you forgot to upload the copy in the reports section?

Whether the patches are responsible for the vertigo is hard to say without the report, without knowing much about their location and size. Given the description of white patches and the term demyelination which do not normally manifest that way I am inclined to believe they are not related, found by coincidence, but I can't exclude it with certainty, if in certain areas involved with balance they may have something to do.

As for suggestions for improvement, since they've been present on both MRIs 6 months apart I am afraid there might not be much to be done to make them disappear, some lesion will remain there. If you have no other symptoms though and things stay as it is they shouldn't affect your functioning though, the focus should be on precising their nature and prevent new lesions from appearing if there is such a risk. So if something like a demyelinating nature is suspected (most commonly that refers to multiple sclerosis) further steps should be taken for the diagnosis. You should see a neurologist (if not done already) and if he agrees with that suspicion further tests like spinal tap might be necessary.

I remain at your disposal for other question, possibly with MRI report so that I might provide more informed answers.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 12 minutes later
Hello Doctor, Please find the reports. I have consulted neurologist and he has dongle couple of tests. Speciman was taken from spinal cord and also few blood tests. and in report it was mentioned as optic neurites near right eye so for which which he has also done eye signal test as well. and all the reports are attached.
doctor
Answered by Dr. Olsi Taka 16 minutes later
Brief Answer:
Still no report uploaded.

Detailed Answer:
I am sorry but I still do not see any report attached, none at all. If cerebrospinal fluid and blood tests were done those reports would be useful as well. But for now I do not see any report attached.
I see from a past question of yours 2 weeks ago you have uploaded reports in the past, so you should be familiar with how to do it, perhaps some connection issue during the upload, can't say but I don't see any upload for now. Please try again.

If there was optic neuritis then the suspicion of multiple sclerosis is even stronger which would warrant regular treatment.

Looking forward to receiving reports.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 13 minutes later
Hello Doc,

Sorry for not uploading reports, Now all the reports are attached.

I don't have any new symptoms from past 2 years(which is when first time MRI scan was done and found to be white patches).

8 months back is what I got vertigo and after all the tests and reports neurologist prescribed me SHELLCAL and VitB capsules for month.

This vertigo started when I don't sleep well and headache started then vertigo and after the above treatment slowly everything is back to normal.

But when I delay or skip my sleep I get headache ideally lasts 4-5 days.



doctor
Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
Read below.

Detailed Answer:
Thank you for those reports.

Regarding the first question I can confirm that I do not think that the vertigo was related to those patches, their distribution doesn't affect any balance involved brain region. Tough to say why the vertigo happened now, one of the most common causes are inner ear issues.

While as I said demyelinating patches are usually synonymous of multiple sclerosis (MS) now I understand why the neurologist didn't treat you for it. The patches are not that characteristically distributed for MS, do not involve some typical regions for MS, nor do they affect the spine. Furthermore spinal tap was negative for MS oligoclonal bands which is another argument against it as it is positive in about 85% of patients. So the neurologist doesn't think it to be MS and has opted for a wait and see approach with which I agree after seeing the reports.

Now to what those patches could be, it is tough to say. They might simply be a remnant of an old process such as an infection or trauma in childhood, discovered by chance only now that you had MRI.
MS still can't be excluded as it takes different forms, so I think you should have control MRIs every 1-2 years for some time to check for appearance of new lesions (would be good if the MRI of 2 years ago was compared with this more recent one, if identical that would be in the favor of it being an old process).

To answer your second question again, you can't reverse those patches, no medication about that, what's been done has been done, you might have always had them even. What matters is that no new ones appear. It is heartening that on diffusion and after contrast there was no enhancement of any of the patches, means that they are not active, old. But as I said I would follow up with control MRIs in the next few years to make sure that no new active areas appear.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 2 days later
Hello Doctor,

Thank you for the reply. Yes the same was understanding was also from my neurologist. Now usually when I get exposed to more sun or when don't sleep properly I get headache and pain for almost 4-5 days and when it pains I feel like dull and when I walk I feel this kind of vertigo or imbalance and kind of slow moment I have to do when I get up after sitting. Don't have any issue when I run or ride bike o don't feel anything but when I am idle standing I feel this kind of vertigo . This was also same 8 Months back when I went to doc and did MRI and this symptoms goes away slowly after few days.
1. Last time doc gave me vitD and VitB supplements . According to you do I have to repeat this suppliments to improve the symptoms I explained .
2. How can it be compared with old reports. 2 year old MRI I had shown to neurologist and their reports says unspecified contrasting multiple white patches. At that point I had only headache and radiologist mentioned could be due to ur previous episode or fever or infection.
3. Is there any allopathic or non allopathic treatment to avoid this for occurring ? May be some practices which will help to avoid based on your experience in treating patients . This would be helpful.
doctor
Answered by Dr. Olsi Taka 4 hours later
Brief Answer:
Read below.

Detailed Answer:
Hello again!

I do not think that the headache is related to those patches, not directly at least. They may make you more prone to fatigue, loss of concentration and as a result tension type headache, but not cause headache directly. And tension type headache affects most of us at one time or the other, may bear no relation at all. Similarly for the balance issue.
1. Regarding the Vitamin supplements, obviously they are only vitamins and do not hurt. There is no proof of any benefit for brain lesions though. I sometime prescribe them as well, but to be XXXXXXX there is no proof of efficacy and it is more because patients find it reassuring, I suspect that is why your neurologist did as well. There are some studies suggesting some benefit of Vitamin D in multiple sclerosis patients, so that can be continued, but it is not a proven and in your case we aren't even confident you have multiple sclerosis at all as already discussed previously.
2. Regarding the MRI comparison it would serve to compare them side by side, to determine whether on this second MRI there are patches where in the previous MRI were none, so can't say much about that. If they were all contrast enhancing though at the same time then it is more in the favor of a one time event like infection, rather then a progressing condition like MS. Hard to say without reading the full report though and without any cerebrospinal fluid and blood tests from the time.
3. This third question is even more difficult to answer. For the moment the origin of those patches is unclear, your neurologist doesn't seem to have a diagnosis either. So without knowing what they are how can one prevent them? They might not need prevention at all, if it is a one time event in the past and there are no new lesions in the last MRI then the process may not be active at all and there is nothing to prevent.

Wishing you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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