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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What does my MRI scan test result indicate?

Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Sat, 4 Jun 2016 in Brain and Spine
Question: what does - moderate cortical sulcal/ventricular prominence - and -several focal defects periventricular white matter bilaterally-mean on a brain MRI. I am a 67 year old female in excellent health except recent (2 months) symptoms of tinnitus, pressure in ear, dizziness, hearing loss, and blurred vision. Do either of the findings correlate with my recent symptoms?
doctor
Answered by Dr. Olsi Taka 19 minutes later
Brief Answer:
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Detailed Answer:
I read your question carefully and I understand your concern.

I must say that those findings do not correlate with the symptoms you describe.

The first part about the "moderate cortical sulcal/ventricular prominence" refers to brain atrophy, shrinking of the brain due to cell loss. Our brain, each and everyone of us, after the third decade of life continuously loses nerve cells, part of aging. As those losses add up over the years after the 60s the reduction in brain mass becomes visible on MRI as enlargement of the spaces between the brain folds and the ventricles. So shouldn't worry much about that finding, the report itself says of questionable significance when it describes it, meaning that unless there are issues with cognitive function making a diagnosis of dementia suspect, that finding doesn't signify much.

As for the periventricular changes, they are changes of the small blood vessels leading to lack of blood supply in those areas. Can be influenced by many factors, some of which can be genetic and not changeable. They are to a point part of aging as well, but also can be accelerated by issues such high blood pressure, diabetes, smoking, high cholesterol etc, vascular risk factors which can lead to damage to blood vessels. They are not alarming, meaning not a threat in short term and shouldn't be causing symptoms, but if the mentioned factors are present should be addressed in order to slow that process down, as when these changes are at advanced stages can also lead to a decline of higher mental functions.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 1 hour later
Thank you for the prompt response. I have noticed some changes in cognitive function like forgetting unimportant things and names. For example just today I went upstairs to get something but when I got upstairs could not remember what I had gone for right away. I remembered as I was heading back downstairs. I don't seem to forget important things just small things but it is annoying. As I mentioned earlier, I am in good health and do not take any prescribed medication. I have always tried to eat healthy and exercise often. I have never been overweight, my HDL cholesterol is higher than the LDL, my blood pressure tends to run somewhat low 113/64, and my blood work is all within limits. If these findings are related to dementia, is there anything I can do to slow the process. I would be grateful for any suggestions.
doctor
Answered by Dr. Olsi Taka 4 hours later
Brief Answer:
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Detailed Answer:
If you feel you are having memory issues you could discuss with your primary physician having neuropsychological tests, sort of standard questionnaires testing different areas of cognition.
It can be started with a simple screening one like MMSE and if it is not normal can be referred to a neurologist for more focused tests. It is only that way that cognitive function can be correctly assessed as this is a very subjective issue. Many of us (me included) can have the impression of forgetting things, also factors like anxiety and depression may play a role as well, so such objective tests are needed.

As for the rest that you report it's all great, you seem to have paid good attention to your health, just keep doing that, nothing to suggest dementia in them and nothing you should do. As I said those MRI findings become more and more common with age and are not necessarily pathological.

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 15 hours later
Dr. Taka thank you for your kind and considerate suggestions. I do have one more question that I would like to get your thoughts on regarding the MRI results. As a means of explanation, the MRI images were initially reviewed by a local radiologist and his findings were very minimum and vague. In addition, there was only an implied result as to whether or not there was an acoustic neuroma. The impressions he notes were - "scattered white matter signal abnormalities which are nonspecific, but could be related to chronic small vessel ischemic changes. Otherwise unremarkable MRI of the brain and temporal bones"-
As a result of his vague findings, I chose to get a second opinion and had an online service review the MRI images. It was the second radiologist that noted the -"cortical sulcal/ventricular prominence" in addition to the white matter changes. What do you think about the initial/local radiologist not noting this finding in his results? As a psychologist and someone who values facts and explanations of findings, I find this disturbing and value your opinion. Thanks again.
doctor
Answered by Dr. Olsi Taka 41 minutes later
Brief Answer:
Read below.

Detailed Answer:
Hello again!

To be honest I can not fault the local radiologist much about the atrophy issue for two reasons.
First because sulcal prominence is a somewhat subjective concept. There is no measuring unit for it, it is not expressed in mm or cm, there are no reference values, it is more of a subjective impression of the interpreter. So since we are speaking about "moderate" changes, not very prominent ones, there is not much of a discrepancy and who is to say that perhaps it is not the second radiologist overestimating it.
Second reason is that perhaps he has had the same impression of moderate atrophy but simply thought that such atrophy was compatible with the patients age, as I said brain atrophy happens in all of us, he might have considered it inside the average for the age and hence not significant and worth mentioning.

So I do not find that disturbing. The scattered white matter abnormalities refer to the same small blood vessel changes already mentioned, I would say there is no difference between the reports there, simply using different terms.

You do have a point if he was vague about the acoustic neuroma. Since that was the indication the MRI was done for, he should give it priority and address that issue in a clear manner, so that should have been handled better on his part.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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