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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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    What does this MRI report of brain indicate?

Had a MRI of brain and this is what came back: No mass effect or midline shift. No intracranial hemorrhage or extraaxial fluid collections. The ventricles and sulci are symmetric and normal size for patients age. Post contrast images demonstrate no abnormal intraparenchymal or extraaxial enhancement. Diffusion of weighted images demonstrate no areas of restricted diffusion. The visualized mastoid air cells, paranasal sinuses and orbits are normal.My concern is these statements, what does this mean? Normal MRI of brain with and without contrast except for a few tiny punctate areas of subcortical white matter signal abnormality in the high frontal lobes. T2/FLAIR white matter signal hyperintensitites in the the high frontal lobes. These are very nonspecific in appearance.I am 31 years old. 5 1 and 165 lbs. I have history of headaches, tension types and occipital neuralgia. Also have some symptoms of migraines, but not full on migraines.
Thu, 12 Dec 2019
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Neurologist 's  Response
Hello,

I will break down the report for you:

No mass effect or midline shift: there is nothing pushing on one side of the brain to make it move to the opposite side

No intracranial hemorrhage or extra-axial fluid collections: There is no bleeding, no old blood or areas where the blood was absorbed and fluid was left behind.

The ventricles and sulci are symmetric and normal size for patients age: The ventricles are normal fluid filled spaces inside the brain, they enlarge slightly with age and can be enlarged also in conditions like hydrocephalus "water on the brain". You're are normal in size

Post contrast images demonstrate no abnormal intraparenchymal or extra-axial enhancement: When they gave you dye, no areas became bright. Areas that typically are bright are things such as tumors, infection, inflammation and bleeding. You have none of these. It is a normal result.

Diffusion of weighted images demonstrate no areas of restricted diffusion: There is no abnormal movement of water molecules, which is seen in stroke, infection and in some tumors. You do not have any of these and the result is normal.

The visualized mastoid air cells, paranasal sinuses and orbits are normal: Your sinuses are clear and don't show any sign of infection. A few tiny punctate areas of subcortical white matter signal abnormality in the high frontal lobes. T2/FLAIR white matter signal hyperintensitites in the the high frontal lobes. These are very nonspecific in appearance:

This statement refers to a specific type a signal seen on two different types of pictures seen on MRI: T2 and FLAIR. There are multiple different reasons for these, and almost everyone will have a few. Factors such as high blood pressure, diabetes, smoking, vascular disease and multiple sclerosis can cause such spots, though the ones in multiple sclerosis have a particular look to them and per the radiologist report he/she did not suspect that.

We think that the spots are formed when tiny blood vessels become diseases from high blood pressure,diabetes and high cholesterol. HOWEVER, people with migraines are known to develop them as well, and we don't know exactly what they mean. Because of that we literally called them "UBOs" - unidentified bright objects. You have very few, they are as the radiologist said "nonspecific" meaning they are not pointing to a particular disease process. So a few rare spots in a person with migraines is to be expected and is of no consequence. Even if not caused by migraines, they are very few and far in between, so you shouldn't be concerned about them. Essentially you have a normal brain MRI for your age and history of possible migraines.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Janne Nissinen, Neurologist
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