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Few punctate foci of increased signal on long TR images

Resolved Question:

MRI Brain without contrast

Clinical History: Fall. Headaches

Multiple images are obtained in multiple planes using multiple pulse sequences. Comparsion: None

The ventricles are normal in size and configuration. No mass effect or midline shift is present. There are a few punctate foci of increased signal on long TR images in the white matter of both cerebral hemispheres. These are nonspecific in etiology but may be related to Lyme Disease, migraine headaches, or other demyelinating processes. Be are most likely incidental findings. No extra-axial fluid collections or mass lesions are visualized. The sellar region, craniovertebral junction, paranasal sinuses and orbits are unremarkable.

Impression: Few punctate foci of increased signal on long TR images thie white matter post triple hemispheres. These are most likely incidental findings but see above for discussion.

My question is what would be your next step after reading this report if I was your patient? I have been tested for Lyme disease recently which is negative. (I have had a couple bands positive in the past but they said it was negative) I do have TMJ could that be related. Are any further tests needed and is this serious and could someday kill me if it continues?

Optional Information:
Person's Gender: Male
Person's Age: 22
What have you tried so far?: nothing

Optional Information:
Person's Gender: Male
Person's Age: 22
What have you tried so far?: nothing

Category: Family Physician-GP

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Category: Pediatric Neurologist
 26 Doctors Online

Thank you for asking your query at DoctorSpring.

I will consider this MRI report in a normal person or a patient with TMJ dysfunction as normal. The finds are definitely incidental in that case.
But context is very important in an imaging study. If the MRI result is of patient with a clinical history of falls and headaches (as mentioned in the beginning of the report ) , I might look further.

If it is acceptable for you I would like to know a brief medical history, symptoms and the indication for this MRI. This will help me in providing a better and learned opinion. Also the standing diagnosis of the patient.

Thank you
You can reply as a followup.

Patient replied :

I'm 22 no neurological history had the mri because I fell avoiding something no previous falls I run exercise daily I do get stiff muscles time to time they do get tight muscles otherwise healthy should I have follow up mri are these lesions normal for a 22 year old male

I would consider this MRI as normal provided the following conditions are met :

1. NO abnormalities detected on a thorough Neurological physical examination. A thorough Neurological exam will look for all the muscle tone, strength, and reflexes. If these are normal, chances are that these lesion are a normal finding.

2.NO recurring neurological symptoms - like headaches, unsteadiness, frequent falls, seizure etc.

3. I am not still very sure why your Doctor ordered a MRI. The first investigation of choice for fall or head trauma is usually a CT brain. Discuss with your Doctor whether he/she was looking for anything particular.

99% the lesion are normal. When the MRIs got better technically (thinner slicers and stronger ) it paradoxically shows up more normal features of brain as incidental finding. This mostly likely the case.

Hope this helps.

Patient replied :

The MRI was ordered at my request as I have had a couple CT scans due to possible appendicitis in the past and didn't want to be exposed to more radiation since I am so young. I am wondering however about lyme disease. A year ago my sister and I were in the woods and we both had ticks on our body and she ended up getting the classic bulls eye rash and treatment however I never developed a rash. I also have a dog I play with a lot we try to spray her a lot however where I live in the hudson valley new york there is a high lyme disease rate. I always come back negative with the tests but I always have at least a couple bands positive with the Western Blot. Could I have lyme disease and not even know it? I have been getting headaches the past month and my ESR is normal as well. Other then headaches I don't have any neurological problems and my neurological exam (reflexes/vision/balance) was all normal. Should I have a follow up MRI in 6 months or any other testing

ADMIN MESSAGE : This consult appears to be closed and cancelled (with a complete refund). Please contact [email protected] for any kind of assistance. Thank you.

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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