Subcortical Hyperintensities

[jimells]

After waiting for more than two years I finally received a referral for a brain MRI. The radiologist found "subtle punctate subcortical T2 hyperintensities within the right frontal lobe..." Naturally, his conclusion is that these abnormalities don't mean anything and the MRI is "normal".

My impression is that "punctate subcortical T2 hyperintensities" means there are bright spots in my brain that aren't supposed to be there, and that they are frequently found in people with ME/CFS. My question is, what does "subtle" mean? Is it a quantity, a size, or gibberish?

The report's history section claims "migraine with aura". This is hardly an accurate description of my illness, and I don't even have auras. I filled out several forms listing all my various symptoms, but apparently those forms went into the "circular file". The PCP sent me a form letter to report the MRI results, and "Normal" was checked off.

I now have a number of reports (sleep study, psychological exam, MRI) noting anomalies that individually mean little, collectively they appear to support possible ME/CFS, but I still don't have a diagnosis. Is there some kind of specialist who will look at all the various reports and come to a useful diagnosis, or is this The Impossible Dream?

 

[merylg]

I recently had an MRI Brain & Cervical Spine.

"Clinical Info: (included)....History of migraines and chronic fatigue...

Technique: Axial T2 FLAIR, DWI, sagittal T1, axial SWAN, coronal T2 FLAIR sequences of the brain, time-of-flight MRA, T1 and T2 sagittal, T2 axial and T2 sagittal oblique sequences of the cervical spine have been performed. Comparison is made to the films of ../../....(..... ..... ....)

Findings: (included).....There are several tiny non-specific foci of T2 FLAIR hyperintensity in the deep white matter of the frontal lobes. No intra or extra-axial haemorrhage or mass lesions are seen. Grey-white matter differentiation is normal. The ventricles, cortical sulci and basal cisterns are of normal calibre. There is no diffusion restriction and the temporal lobes have a normal appearance.

MRA demonstrates a normal arrangement of the circle of Willis with no stenosis, dissection or aneurysmal dilatation seen..............

Conclusion: (includes) - No intracranial or vascular abnormality demonstrated........."

 

[jimells]

I recently had an MRI Brain & Cervical Spine.

"...There are several tiny non-specific foci of T2 FLAIR hyperintensity in... "

Hi meryl, it's nice that your report gives a clue as to size and quantity...

 

[Enid]

Just to add I had them too - slightly different language " a few patchy high signal changes" on the MRI brain scan. Nothing concluded and I heard only could be to do with MS but that didn't develop.

 

[merylg]

Hi meryl, it's nice that your report gives a clue as to size and quantity...

Hi jimells,

Yes I guess so. Good for future reference too. I have a DVD to keep which came free. I forgot to ask the Neuro to point out the hyperintensities...probably because he said they weren't significant...that they are seen in people who get migraines & high blood pressure.

 

[Enid]

Thanks for that merylg - I can see why my "high spots" were not listed under abnormalties now.

 

[Googsta]

I am researching this subject myself as I have some Lesions on three MRI's. The Humminbirds Foundation has some excellent research findings http://www.hfme.org/testingforme.htm

MRI scans of the brain : Punctate, subcortical areas of high signal intensity consistent with edema or demyelination were identified by MRI in 78% of ME/CFS patients (similar to those seen in MS). The abnormalities in M.E. patients most closely resemble those seen in AIDS encephalopathy. Research has shown that 50% - 80% of ME/CFS patients will have abnormal MRI scans. (Hyde, 2003) (Carruthers et al. 2003)

My next plan of attack is SPECT & PET scans. This site shows images of ME patients brains from SPECT, MRI, PET & EEG.
http://www.name-us.org/ResearchPages/ResNeuro.htm#These_Xenon_SPECT_scans

SPECT and xenon SPECT scans of the brain : to measure decrease in cerebral blood flow, especially 24-48 hours after exertion. Recent studies have shown that 80% of ME/ICD-CFS patients will have abnormal SPECT scans. These abnormalities have also been shown to correlate with clinical status. (Carruthers et al. 2003)


PET scans of the brain. PET scans have shown decreased metabolism of glucose in the right mediofrontal cortex. PET scans have also shown generalised hypoperfusion of the brain with a particular pattern of decreased neuronal metabolism in the brain stem. (Carruthers et al. 2003)

Hope this info helps, I'd put together a proper post but lost it somehow

 

[Enid]

Very interesting Googsta - my brain "high spots" definately correlated with clinical status - virtually immobile in bed, unable to converse, think etc. The full E part of ME. in the early days.