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What Causes White Spots On The Brain

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What Are The Risk Factors

What is the cause of white spots on the skin? – Dr. Rasya Dixit

Following are the risk factors that can increase the chance for an individual to get brain lesions:

  • Increasing age.
  • Any activity involving rapid acceleration or deceleration or any other activity that might increase the chance of injury to the head.
  • Infections caused by viruses, bacteria and worms also increase the chances for an individual to get brain lesions.
  • A positive family history of brain lesions is an important risk factor because this condition mostly runs in families.
  • Exposure to radiations or certain chemicals that increase the chance of tumors and lesions in the brain.
  • Cigarette smoking.
  • Too much consumption of alcohol.
  • Eating a diet rich in fats and cholesterol.
  • Exposure to environmental toxins.

White Matter Lesions In Stroke Patients

Aging is associated with the appearance of increased white spots visualized on brain MRI scans. The presence of these anomalies, called white matter hyperintensities, characterizes elderly subjects as well as ischemic stroke patients, regardless of their age. White matter hyperintensities are thought to be caused by small vessel infarcts in the white matter and ultimately result in impairment of brain functions, such as cognition, balance and gait, that depend on complicated interactions between regions.

A recent study carried out by scientists from the Catholic University of Korea indicates that white matter hyperintensities in ischemic stroke patients may be subject to dynamic changes over time. The participants underwent brain MRI scans from which Analyze software was used to visually assess the hyperintensities and measure their volume. The differences in lesion volumes between the initial scans and the follow-up ones were interpreted as progression , regression or progression in particular areas of the brain and regression in others.

While about 32% of the patients developed new white matter hyperintensities over time, about 21% of them showed smaller lesion volumes. The reversibility of these abnormalities, that is, the observation that hyperintensities may not only progress but also regress, had never been observed in stroke patients in any previous study.

What Causes White Matter Lesions

Lots of different diseases, as well as injuries and toxic substances, can cause damage to the white matter. High blood pressure is a very common cause. Other causes include diabetes mellitus, high cholesterol and smoking. Other factors such as genetics are likely to play a role. Sometimes, white matter lesions are caused by inflammation of the brain.

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How Is It Diagnosed

Advances in medical imaging have made white matter disease easier to spot. A magnetic resonance imaging test, which takes pictures of the inside of your brain, can show any damage. Changes to white matter will show up super-bright white on an MRI scan. You may need more tests to rule out other causes.

White Matter On The Brain Is A Difficult Subject Even The Terminology Is Varied Making Differential Diagnosis Complex An Understanding Of Prevalence And Of The Tools Available To Facilitate The Diagnosis Of Individual Diseases Is Important Dr Gunther Fesl Radiologist At Praxis Radiologie Augsburg Explains

Spots on an MRI: White Matter Hyperintensities

Report: Marcel Rasch

Differential diagnosis of white matter on the brain is difficult. Even the terminology varies considerably. We talk about Leukoaraiosis, Leukoencephalopathy, white matter lesions, white matter hyperintensities, white matter changes or white matter disease, Gunther Fesl explains. However, as the underlying causes differ significantly, the radiologists differential diagnosis must be accordingly precise.

Based on a T-2-weighted image alone, its usually impossible to make a precise diagnosis, as seen in the example image. The list of differential diagnoses is long. The reasons for white matter range from the normal, human aging process to very rare diseases, Fesl explains. The older we become, the more of these white spots can be seen on the brain. The transitions from normal aging to disease are smooth, he adds. Therefore, it is important to determine the margins to actual disease. Leaving aside physiological processes, such as aging, caps, bands or perivascular spaces, which are often diagnosed by chance, there can be hypoxic-ischaemic or inflammatory/autoimmune processes, right down to toxic, infectious or even traumatic occurrences in the brain. Tumours or metastases also need to be ruled out, he points out.

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Enhancing Healthcare Team Outcomes

As described, white matter lesions have varied clinical presentations, differential diagnoses, and complications. Managing these patients requires extensive collaboration and coordination among a team of professionals, which consists of neurologists, radiologists, internists, ophthalmologists, psychiatrists, neurosurgeons, rheumatologists, microbiologists, pain specialists, nurse specialists, mental health nurses, pharmacists, physical therapists, and nutritionist. It is compulsory to identify the right set of professionals depending on the etiology of a case. Clear and effective communication between these professionals while monitoring the progression and complications of WMLs can decrease mortality.

What Do They Mean

Depending on the amount of brain affected, they are usually not causing any problems . However, if they accumulate more and more, they can affect thinking and memory and also, are a marker of an increased risk for stroke and worse type of stroke.

They also affect other changes, such as speed of movement, as described in a 2015 study.

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White Matter In The Brain

Think of the brain as a computer system, and it might be easier to understand. According to the UC Davis Health System, the gray matter of our brain is the computer and the white matter is the cables that connect everything together and transmit signals.

Want more of a biological explanation? White matter is tissue in the brain composed of nerve fibers. The fibers connect nerve cells and are covered by myelin . The myelin is what gives white matter its white color.

Myelin speeds up the signals between the cells, enabling the brain cells to quickly send and receive messages. It also provides insulation for the fibers, preventing the brain from short-circuiting.

White matter makes up about half of the brain, with gray matter making up the other half.

Treatment Of White Matter Lesions Associated With Migraine

White Matter Abnormalities, Neurodegeneration And Migraines
  • Bashir, A., et al. . “Migraine and structural changes in the brain: a systematic review and meta-analysis.” Neurology 81: 1260-1268.
  • Bayram, E., et al. . “Incidental white matter lesions in children presenting with headache.” Headache 53: 970-976.
  • Brownlee WJ. Misdiagnosis of multiple sclerosis. If you have a hammer, everything looks like a nail ? Editorial. Neurology, 2019 92:15-16.
  • Candee, M. S., et al. . “White matter lesions in children and adolescents with migraine.” Pediatr Neurol 49: 393-396.
  • De Benedittis, G., et al. . “Magnetic resonance imaging in migraine and tension-type headache.” Headache 35: 264-268.
  • Hamedani, A. G., et al. . “Migraine and white matter hyperintensities: the ARIC MRI study.” Neurology 81: 1308-1313.
  • Palm-Meinders, I. H., H. Koppen, et al. . “Structural brain changes in migraine.” JAMA 308: 1889-1897.
  • Sacco, S. and T. Kurth . “Migraine and the risk for stroke and cardiovascular disease.” Curr Cardiol Rep 16: 524.
  • Sprint MIND investigators . “Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions.” JAMA 322: 524-534.
  • Toghae, M., et al. . “The Prevalence of Magnetic Resonance Imaging Hyperintensity in Migraine Patients and Its Association with Migraine Headache Characteristics and Cardiovascular Risk Factors.” Oman Med J 30: 203-207.

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Sleep Apnea’s Effect On The White Matter Of Your Brain

White Matter and Obstructive Sleep Apnea

I have been sleeping with a CPAP for several months now and have notice somewhat of an improvement. I am obese now, but most of my life I have not been. I’ve recently been told that I have a low soft palate, so even when I lose the weight, I will still have sleep apnea. Yesterday I had an MRI of the brain and it showed a change in the white matter. I have no signs of MS, and I’m only 44 years old. Could having sleep apnea my whole life be causing this issue with my brain? If so, is there anything I can do to reverse these effects?

Possible Causes Of White Spots Showing On Brain Scan

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Vascular Supply And Vascular Pathology

White matter lesions or leukoaraiosis indicate small vessel vascular brain disease as well as degenerative or inflammatory processes. WMLs appear as hyperintense periventricular or subcortical patchy or confluent areas on T2 or fluid-attenuated inversion recovery MRI sequence. The pathology of WML includes a triad of demyelination, axonal loss, and lacunar infarcts in the periventricular and subcortical white matter. Cerebral white matter receives its blood supply through long medullary arteries, which have an average diameter of 100200 m, originating from the pial arteries. Arteriosclerosis, hyalinosis, and focal fibrinoid necrosis are observed in the long medullary arteries. Although lacunar infarcts are produced when the ischemic damage is focal and severe enough to result in a small area of necrosis especially in the basal ganglion, diffuse WMLs are caused by leakage of fluid from abnormal arterioles and capillaries with resultant gliosis. Some WMLs are caused by diffuse ischemia related to reduced blood flow.

Velandai Srikanth PhD, … Amanda G. Thrift PhD, in, 2007

General Considerations When Using Mri For The Diagnosis Of Multiple Sclerosis

Microvascular Ischemic Disease

There are general considerations when applying the MRI aspects of the 2017 revision of the McDonald criteria in the diagnostic work-up of patients with suspected multiple sclerosis:

The clinical syndrome should be typical of demyelination.

  • The criteria should be applied to adult patients however, they also perform well in identifying paediatric patients with multiple sclerosis from those suffering from monophasic demyelination , although special care is needed in patients under 11 years . In paediatric cases, the presence of at least one black hole and at least one periventricular lesion at baseline contribute to distinguish children with multiple sclerosis from those with monophasic demyelination . For a comprehensive review of multiple sclerosis differential diagnosis in pediatric population, which is beyond the scope of this review, see .

  • In patients older than 50 years or with vascular risk factors, more stringent criteria should be considered .

  • MRI studies should be of adequate quality, with few artefacts and performed on scanners with a minimum field strength of 1.5 T. Using 3D acquisitions or 2D with 3-mm thick slices and no gap between slices will increase diagnostic yield.

  • Key MRI sequences include T2-weighted and T1 pre- and post-gadolinium images of the brain and the spinal cord .

  • Fat-suppressed MRIs of the optic nerves should be considered especially in atypical cases to rule out possible alternative diagnoses.

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    Prevalence Of White Matter Lesions

    Lin et al . WML in 4693 hospitalized patients. Here the percent positive are all kinds of WML, small or large. Also, these patients are not selected to be well.Chowdhury et al . WML in patients with NO vascular risk factors. DSWMH refers to some confluence of WML. Note that these are only confluent lesions, and “punctate” lesions are excluded. Thus this graph would make the situation appear better than the study of Lin et al on the left, which includes all types of WML in sicker patients.

    What Are The Different Types Of Brain Lesions

    Although they share a common definition — injury or damage to tissue within the brain — brain lesions vary greatly. Here are some common brain lesions.

    Abscesses: Brain abscesses are areas of infection, including pus and inflamed tissue. They are not common, but they are life threatening. Brain abscesses often occur after an infection, usually in a nearby area, such as an ear, sinus, or dental infection. They can also appear after injury or surgery to the skull. Read more about the causes of abscesses.

    Arteriovenous malformations : An AVM is a type of brain lesion that occurs during early development. Arteries and veins in the brain grow in a tangle and become connected by tube-like structures called fistulae. The arteries are not as strong as normal arteries. The veins are often enlarge because of the constant flow of blood directly from the arteries through the fistulae to the veins. These fragile vessels may rupture, leaking blood into the brain. In addition, the brain tissue may not receive enough blood to function properly. Damage to the brain may cause seizures as the first symptoms of an AVM.

    Cerebral infarction: Infarction refers to death of tissue. A cerebral infarction, or stroke, is a brain lesion in which a cluster of brain cells die when they don’t get enough blood. Recognize the signs and symptoms of a stroke.

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    Early And Delayed White Matter Changes: Anoxic Leukoencephalopathy

    White matter lesions typically become visible in the late subacute or chronic phase of evolution of anoxic-ischemic brain damage and worsen over time.6,18 .

    It has been suggested that this delayed leukoencephalopathy may be more common after prolonged hypoxemia combined with hypotension and acidosis,19 yet surprisingly little research addressing this form of leukoencephalopathy has been reported in the literature.

    Early white matter changes have been observed in some patients.20 The actual prevalence of this finding is unclear, but from our experience, it is probably quite low.

    C.M. Ryan, in, 2009

    What Causes Brain Lesions

    I have lesions on my brain but my neurologist doesn’t think it is MS. What can I do next?

      Symptoms of a brain lesion depend upon what part of the brain is affected. Large parts of the brain can be involved in some diseases and there may be relatively few symptoms. Alternatively, very tiny lesions may be catastrophic if they occur in a critical part of the brain. For example, the reticular activating system is a tiny area located within the brainstem that is effectively the master on/off switch of the brain. If a midbrain stroke affects this area, the result is permanent coma. A patient needs the RAS and one functioning hemisphere of the cortex to be awake. If the patient is unconscious, then the RAS isn’t working or there is significant damage to both sides of the brain.

      Initial signs and symptoms of a brain lesion are often non-specific and may include:

      The diagnosis of a brain lesion begins with the health care practitioner taking a history and asking the patient questions about the symptoms such as:

      • When did they start?
      • Do they come and go or are they constant?
      • Have they progressed over time?
      • What makes them better or worse?

      Depending upon the circumstances, the patient may not have insight or may not remember the symptoms or complaints, and it may be up to a family member, caregiver, or friend to supply the appropriate information.

      Medical history and physical exams

      Past medical history of the patient, exploring associated symptoms and complaints may be helpful in determining the diagnosis.

      Imaging and other tests

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      How Are Brain Lesions Diagnosed

      If symptoms suggest that a person may be suffering from a brain lesion, it is important to contact the doctor for an appointment. A doctor will help diagnose and offer treatment options for each patient depending on the extent of the condition.

      The doctor will ask questions about the patients symptoms and medical history and then perform a physical examination.

      In order to find the location of the lesion, the doctor may touch the patients skin with hot, cold or vibrating objects, and also may pinch the patient to check for the feeling of pain. Additional tests may also be recommended by the doctor to further assess the condition.

      Which Disease Causes White Spots On The Brain And Spine

      Ask U.S. doctors your own question and get educational, text answers â it’s anonymous and free!

      Ask U.S. doctors your own question and get educational, text answers â it’s anonymous and free!

      HealthTap doctors are based in the U.S., board certified, and available by text or video.

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      What Diseases Cause Brain Lesions

      • Stroke, vascular injury, or impaired supply of blood to the brain is perhaps the leading cause of lesions on the brain.
      • Multiple sclerosis, or MS, is a disease where brain lesions are located in multiple sites of the brain. Those suffering from MS have significant problems with motor and sensory functions.
      • Lupus, an autoimmune disease, affects almost all systems of the body ranging from skin to heart, liver, muscles and brain. Brain lesions are typically a symptom of this disease.
      • Tumors are also a cause of brain lesions and abnormal growth of brain cells.

      What Are White Matter Lesions

      My brain MRI showing white matter lesions caused by lupus ...

      White matter lesions affect the white matter . White matter is the deepest part of the brain that contains millions of nerve fibres connecting other parts of the brain and spinal cord. The nerve fibres are surrounded by a fatty material called myelin. This protects the nerve fibres and gives white matter its colour.

      Deterioration of the white matter happens with ageing and can be seen on brain scans as white matter lesions . These appear as bright areas or white matter hyperintensities on some brain MRI scans. White matter lesions are one of the most common incidental findings on brain scans. White matter lesions might be referred to as age-related, wear-and-tear changes.

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