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White Matter Abnormalities on MRI
An_205333 posted:
I recently saw a neurologist regarding tremors and headaches I have been experiencing for a few years now. About 6 years ago I was diagnosed with depression and anxiety and have tried a couple of different medications to help with this. I have been on Wellbutrin for about 4 years now. A couple of years ago I noticed that I was having tremors. I also started having headaches, which I had never had in my entire life. (They are not terribly painful though and happen in different spots all over my head.) My PCP thinks both the tremors and headaches are side effects of the Wellbutrin, but she sent me to a neurologist just to be sure. The neurologist did not find anything wrong with me neurologically and actually diagnosed me with TMJ, which she thinks the headaches are coming from. She sent me for a Brain MRI just to be safe. I had the MRI yesterday. I work in the medical group so I have access to my report, which I looked at today. What I saw worried me, and my neurologist is not in the office until Monday so I am hoping someone can give me some sense of what this might mean.

The report said, "Tiny white matter signal hyperintensity in left frontal lobe white matter on axial FLAIR image 15 and in the left anterior frontal white matter and axial FLAIR image 12. Incidental finding suspected. No regions abnormal signal brainstem or cerebellum. Impression no intracranial mass or hydrocephalus. Two tiny white matter signal hyperintensities." (This is copied exactly from the report, I suspect there may be some punctuation errors/omissions there.)

I have tried looking up white matter signal hyperintensities on the internet and am seeing this could be related to such things as MS, Alzheimer's, and old age, among other things. I am 30 years old so I do not fall into the elderly category. If anyone could give me some insight into what this could possibly mean, I would greatly appreciate it. I am worried sick and can't concentrate on anything but this. Thank you so much for your help.
Timothy Collins, MD responded:
Thank you for putting the exact words from the report into your post. That makes it much easier to talk about. What they are describing is truly nothing to be worried about. I usually like to actually see the pictures just to be sure.

The type of white matter spot they describe is fairly common. We don't actually know what these are but we know they are not a serious problem. People with migraines have an increased chance of having 2-3 of these types of spots. 2 is really considered "normal".

We think some patients may be born with 1 or 2 of these, and its not clear where they come from. They are not the same type of spot as what we see in Multiple Sclerosis (the ones in your MRI scan are in the wrong location). Patients with MS or strokes as a cause for these have a large number of them.

you don't mention other medical problems. These types of spots are very common in people with high blood pressure and diabetes, depending on how long they have had these problems.

If you are otherwise healthy, these are likely nothing to worry about.You probably should talk with your neurologist about your concerns about this also, and if you are still very concerned (or if he/she thinks they look "funny" on the pictures) they may do a follow up scan at some point.

Hope this helps.
lms11 replied to Timothy Collins, MD's response:
Thank you so much for your quick response, Dr. Collins!

The only medical problems I have are depression, anxiety, and GERD. I do not have a history of high blood pressure or diabetes, but my cholesterol was in the high normal range at 190 when tested last August.

I left a message for my neurologist to call me when she is back in the office on Monday, but I feel much better now after reading your response and should be able to get through the weekend now. I really appreciate your help, and thank you again!
carpetcrawler5 replied to lms11's response:
Some people with migraines get white and grey matter in thier brains from having a lot of headaches. If you didn't have headaches before you took the welbutrin, it's most likely a side effect of that. Can you take any other meds for depression or does the welbutrin work better than others?

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