When Should I See A Doctor Or Healthcare Provider
Brain lesions can indicate you have a severe or even life-threatening issue. For example, a stroke is a time-sensitive medical emergency. If you think someone with you is having a stroke, call 911 or your local emergency services number.
Other symptoms of brain lesions that mean you need medical attention quickly include:
- Sudden, severe headache, especially those that get worse over time or that dont respond to over-the-counter pain relievers.
- Unexplained vision changes, such as double vision or blurring, flashing lights or spots, distortions, haze or black spots in your vision.
- Seizures that last more than five minutes, or that happen back-to-back without enough time to recover between them.
- Any loss of consciousness following an impact to your head or body, as well as nausea or headache immediately after such an impact.
- Altered consciousness or behavior, such as a person suddenly acting very differently than they usually do.
A note from Cleveland Clinic
Brain lesions can happen for many reasons, making them a very common sign of a brain-related condition. Some lesions are minor and need little or no treatment to heal. Others are more severe and may need medical care, such as surgery. Unfortunately, some lesions are severe, permanent or happen for reasons that arent treatable.
Last reviewed by a Cleveland Clinic medical professional on 11/16/2022.
References
Are There Treatment Options
White matter disease doesnt have a cure, but there are treatments that can help manage your symptoms. The primary treatment is physical therapy. Physical therapy can help with any balance and walking difficulties you may develop. Your overall physical and mental health can be improved when youre able to walk and get around better with little or no assistance.
Based on current research, managing your vascular health may also be an effective way to manage the symptoms of white matter disease. Not smoking and taking needed blood pressure medications as directed may help slow the progression of the disease and your symptoms.
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PEDIATRICS Vol. 108 No. 2 August 2001, p. e21 Kieslich M, Errazuriz G, Posselt HG, Moeller-Hartmann W, Zanella F, Boehles H. Departments of Pediatrics, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
Celiac.com Sponsor :Celiac.com 08/24/2001 – It is well known that celiac disease causes destruction of the villi in the small intestine that results in malabsorption of nutrients in affected individuals. There is solid evidence that additional neurological complications can result, such as epilepsy, possibly associated with occipital calcifications or folate deficiency and cerebellar ataxia. An increase in brain white-matter lesions has been reported in patients with Crohn disease and ulcerative colitis, but until now, not in patients with celiac disease. A recent study published in the August 2, 2001 issue of Pediatrics has now demonstrated a similar increase of these lesions in patients with celiac disease.
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Impairment Of Brain Growth And Long
Periventricular white matter injury has been strongly associated with long-term neurodevelopmental deficits in preterm infants.127,128 The significance of abnormalities in myelination in relation to functional development has been extensively studied. Correlation was found between neurodevelopmental delay and delay in myelination. The major long-term morbidity of the focal component of periventricular leukomalacia is spastic diplegia . This motor disturbance has as its central feature a spastic paresis of the extremities with greater effect on lower than upper limbs. More severe lesions, with lateral and posterior extension into the centrum semiovale and corona radiata, are associated with effects on the upper extremities or visual and cognitive deficits .
Velandai Srikanth PhD, … Amanda G. Thrift PhD, in, 2007
Scientists Discover Roadblocks That Stop Brain White Matter Healing
NIH-funded study identifies molecule that may prevent repair.
A new study identifies a molecule that may be critical to the repair of white matter, the fatty tissue wrapped around parts of brain cells that helps speed up communication. Damage to white matter is associated with several conditions, including multiple sclerosis and cerebral palsy, and can occur in the brains of preterm babies. New findings suggest that the molecule triggers a pathway that is normally used by the immune system to prevent excessive damage but may contribute to chronic white matter injury by completely blocking repair operations. The study, published in the May issue of Journal of Clinical Investigation, was funded by the National Institute of Neurological Disorders and Stroke , part of the National Institutes of Health.
This study uncovers a new player in white matter disease and identifies a potential drug target, said Jim Koenig, Ph.D., program director at NINDS. It also describes a unique situation in which the brain tries to take over immune system functions, with devastating results.
A team led by Stephen Back, M.D., Ph.D., professor of pediatrics and neurology at the Oregon Health & Science University in Portland, took a detailed look at the HA fragments to see how they block myelin repair. Using state-of-the-art techniques, Dr. Back and his colleagues were able to create HA fragments of different sizes.
NIHTurning Discovery Into Health®
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Structural Equation Modelling Of White Matter Lesions
The model that was fitted to the data is shown in fig 2. Following common practice we describe the fit of the model in technical terms and then describe its meaning in a more accessible way. The fit indices were as follows: average of the off-diagonal absolute standardised residuals = 0.04 2 = 11.0, df = 10, p = 0.36 BentlerBonett normed fit index = 0.95 BentlerBonett non-normed fit index = 0.99 comparative fit index = 0.99. The Wald test indicated that none of the paths should be dropped from the model and the Lagrange multiplier test indicated that there were no additional paths that might improve the model significantly.
Figure 2
Structural equation model of the relations between magnetic resonance imaging detected white matter lesions , periventricular lesions , and brain stem lesions with fluid intelligence , hospital anxiety and depression score , walking time, and balance. All correlations reflect a worsening in outcome compared with the latent traits.
How White Matter Lesions Are Quantified On Mri
There are many scales that are mainly used in research studies to quantify white matter lesions. Schelten and associates reviewed 26 different scales in 1998 . Right now , the terms “mild”, “moderate”, and “severe” are favored clinically, and thus you can ignore this section if you wish.
ARWMC – age related white matter changes.
This scale is a 4 point one, based on MRI images with either proton density , T2, or T2-FLAIR. White matter changes were defined as “ill-defined hyperintensities > = 5 mm. Lacunes were defined as well-defined areas > 2 mm, with the same signal characteristics on MRI as spinal fluid.
ARWMC Rating scale
Large confluent areas Van Swieten scale
Another similar scale for rating white matter lesions is the van Swieten scale . This scale requires grading of two regions — one involving the anterior white matter in the slice through the choroid plexus, and another for the posterior white matter. There were three values for MRI–0 , 1 — multiple focal lesions 2, multiple confluent lesions. The two regions and 2 numbers were then added together to provide a score ranging from 0-4. This one is pretty close to the Fazekas scale – it doesn’t require making a distinction between two different types of confluence, and it excludes the deep white matter. It seems pretty close to the clinical scale however, and the advantage of the clinical system is that it is pretty obvious even to persons who are not radiologists.
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Ial Wml Volumes As Predictors Of Cognitive Performance
The relationships between partial WML volumes and longitudinal cognitive performance are summarized in Table 2. Linear mixed models adjusted for age, sex, and education showed significant negative associations between VDC33 and the compound score for executive functions. Firstly, VDC33 was associated with a significant main effect on overall level of executive performance . Secondly, the interaction between VDC33 and time indicated significant predictive value of VDC33 on change in executive performance over the 3-year follow-up. Specifically, higher load of VDC33 related to poorer performance at baseline and steeper decline in executive functions at each subsequent assessment year. After additional adjusting for VFLAIR, these results remained unchanged. Moreover, there was a weak baseline association between VDC33 and VADAS total score, but this result was no longer significant after controlling for VFLAIR.VDC33 had no significant main effects or interactions with time in MMSE, VADAS, processing speed, or memory functions.
Table 2. Relationship between partial white matter lesion volumes and cognitive performance in the 3 year follow-up.
Despite VDC33 and VDC66, VFLAIR remained a significant predictor on overall performance over the follow-up period in VADAS and executive functions. However, VFLAIR had no independent predictive value incremental to that of VDC100 on any of the cognitive measures.
Late Infantile Metachromatic Leukodystrophy
This condition occurs between 12 and 18 months of age and causes deterioration in thinking skills, speech, and coordination.
Within 2 years, children can develop gait and posture problems, as well as blindness and paralysis. It is not possible to stop disease progression, and it is typically fatal within 6 months to 4 years of symptom onset.
People with the juvenile form of metachromatic leukodystrophy, which develops between the age of 4 and adolescence, may live for many years after diagnosis.
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What Are Incidental Findings
These are findings on a brain scan that are unrelated to the reason the scan has been requested. For example, brain scans are sometimes done because a patient is seeking reassurance that there is no sinister cause for their headache. Brain scans requested in this situation can be reassuring but they may show unexpected or incidental findings.
Ideally, it is good to be aware of the possibility of incidental findings being identified before having a brain scan.
Do White Matter Lesions Cause Any Problems
Very often, white matter lesions dont cause any noticeable problems for the individual. Sometimes, white matter disease, particularly when it is severe, can interfere with the way the brain works and the processes that it controls, including thinking and walking. This is because the nerve signals cant get through as normal.
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How Are White Matter Lesions Treated
There is no specific treatment for white matter lesions. It is sensible to make sure that treatable conditions such as high blood pressure are recognised and treated in case the white matter lesions are due to this. It is sensible to make sure conditions such as diabetes mellitus and high cholesterol are under control. If you smoke, it is sensible to stop.
Contact Professor Emsley to learn how he can help you with the diagnosis and management of a wide variety of neurological conditions.
Can It Be Prevented
Age-related white matter disease is progressive, meaning it can get worse. But you can take steps to stop it from spreading. Scientists think you might even be able to repair the damage, if you catch it early.
Keep your blood pressure and blood sugar in check. That can lead to white matter changes. To keep your heart healthy, follow a low-fat, low-salt diet, and get about 2 and a half hours of moderate-intensity exercise each week. Manage diabetes if you have it and keep your cholesterol in check. If you smoke, stop now.
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How Can Brain Lesions Be Prevented
Brain lesions are sometimes preventable, depending on the cause. The types of lesions that are most preventable are those that happen because of concussions and traumatic brain injuries. Treating infections in your body promptly can also prevent an infection from spreading to your brain and causing damage.
Some of the most helpful things you can do to prevent brain lesions, or at least reduce your risk of developing them, include:
Ial Wml Volumes And Other Mri Findings
Table 1 shows the volumes obtained by the conventional segmentation method, the partial lesion volumes estimated by DC, and the Dice similarity coefficient comparing both segmentation methods. Figure 1 presents a comparison between the original FLAIR image , the conventionally estimated hyperintensity volume, VFLAIR , and the results obtained for partial WML volumes VDC100 , VDC66 , and VDC33 . Frames 1F-1J shows the corresponding images in the zoomed area denoted by the white rectangle of frame 1A. The evolution around the foci of lesion, from fully blown in the center to the intermediate stage and small proportion of lesion at the edges, can be seen in frames 1HJ. Note that the voxels classified as VDC33 are not included in VFLAIR, but are indicative of possible locations of future lesions. Figure 2 shows similar findings on a higher, centrum semiovale level. The DC segmentation procedure used three different sequences . Here, only FLAIR is shown for illustrative purposes.
Figure 1. White matter lesions at a middle level height. FLAIR image for a given subject. Conventionally estimated WML. Estimated WML, using the proposed segmentation algorithm, for full, intermediate, and small proportion of lesion. Similar images for the zoomed portion depicted by the white box in .
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Single Variable Associations With White Matter Lesions
There was no significant difference detected by analysis of variance between men and women for walking time or ability to balance . A longer walking time was significantly associated with increased brain stem lesions , but not with white matter lesions or periventricular lesions . Several variables correlated with walking time . Inability to balance was significantly associated with increased brain stem lesions , white matter lesions , and periventricular lesions . Significant differences were noted for some individual psychological and physical variables between those subjects who were able to balance on one leg and those who were not .
Table 2
Mean values of variables for those ABC 1921 birth cohort subjects who were able and not able to balance on one leg for five seconds
White Matter Brain Lesions
Hello,I am a 24 year old male, and 2 years ago an MRI scan showed up to 20 deep white matter brain lesions up to 5 mm in size . I had a followed up lumbar punction which was negative for MS. At the time I experience paresthesia on my right thigh, which are gone now.I do have ectopic heartbeats and occasional palpitations . I do have a slightly crooked nose, sleep with open mouths no snoring. My blood pressure is on the lower border 100/65 average heartrate 70, and I frequently experience orthostatic hypertension , rare but strong headaches .
My neurologist is currently suspecting that lesions maybe due to thrombosis. I am just wondering if perhaps anyone could inform me, of perhaps any other causes for my lesions. I would really appreciate any additional information.
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What Are The Symptoms Of White Matter Disease
Signs and symptoms of white matter disease include:
- Memory problems.
- Urinary incontinence.
These signs and symptoms may be worse in people who have more advanced white matter disease.
While people can experience many of these signs and symptoms as normal changes with aging and other medical conditions , a rather quick onset and progression of these symptoms may be cause for concern.
Sometimes white matter disease is detected when getting a brain MRI for other reasons. In some people, white matter disease may not cause symptoms . You should discuss with your healthcare provider whether your symptoms could be due to white matter disease or other causes.
Subjects With Cognitive Impairment
Nineteen cross-sectional studies and 2 longitudinal studies were performed in patients with cognitive impairment. Characteristics and results of these studies are presented in table 2. In 5 studies , both global and regional brain atrophy were investigated, and therefore these studies are presented twice in table 2.
Table 2
Studies investigating the relation between WML and brain atrophy in subjects with cognitive impairment
Study populations consisted of patients referred for evaluation of cognitive impairment or dementia or of patients who were recruited at specialized dementia centers . Two studies were performed in MCI patients participating in a clinical trial , one study was part of a large genetic study in AD patients and their non-demented siblings , and in the other study participants were selected because they met the criteria for probable AD and did or did not show severe WML on MRI . Finally, 1 study was performed in a heterogeneous group of patients with lacunes and a spectrum of cognitive impairment, in patients with probable AD without lacunes, and a control group of individuals without cognitive impairment and without lacunes .
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Multivariate Modelling Of Associations With White Matter Lesions
Entering those variables that were significant individually into a combined general linear model identified Raven score and HADS depression score as the only independently significant associations with walking time. Once the Raven score and HADS depression score were adjusted for, brain stem lesions were no longer significant , neither was childhood IQ or any of the physical measures. Including ability to balance in the model eliminated any significant effect of HADS depression score, but the Raven score remained significant . Binary logistic regression identified brain stem lesion rating 0.22, 95% confidence interval 0.09 to 0.54) and HADS depression score as the only significant associations with balance ability. No other variable significantly improved the model.
How Are Brain Lesions Treated
Brain lesions can happen for many reasons, which means there are many ways to treat them. Your provider will base their treatment recommendations on the underlying cause of your brain lesion.
Some conditions that cause brain lesions, like a mild concussion, go away on their own. If the lesion isnt severe, treatments are unnecessary. Rest and reduced activity are often all that youll need.
Other conditions that cause brain lesions are treatable in different ways. Infections are often treatable with antibiotics or supportive care. Growths or tumors especially easy-to-reach ones may be removable with surgery. Some lesions are very small and dont cause symptoms or harm.
Unfortunately, there are also times when brain lesions arent treatable. This is most likely with lesions that cause severe damage. The same is true for incurable conditions like Alzheimers disease.
Because the treatment options can vary, your healthcare provider is the best person to tell you which one they recommend and why.
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