What does my MRI result showing mild to moderate multifocal hyperintense T2/FLAIR signal foci in the periventricular and subcortical white matter bilaterally indicate?

Understanding Your MRI Results: White Matter Changes

Your MRI shows small areas of age-related changes in the brain's white matter that are common findings and typically represent minor blood vessel changes that develop over time.

What Your MRI Shows

Your MRI report describes:

• Mild to moderate hyperintense T2/FLAIR signal foci in the white matter of both sides of your brain
• These changes are located in the periventricular area (around the fluid spaces) and subcortical regions (just below the brain's outer surface)
• No abnormal contrast enhancement (meaning these areas don't show signs of active inflammation)
• Mild enlargement of ventricles, cisterns, and sulci (the fluid spaces in and around the brain), which is consistent with normal aging

What These Findings Mean

These white matter hyperintensities (WMHs) are very common findings, especially as people age. They represent:

• Small areas where tiny blood vessels have experienced some changes over time
• These are often called "chronic microvascular ischemic changes" because they reflect minor, cumulative effects of small blood vessel disease 1
• They appear as bright spots on certain MRI sequences (T2/FLAIR) because these areas contain slightly more water than surrounding tissue

How Common Are These Findings?

• These findings are extremely common with aging
• Present in about 50% of people in their 40s
• Present in over 90% of people in their 60s 1
• The mild enlargement of fluid spaces is also a normal part of aging

What These Findings Do NOT Mean

• These are NOT tumors
• These are NOT acute strokes
• These are NOT multiple sclerosis lesions (which would typically have different patterns and locations) 2
• The absence of contrast enhancement is reassuring, as it suggests these are chronic, stable changes rather than active inflammatory processes

Health Implications

While these findings are common and often don't cause symptoms, they can be associated with:

• Slightly increased risk of future stroke 3
• Potential subtle effects on cognitive function, particularly processing speed and executive function 4
• Possible association with gait problems in some people 5

Recommended Follow-up

Based on these findings, your doctor may recommend:

1. Management of vascular risk factors:

   • Blood pressure control (target <130/80 mmHg)
   • Cholesterol management
   • Blood sugar control if you have diabetes
   • Smoking cessation if applicable 1

2. Healthy lifestyle measures:

   • Regular physical activity (150 minutes of moderate exercise weekly)
   • Mediterranean or DASH diet
   • Adequate sleep (7-8 hours nightly)
   • Stress reduction techniques 1

3. Follow-up imaging may be considered in 12 months to assess for any changes 1

When to Contact Your Doctor

These findings generally don't require urgent attention, but you should discuss with your doctor if you experience:

• New or worsening headaches
• Changes in thinking or memory
• Balance problems or difficulty walking
• Weakness or numbness in any part of your body

Remember that these MRI findings are very common and often stable over time. Your doctor can help you understand how they relate to your specific health situation and any symptoms you may be experiencing.