Understanding Your Brain MRI Results
Your MRI shows moderate to severe chronic small vessel disease with several old, small strokes—this is damage to the tiny blood vessels in your brain that has accumulated over time, but importantly, there is no new stroke or acute problem happening right now. 1
What the MRI Found
The Main Problems
White matter disease (small vessel disease): The "widespread, multifocal areas of abnormal increased signal" means there are many areas where the small blood vessels in your brain have been damaged over time, affecting the brain's white matter (the wiring that connects different brain regions). This is described as "moderate to severe" and appears similar to your previous scan, meaning it hasn't gotten worse recently. 1, 2
Old strokes: You have several tiny chronic (old) strokes in your right cerebellum (back of the brain) and one small stroke in the right front-side area of your brain. "Chronic" means these happened in the past and have healed—they are not new or active. 1
Perivascular spaces: The "prominent perivascular spaces" are enlarged fluid-filled spaces around blood vessels, which are commonly seen with small vessel disease. 1
What's Normal
- No new stroke or bleeding
- No brain tumors or masses
- Normal brain fluid spaces (ventricles)
- Normal pituitary gland and sinuses 1
What This Means for You
Small vessel disease is the most common chronic blood vessel problem in the brain, particularly affecting people over 60. It's responsible for about 25% of strokes and 45% of dementia cases. 2 The damage occurs when the tiny arteries, capillaries, and small veins that supply blood to the deep parts of your brain become diseased, usually from long-standing vascular risk factors. 3, 4
This condition can cause:
- Increased stroke risk
- Problems with thinking and memory
- Difficulty walking or balance problems
- Mood changes like depression 5, 2
Treatment Plan
1. Control Vascular Risk Factors (Most Important)
Blood pressure control is the single most critical intervention. 1
- Target blood pressure: Aim for systolic blood pressure <130 mmHg (your doctor may adjust based on your specific situation)
- Diabetes management: If you have diabetes, maintain HbA1c <7% 1
- Cholesterol control: Take a statin medication to lower cholesterol 1
- Stop smoking: If you smoke, quitting is essential 1
2. Antiplatelet Therapy
You should be on daily aspirin (75-325 mg) or clopidogrel (75 mg) to prevent future strokes. 1, 6 Your doctor will choose which one based on your history and whether you've had recent strokes.
3. Lifestyle Modifications
- Regular exercise: Aim for 30 minutes of moderate activity most days 5
- Healthy diet: Mediterranean-style diet with fruits, vegetables, whole grains, and fish 1
- Maintain healthy weight: If overweight, weight loss can help 5
- Good sleep patterns: Address any sleep problems like sleep apnea 5
4. Additional Testing Needed
Your doctor should order blood tests including: 1
- Complete blood count (CBC)
- Thyroid function (TSH)
- Vitamin B12
- Kidney function (creatinine)
- Liver function (ALT)
- Lipid panel (cholesterol)
- Hemoglobin A1c (diabetes screening)
5. Monitoring
- Cognitive assessment: Regular screening for memory and thinking problems 1
- Follow-up MRI: Typically in 1-2 years to monitor for progression 1
- Watch for warning signs: New weakness, speech problems, vision changes, or sudden confusion require immediate medical attention 1
Important Points
There is no medication that directly reverses small vessel disease, but strict control of risk factors can slow or stop progression. 2, 4 The white matter damage and old strokes you have are permanent, but preventing new damage is entirely possible with proper treatment. 3, 7
Depression is both a risk factor for and a consequence of small vessel disease, so if you experience mood changes, discuss this with your doctor. 5
This is a systemic condition—when small vessel disease appears in the brain, it often affects other organs like the kidneys and eyes, so comprehensive vascular care is important. 1, 5