I had a brain MRI taken in response to a concussion. There were no abnormalities related to the concussion, but 'subcortical white matter hyperintensities in the high frontal lobes" were detected, with the description “The appearances are mostly of a vascular aetiology, migraines and premature small vessel disease are possible.” I don’t get migraines. The doctor thought it might be related to years of lifting (I’m doubtful) and referred to a neurologist. As I wait for my appointment, can you give me any further information on what this finding might mean? Is this even a significant finding, considering what we know about scans and musculoskeletal significance?
Thank you in advance for anything you might be able to offer.
So, white matter hyperintensities are “bright” objects observed in the white matter on brain MRI. These are often reported as “normal” findings but may represent pathological changes, such as demyelination and axonal loss, reduced glial density and atrophy, cerebral atrophy, immune system reactivity, ischemic damage, etc.
That said, these hyperintensities are known to disappear as they do not always signify permanent glial or axonal loss; instead subtle shifts in water content. Additionally, they are quite common in those over 55, though not necessarily uncommon in younger individuals either (2-5%).
In any event, there doesn’t appear to be a connection between exercise and these findings from a causative standpoint. As far as what your findings mean, it would depend on your medical history, demographics, the presentation, etc. of these findings.
We would recommend following up with the neurologist for evaluation given these findings.
Thank you, Jordan. I appreciate the time taken to explain this. It’s very encouraging to hear that they often disappear. Perhaps this will be the case, given I have no symptoms and am otherwise healthy. It’s interesting to confirm that there is no connection with lifting, too. I’m following up the results of a brain CT taken two years ago. I’m curious if signs were noted then, though I suppose pathology could develop in two years. Regardless, I’ll consult with the neurologist.
It’s common to see a few white matter hyperintensities, especially if you are over 50. A few would be 2-3 or so. We would associate them with high blood pressure, migraine, diabetes, smoking, but they can also just happen. As Jordan said, these can disappear, but that is actually the exception, as mostly they persist once they appear. So if you had poorly controlled diabetes several years ago, for example, the WMH might be a residual sign of that, even if your sugars are now managed well.
seeing a neurologist is a good idea, though if you have no current neurological symptoms they are not likely to recommend anything specific. And that’s OK, most people with these imaging findings are asymptomatic and always will be. Just like your spine MRI might have some “findings” that you shouldn’t worry about, as you said.
As these WMH are usually vascular in nature, I would recommend paying particular attention to reducing your vascular risk factors: manage BP, take a statin, don’t smoke, control sugar tightly if you’re diabetic, treat sleep apnea, consider a daily aspirin, etc. We all should do this anyway, but especially if you are wanting to protect your brain microvasculature.
there is no rationale to associate these with lifting, although this hasn’t been studied, and Austin looks like his brain might be exploding when he deadlifts heavy. The known benefits of lifting are vast, however, so I wouldn’t worry about the speculative potential downsides.