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What can be the white hyperintensities on MRI?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

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Published At March 7, 2018
Reviewed AtAugust 29, 2023

Patient's Query

Hello doctor,

I am a 39-year-old female who is otherwise healthy. I recently had an magnetic resonance imaging (MRI) due to smelling smoke. Some white hyperintensities were found on the MRI. As a result, I had a lumbar puncture. Everything came back normal, no oligoclonal banding was present. However, my IgG synthesis rate appears abnormal. The values are IgG cerebrospinal fluid (CSF) 19.4 mg/dl, albumin CSF 69.2 mg/dl, IgG serum 453 mg/dl, albumin serum 2.3 g/dl and IgG CSF index 1.42.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome to icliniq.com. The increase of protein (IgG and albumin) production in the LCS (liquide cerebro-spinal) could be related to different chronic neurological disorders like an autoimmune disorder, a chronic infection like Lyme disease, multiple sclerosis (MS), etc. Although the presence of oligoclonal bands has been excluded, multiple sclerosis (MS) cannot be excluded (in 20 % of the patients with MS, these bands are not present). As there is a presence of white matter changes, there is something wrong, and further investigations (blood and LCS laboratory tests) are needed to determine the diagnosis. I would like to directly review your brain MRI report for a more professional opinion. What is your medical history?

Patient's Query

Hi doctor,

Thank you for your prompt reply. I have nothing significant in my medical history, and I am otherwise healthy. Unfortunately, I do not have a copy of the magnetic resonance imaging (MRI) report. Is it possible to have the elevated values that I have and no neurological disorder be present? Can anything else cause an increase in the IgG and albumin? I have attached my remaining cerebrospinal fluid (CSF) study.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com. We cannot conclude about any neurological disorder as you have no symptoms or medical history of any neurological disorders. I would like to directly review your magnetic resonance imaging (MRI) images. As you have no clinical history, I would recommend a follow up with brain MRI study after a year, to investigate for any possible progression of the white matter changes, which would be indicative of any neurological disease. As I told you, there are different neurological disorders which are associated with increased IgG in LCS. In case of concrete clinical history, further investigations in the lumbar canal stenosis (LCS) would be needed (including antibodies for Lyme, and other chronic infections). Anyway, for the moment, I would recommend just follow up with brain magnetic resonance imaging (MRI).

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Aida Abaz Quka
Dr. Aida Abaz Quka

Neurology

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