What is the cause of my white matter lesions and how are they determined to be “nonspecific”?

Here is My Question:
I’m a 34 year old female. I have had extreme fatigue for 2 years (sometimes sleeping 18 hours in a day) and experience regular eye movement problems (daily for 1.5 years now.) My brain MRI from April found “minor scattered nonspecific FLAIR white matter hyperintensities.” I have never consumed alcohol or smoked, have only ever had low blood pressure, and have been vegetarian for 20+ years with no cholesterol problems.

I visited an ophthalmologist who said my optic nerve looks good but my eye problem is a hallmark symptom of MS (it gets worse in the heat) and suggested I see a neurologist. One last thing I’ll mention.. I had severe mono 20 years ago and was curious about my EBV antibodies. Over the last year my VCA igG AB climbed from 463 to 529 u/ml and NUC ag igG has been >600 u/ml. Sorry for the long message and the specificity to my situation.

Questions:
1) What else can I look into for the cause of my WMHs?
2) How are WMHs determined to be “nonspecific” or not?

Any advice would be very appreciated as I’ve been struggling to get appointments with specialty centers. Thanks very much.

Answer:
Very good questions. Let me break up my response into specific points

1. There are certain very specific symptoms of MS, particularly in a young adult. One is either double vision, transient blurring of vision with rapid eye movement, or difficulty with rapid visual tracking caused by an internuclear ophthalmoplegia, especially when the problem is bilateral (i.e. in both directions of gaze). Other causes of impaired eye movements are also common in MS and are more specific in young people. The fact that symptoms worsen in the heat is also suggestive of MS in your age group. It would help to know if the ophthalmologist detected any abnormalities of eye movements on your examination. If the ophthalmologist was not able to detect a specific problem with eye movements, you may benefit from seeing a neuro-ophthalmologist as well as a neurologist
2. We use specificity criteria to determine if white matter lesions (WMLs) on MR imaging support a diagnosis of MS. This includes their number, specific location, shape, border characteristics, lesion tissue characteristics using different imaging sequences, the presence or absence of enhancement and the proportion of lesions with a central venule. Non-specific WMLs do not meet the necessary specificity criteria, but it is important to note that non-specific WMLs also do not exclude the diagnosis of MS; it simply means that other criteria must be used to establish a diagnosis including your neurologic history, examination findings, and other testing (evoked potentials, spinal fluid analysis and other biomarkers).

Revere P (Rip) Kinkel, MDProfessor of Neurosciences
Director of the Multiple Sclerosis Program
University of California San Diego
#multiplesclerosis #MS