I had an MRI done and the results were negative

Patient

Q: I had an MRI done and the results were negative except this statement: solitary T2 hyper intense punotate lesion in the right frontal white matter. What does this result mean?

Doctor

A:   Hi.
Thanks for your query.
The MRI Report shows the following:
Solitary- means single
T2 is a technique of MRI
Hyperintense - means intensity is more than rest of the area.
Punotate - looks to be a typing mistake- it is PUNCTATE- as you know, is very small
Right frontal - front portion of the brain
White matter - the outer part of the brain

This means in short that on T2 typing on MRI sequence there is a very small lesion in the outer part of the front portion of the brain -

I hope this clears and answers your query.

Comments / Follow Ups

Doctor: White matter- a bit inner part in the brain ( and outer part in the spinal cord)
Punctate - also means tiny.
Patient: Thank you for your answer. Why would I have this small lesion ? Is there a disease that would cause this ? Is it serious ?
Doctor: Ideally any single parameter should never be considered to come to a conclusion and particularly in Neurological problems.
It is always a combination of your past and present detailed history, clinical evaluation and actual physical examination and various other reports that decides the proper diagnosis.

May I please know the other parameters just wrote about?
Patient: My past diagnosis:

Type one diabetes diagnosed in 1993
Hypothyroid 2002
Look vitamin d 2012
Mono 2014
EBV 2014
CMV 2014
Sleep apnea 2015
Low iron 2015
My platelets and white blood cells have been elevated for a year. I'm seeing a hemotogist. So far pilimanary test are normal.
Complete cardiac testing 2014 all normal

My biggest issues, started when I was diagnosed with mono I developed this vertigo sensation where I feel like I'm in motion when I'm not or feel like I'm rocking on a boat. It is not constant but can come on for several hours , go away for a few hours, and then come back.

Also, in the past two months my eyes seem to have a difficult time adjusting from a dark room when I wake up to light. My vision has first white round grid like spots over my whole vision, wavy lines, then as I'm more exposed to more light I have block spots and everything looks wavy. After about 20-30 minutes my vision is normal.

I've seen a ophthalmologist who says I have a swollen retina but no treatment is needed yet. I explained my symptoms and he said its neurological not my eyes.


I've seen two ENT doctors who say it's not my ears. Hearing tests are normal and consistent. ENG test shows normal only 6 percent weakness in the left ear --- which the doctors say is normal.
Patient: My past diagnosis:

Type one diabetes diagnosed in 1993
Hypothyroid 2002
Look vitamin d 2012
Mono 2014
EBV 2014
CMV 2014
Sleep apnea 2015
Low iron 2015
My platelets and white blood cells have been elevated for a year. I'm seeing a hemotogist. So far pilimanary test are normal.
Complete cardiac testing 2014 all normal

My biggest issues, started when I was diagnosed with mono I developed this vertigo sensation where I feel like I'm in motion when I'm not or feel like I'm rocking on a boat. It is not constant but can come on for several hours , go away for a few hours, and then come back.

Also, in the past two months my eyes seem to have a difficult time adjusting from a dark room when I wake up to light. My vision has first white round grid like spots over my whole vision, wavy lines, then as I'm more exposed to more light I have block spots and everything looks wavy. After about 20-30 minutes my vision is normal.

I've seen a ophthalmologist who says I have a swollen retina but no treatment is needed yet. I explained my symptoms and he said its neurological not my eyes.


I've seen two ENT doctors who say it's not my ears. Hearing tests are normal and consistent. ENG test shows normal only 6 percent weakness in the left ear --- which the doctors say is normal.
Doctor: Sorry to know the plight you must be going through all the problems you mentioned.
Studies, they may be associated.
MRI of the ear apparatus at the same time of brain would have helped more.

With the history you have mentioned, Neurologist's opinion must be sought after for clinical evaluation, physical examination and further investigations if any.

Neurologist would go for further investigations as per the MRI report.
Patient: Your report does not help much. As you say to see a doctor. I was hoping for some insight to a diagnosis or possible cause.
Doctor: I had an MRI done and the results were negative except this statement: solitary T2 hyper intense punotate lesion in the right frontal white matter. What does this result mean?
......................................................................................................
This was your question.
With regards!
This indicates thus:
Even the solitary punctate lesion seen as hyperintense on T2 weighted image indicates that this is NOT normal.
This can further be evaluated by the Neurologist only and you should see one as he only can examine you'' in-person'', go for further investigations as spinal tapping for analysis and other supportive as per the actual findings on examination.
You have noted your other problems in the follow-up not in the initial question.
....................
We are here to give a proper guideline and NOT to alarm or frighten you.
I hope you agree and understand what I mean by and helps you.

The MRI suggests that you should seek a direct interaction with the Neurologist if not yet done. This single investigation alone can not give a diagnosis unless aided by supportive other investigations, hence the need to see the Neurologist at the earliest.

Take care.
Please feel free to ask further relevant queries if you need to or if you feel that there is a gap-of-communication.

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