White Spots on the Brain in an MRI

You may be alarmed to hear that your brain magnetic resonance image (MRI) shows several small white spots. Certainly, white spots may be a cause for concern. They may even explain the symptoms that led your healthcare provider to prescribe an MRI in the first place. However, there are also a variety of explanations that are not alarming.

Your healthcare provider will determine the significance and cause of the spots based on your medical history and an examination. Other diagnostic tests may also be used to determine the number of spots, their size and appearance, and where they are located in the brain.

This article will look at some common causes of white spots on a brain MRI, along with risk factors and treatment options.

What Are White Spots?

Spots on a brain MRI are caused by changes in water content and fluid movement that occur in brain tissue when the brain cells are inflamed or damaged. These lesions are more easily seen on T2 weighted images, a term that describes the frequency (speed) of the radio impulses used during your scan.

White spots may be described in different ways on an MRI report:

• "High signal intensity areas"
• "White matter hyperintensities," or lesions the appear bright white on certain sequences of MRI scans
• "Leukoaraiosis," a term that is used if the spots are thought to be caused by decreased blood flow
• "Nonspecific white matter changes"

Causes

Small strokes are the most common cause of white spots on a brain MRI. Small strokes are often caused by blockages of small blood vessels due to high blood pressure and/or diabetes. Large strokes are usually caused by heart disease or carotid artery disease.

Sometimes white spots are caused by silent strokes, which are small strokes that don't cause symptoms. A silent stroke may not cause symptoms if you have enough healthy brain function to make up for the small area of brain damage.

Silent strokes often occur in deeper regions of the brain and are usually caused by blockage of small blood vessels.

Other causes of white spots on a brain MRI include:

• A brain tumor such as lymphoma
• B12 deficiency
• Infection such as Lyme disease or HIV
• Lupus
• Migraines
• Multiple sclerosis (MS)

Risk Factors

Risk factors that lead to and worsen causes of strokes include:

• Hypertension
• High cholesterol
• Smoking
• An unhealthy diet
• Diabetes
• Obesity
• Drinking alcohol heavily

Other risk factors that play a role in white spots on a brain MRI include:

• Increased age: A certain degree of white matter change is expected as you age.
• Genetics: If you are of Hispanic or African-American descent, you are at higher risk of developing white matter lesions on your brain MRI.

Treatment and Prevention

Sometimes a white spot can go away if treated—for example, if it is an infection or brain tumor. They may also temporarily get smaller and possibly worsen again later. This is often the case with inflammatory conditions such as lupus or MS that flare up and then improve.

The spots may shrink in size months after a small stroke. Alternatively, they can also worsen if risk factors for strokes are not treated, leading to further lesions.

Working with your healthcare provider can help you understand your MRI findings and create a treatment plan to prevent and/or address the underlying cause of the white spots.

Treatment may include prescription medications, surgery, or lifestyle strategies to build a healthier brain, such as eating a healthy diet and exercising.

Summary

White spots on a brain MRI are not always a reason for concern. There are many possible causes, including vitamin deficiencies, infections, migraines, and strokes. Other risk factors for white spots include age, genetics, obesity, diabetes, hypertension, and high cholesterol. The best way to prevent white spots is to practice brain-healthy habits like eating a nutritious diet and exercising regularly.

A Word From Verywell

It can be frightening to hear that there are white spots on your MRI scan.

The cause of these changes is complex, and you may need further testing to find out whether you have an inflammatory disease, a vascular disease, or some other cause. While the lesions themselves are not always treatable, there are a number of effective strategies that can reduce your chances of developing more spots in the future.