Tiny white spots on your brain


If you have ever been to a neurologist, and though this is my full-time profession, I sincerely hope you haven’t, you may have had an MRI of your brain. Perhaps you were having headaches, maybe some vision changes or some numb, tingling sensations somewhere on your body, and your doctor thought an MRI would be a good idea. She discussed the rational and probably offered a generic reassurance such as “this is just out of an abundance of caution”. Am I right so far?

So you bravely say “Sure doc, whatever you think”, grab your order slip and head for the door. Maybe you make it to the parking lot before the mental agony kicks in, but I’m betting you don’t. Sweaty palms seem married to a fast heart beat and a sense of light headedness as your mind spins with the implications. “She wouldn’t order this unless she thought something was wrong” you think. “I knew it” echoes through your skull as you feel the dread, confirmation that all along you have had that brain tumor and likely, you have but a few short months.

Four or five agonizing days slowly tick by as you wait for your appointed time, each new little twinge in the head, or tingling in the finger, further support for your poor fortune. To make matters worse, when you get to the MRI facility, you face another hurdle. MRI’s are tight, deep little tubes. So in addition to your fears surrounding mortality, you must quickly decide if you are going to be able to conquer claustrophobia. About 30% can’t or won’t, at least without the equivalent medical support of a few drinks.

But you did it and now it’s over. Somehow you managed to lay still and the technician, satisfied the pictures are adequate, begins to pull you out of the tube. As soon as your head clears the edge, you begin to scan his face, intently looking, without care for what would otherwise be an awkward stare. Is that concern in his eyes, are those sad lines on his forehead, am I dying and he is already grieving for me, a stranger?

You return home and wait.

Finally you get the call. Here it is, the moment your whole life changes. The next calls will be tearful conversations with family and friends as you try to piece together an ending.

But wait. If you are like most patients, the call is actually a huge relief. In fact, things look just fine. Your brain is present and accounted for. No evidence for stroke, tumor, infection or whatever badness could have ruined your life. Just before she finishes, the doctor mentions something about some tiny white spots on your brain. There are just a few spots. Quite small even, and scattered about as if an after thought, no pattern to suggest a terrible disease. Just the consequence of aging. The phone call is over.

So what are these little white spots? And should you care? If you did, what would you do?

Well I hope to help you save a few neurons right now.

So yes, those white spots turn out to be important, if not in isolation, then for their implications. These are small little scars on your brain, vestiges of left over inflammation perhaps or vascular inadequacy, which you can read as not enough blood flow, but I don’t often get to use that term and it makes me feel really cool. Anyhow, moving right along, the take home message is that these tiny changes signal underlying forces that can, and very well might, reduce the amount of brain tissue you have to figure out the tip at Saturday nights dinner.

And while you may not care so much, your waiter does. What you may care more about is that this decline in brain tissue is progressive. We do lose some brain with aging even in the best of circumstances, so it makes sense to minimize the loss of these tiny cells that underpin, well, you.

A recent observational study published in my favorite neurology journal, creatively named Neurology, gives us some tools perhaps to stop some of this decline. And by the way, what is it that the very scientists who study brain function and creativity can’t name a journal a little better than that?

Dr. Gow and his many colleagues looked at a group of 70 year old Homo sapiens with brain MRI’s and determined baseline brain volume including white matter and gray matter, as well as specific tracts in the brain like the inferior longitudinal fasciculi (Isn’t this fun? And by the way you can find the location of these fasciculi using Google maps). In three short years these same bipeds were imaged with MRI again. The same measures were taken and then compared to the findings at age 70.

Well here is what they found. Those 70 year olds who got up and exercised regularly instead of watching Honey boo boo’s mother set the human race back a millennia, showed less brain atrophy and white matter lesions. In fact, gray matter volume was higher in the exercisers even after adjusting for factors such as social class and overall health. This study has some weaknesses primarily because, as an observational study, cause and effect cannot be proven.

But here is the take home message. Physical activity on a regular basis, at least three times a week, of moderate intensity and duration seems likely capable of preserving brain cells. That is huge news. The vast majority of us can do this. So take a walk, take the stairs, park further away, get amorous with your partner, whatever it takes*, but put out some consistent effort and keep your brain cells happy.

*Always check with your qualified health care provider before starting any physical activity to which you are not accustomed, to make sure it is safe and doesn’t pose a significant health risk.

Gow, Alan PhD, et. al. Neuroprotective lifestyles and the aging brain.  Neurology 201802-08.12;

4 Responses to “Tiny white spots on your brain”

  1. I certainly don’t want any more “friends” joining the white spots already in my brain — thanks for providing me some additional incentive to stick to my new year resolution (which is to ramp up my exercise routine)!

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