In a 45 yr old, what are the possible causes of multiple small t2 hyperintensities in periventricular and deep white matter of brain if spine clear and not in ms pattern? significant or dismiss?

Usually strokes: It depends on the patient's history. Migraines have been associated with hyperintense spots in the brain. Uncontrolled diabetes mellitus, hypertension, or hyperlipidemia may cause "silent" small strokes which can also take on a similar experience. Have a neurologist evaluate you as a whole in conjunction with the mri, not just the MRI alone.

Not uncommon: Seen in patients with depression and bipolar disorder and in those with hypertension.

Examples: Can be seen with smokers, folks with hypertension, and high blood fats, even diabetics, prior head injuries, aging, microvascular angiopathy, and a variety of other conditions, and more often than not, MS is not the cause.