Should You Worry About Spots on Your Brain MRI? (2023)

If you've had a brain magnetic resonance imaging (MRI), you may be alarmed to hear that it shows small white spots. These white spots may indicate a cause for concern, including strokes or multiple sclerosis (MS). However, there are also a variety of explanations that are not alarming, such as vitamin deficiencies or migraines.

If you have white spots, or white matter hyperintensities, on your brain MRI, your healthcare provider will determine the cause based on your medical history and doing an exam. Other diagnostic tests may be used to determine the number of spots, their size and appearance, and their location in the brain.

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

Should You Worry About Spots on Your Brain MRI? (1)

What Are White Spots on a Brain MRI?

Spots on a brain MRI are caused by changes in the water content and fluid movement in the brain tissue. These changes happen when the brain cells are inflamed or damaged.

These spots (lesions) are easier to see on T2 weighted images—a medical term that refers to the frequency (speed) of the radio impulses that are used during the scan.

In an MRI report, the white spots might be described as:

  • "High signal intensity areas"
  • "White matter hyperintensities" (lesions that 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"

White spots can appear anywhere in the brain but are usually found in the white matter near the four cavitiesthat contain cerebrospinal fluid (ventricles).

Causes of White Spots on MRI

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 or diabetes. Large strokes are usually caused by heart disease or carotid artery disease.

Sometimes, white spots are caused by silent strokes—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 the blockage of small blood vessels.

Other causes of white spots on a brain MRI include:

Risk Factors for White Spots on MRI

Since most white spots on an MRI of the brain are from strokes, there are some stroke risk factors to keep in mind:

Other risk factors for white spots on a brain MRI include:

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

How Are White Spots on the Brain Treated?

Sometimes, a white spot can go away after treatment for a condition like an infection or brain tumor. The spots may also temporarily get smaller and worsen later. This is often the case with chronic inflammatory conditions such as lupus or MS that flare up and then improve.

White spots on a brain MRI may shrink months after a small stroke. They can also get worse if your risk factors for strokes aren't treated,leading to more lesions on the brain.

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

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


White spots on a brain MRI are not always a reason to worry. There are many possible causes, including vitamin deficiencies, infections, migraines, and strokes.

Other risk factors for white spots include getting older, race/ethnicity, genetics, obesity, diabetes, hypertension, and high cholesterol.

You can't always prevent white spots on the brain but there are some steps you can take to protect your brain. This includes following your provider's treatment plan, eating a diet that meets your nutritional needs, and staying physically active.

5 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. American Stroke Association. Silent stroke.

  2. Weidauer S, Wagner M, Hattingen E. White Matter Lesions in Adults – a Differential Diagnostic Approach.RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren. 2020;192(12):1154-1173. doi:10.1055/a-1207-1006

  3. Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res. 2017;120(3):472-495. doi:10.1161/CIRCRESAHA.116.308398

  4. Beecham A, Dong C, Wright CB, et al. Genome-wide scan in Hispanics highlights candidate loci for brain white matter hyperintensities. Neurol Genet. 2017;3(5):e185. doi:10.1212/NXG.0000000000000185

  5. Mora F. Successful brain aging: plasticity, environmental enrichment, and lifestyle. Dialogues Clin Neurosci. 2013;15(1):45-52. doi:10.31887/DCNS.2013.15.1/fmora

Additional Reading

By Peter Pressman, MD
Peter Pressman, MD, is a board-certified neurologist developing new ways to diagnose and care for people with neurocognitive disorders.

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Should You Worry About Spots on Your Brain MRI? ›

Brain lesions can happen with any condition or circumstance that can damage your brain. Medical conditions that can cause brain lesions include: Brain tumors (including cancer). Congenital disorders (conditions you have at birth) and metabolic disorders.

What does spots on the brain mean? ›

Brain lesions can happen with any condition or circumstance that can damage your brain. Medical conditions that can cause brain lesions include: Brain tumors (including cancer). Congenital disorders (conditions you have at birth) and metabolic disorders.

Can spots on the brain be harmless? ›

Brain lesions are areas of abnormal tissue that have been damaged due to injury or disease, which can range from being relatively harmless to life-threatening. Clinicians typically identify them as unusual dark or light spots on CT or MRI scans which are different from ordinary brain tissue.

What does it mean when you have white matter on a brain MRI? ›

White matter disease is commonly detected on brain MRI of aging individuals as white matter hyperintensities (WMH), or 'leukoaraiosis.” Over the years it has become increasingly clear that the presence and extent of WMH is a radiographic marker of small cerebral vessel disease and an important predictor of the life- ...

What problems show up on a brain MRI? ›

A brain MRI can help doctors look for conditions such as bleeding, swelling, problems with the way the brain developed, tumors, infections, inflammation, damage from an injury or a stroke, or problems with the blood vessels. The MRI also can help doctors look for causes of headaches or seizures.

What diseases cause spots on the brain? ›

What Are the Types of Brain Lesions?
  • Traumatic: gunshot wound to the brain.
  • Infectious: meningitis.
  • Malignant (cancerous): glioma.
  • Benign (non-cancerous): meningioma.
  • Vascular: stroke.
  • Genetic: neurofibromatosis.
  • Immune: multiple sclerosis.
  • Plaques (deposits of substances in brain tissue): Alzheimer's disease.

What do bright spots on brain MRI mean? ›

When your white matter becomes damaged, it causes white matter lesions, which healthcare providers can “see” as bright spots on magnetic resonance imaging (MRI) of your brain. Some white matter lesions may not cause noticeable symptoms and can be considered almost “normal” with aging.

What is life expectancy with brain lesions? ›

The 5-year relative survival rate for a cancerous brain or CNS tumor is almost 36%. The 10-year survival rate is over 30%. The survival rates for a brain tumor vary based on several factors.

What are the most common spots for brain tumors? ›

The most common locations for brain tumors in adults are the meninges, pituitary gland, craniopharyngeal duct, and frontal and temporal lobes. In children, brain tumors are found most often in the cerebellum and brainstem.

Can stress cause brain lesions? ›

Significance. Psychological stress is linked to multiple sclerosis (MS) severity (e.g., to a heightened risk of brain lesion development).

Can anxiety cause white matter lesions? ›

White matter dynamically changes in response to learning, stress, and social experiences. Several lines of evidence have reported white matter dysfunction in psychiatric conditions, including depression, stress- and anxiety-related disorders.

Are white spots on brain MRI normal? ›

White matter lesions are among the most common incidental findings—which means the lesions have no clinical significance—on brain scans of people of any age. They may also reflect a mixture of inflammation, swelling, and damage to the myelin.

What are the symptoms of small vessel disease of the brain? ›

The main clinical manifestations of CSVD include stroke, cognitive decline, dementia, psychiatric disorders, abnormal gait, and urinary incontinence. Currently, there are no specific preventive or therapeutic measures to improve this condition.

What are the most common brain MRI findings? ›

In a large series of research volunteers, incidental findings were found in roughly 4% of brain MRIs. The most common type of incidental finding was vascular disease followed by neoplastic and congenital lesions.

What are the most common incidental findings on a brain MRI? ›

In conclusion, incidental findings on brain MRI in the general population are common. The most frequent findings are brain infarcts, followed by cerebral aneurysms and benign primary tumors. Such findings should be anticipated in the design of research protocols and the use of neuroimaging in clinical practice.

How quickly will doctor call with MRI results? ›

The images will be captured by the MRI technologist and then analyzed by a board-certified, subspecialized radiologist. The results will be sent to your doctor, who will schedule a follow-up appointment within 1-2 weeks to discuss the results and develop a treatment plan if necessary.

Can white spots on brain be MS? ›

White matter lesions (WML) are a frequent neuroradiological finding in brain MRI with a large number of underlying causes [1]. Two of the most common etiologies are multiple sclerosis (MS) and vascular disorders causing small vessel disease (SVD), each with distinct and characteristic features [2, 3].

What does early MS look like on MRI? ›

T2 MRI sequences are used to highlight areas of demyelination, which happens when the outer layer of the neurons is damaged due to MS activity. T2 sequences can be used to count the total number of MS lesions, which look like bright white spots on T2 sequences, and can be called “hyperintense”.

Does brain tumor light up on MRI? ›

Magnetic resonance imaging (MRI) and computed tomography (CT) scans are used most often to look for brain diseases. These scans will almost always show a brain tumor, if one is present.

Do brain lesions always mean MS? ›

Although lesions are necessary to confirm a diagnosis of MS, other medical conditions also may result in the development of lesions in the brain. Thus, it is important to rule out other potential causes when determining an MS diagnosis.

What percent of brain lesions are cancerous? ›

And an estimated 90,000 people will receive a primary brain tumor diagnosis in 2022. Here's a breakdown that may surprise many: About 71 percent of all brain tumors are benign and about 29 percent are malignant.

How do you know if a brain lesion is cancerous? ›

A sample of the tumor's tissue is usually needed to make a final diagnosis. During biopsy, a small amount of tissue is removed for examination under a microscope. Biopsy is the only way to make a definite diagnosis of a brain tumor, even if other tests can suggest that cancer is present.

Does everyone get brain lesions as they age? ›

Definitions and Clinical Significance

They are very common in the aging brain, with an in‐life prevalence of over 90% in the over‐65 age group, the volume of lesions increasing with age group in the over‐60s 15, 42. Although often an incidental finding, they are clinically significant.

What are the number 1 symptoms of a brain tumor? ›

Headaches are the most common symptom of brain tumors. Headaches happen in about half of people with brain tumors. Headaches can happen if a growing brain tumor presses on healthy cells around it. Or a brain tumor can cause swelling in the brain that increases pressure in the head and leads to a headache.

Do brain tumors spread fast? ›

A malignant brain tumour is a fast-growing cancer that spreads to other areas of the brain and spine. Generally, brain tumours are graded from 1 to 4, according to their behaviour, such as how fast they grow and how likely they are to grow back after treatment.

Where do brain tumors spread first? ›

Cancer cells can break away from the primary tumor and travel to the brain, usually through the bloodstream. They commonly go to the part of the brain called the cerebral hemispheres or to the cerebellum, where they form a mass.

What is the most common cause of lesions in the brain? ›

Brain lesions can be caused by injury, infection, exposure to certain chemicals, problems with the immune system, and more. Typically, their cause is unknown.

How many brain lesions are normal? ›

An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.

Can you have brain lesions but not MS? ›

The diagnosis of MS cannot be made solely on the basis of MRI because there are other diseases that cause lesions in the CNS that look like those caused by MS. And even people without any disease — particularly the elderly — can have spots on the brain that are similar to those seen in MS.

Can stress show on an MRI? ›

Unless you're having an fMRI, any brain scans from traditional MRIs will only show structural elements. So, even if you feel a brief spike of stress in the beginning of your MRI before you start to relax, medical staff won't have access to any insights into your thoughts or feelings.

What is the life expectancy of a person with white matter disease? ›

In general, the prognosis is grave, with the majority of patients dying after a few years. However, some die only after several months, and some manage to survive for several decades [6].

Do white matter lesions cause fatigue? ›

Brain white matter (WM), and more specifically neuronal connectivity, is thought to perform a crucial role in the central processing of fatigue [1].

What do spots on an MRI mean? ›

On CT or MRI scans, brain lesions appear as dark or light spots that don't look like normal brain tissue. Usually, a brain lesion is an incidental finding unrelated to the condition or symptom that led to the imaging test in the first place.

Does everyone have white matter lesions? ›

White matter lesions are much more common in older or elderly people. Some studies have found that white matter lesions tend to be seen on the majority of brain scans in older adults but are far less frequently seen on brain scans in younger people.

What do white dots on a brain scan mean? ›

The spots represent fluid-filled holes in the brain, lesions that are believed to develop from the breakdown of blood vessels that nourish nerve cells.

At what age does small vessel disease start? ›

Increasing age: older than 45 in men and older than 55 in women.

What is the best treatment for small vessel disease of the brain? ›

Treatment may include medications to reduce cholesterol, regulate glucose levels, and lower high blood pressure. Healthy lifestyle habits such as regular exercise, eating nutrient-rich foods, and quitting smoking are often recommended as well.

Should I be worried about small vessel disease? ›

If left untreated, small vessel disease forces your heart to work harder to pump blood. This puts you at risk for heart attack and heart failure. Women are at higher risk for small vessel disease.

How common is an abnormal brain MRI? ›

Yet, even in healthy volunteers, structural abnormalities are detected quite frequently, in approximately 2–3 % of MRI scans of the brain [1, 2], and possibly in over a third of whole-body MRI scans [3]. So-called incidental findings may be of clinical or reproductive significance to research participants.

How often are brain MRI misread? ›

Getting an abnormal result from your MRI scan is no reason to panic. 18% of MRI scans end with an abnormal result, which simply means that the head or brain is not perfectly healthy.

Does mild brain damage show on MRI? ›

Will brain damage show up on an MRI? It's a question we get asked often by our clients who've suffered brain injuries. And the answer is if it's moderate or severe, most of the time it will show up on an MRI. If it's a mild brain injury, often it will not show up on an MRI.

What not to do before an MRI of the brain? ›

Since the MRI machines are magnets, it is best to not apply deodorants, antiperspirants, perfumes, or body lotions before the examination. These items contain metals that might interfere with the magnetic field inside the MRI machine and cause you to have distorted images and wrong results.

Why would a doctor order an MRI of the brain? ›

If you've been in an accident and had a brain injury, an MRI with contrast shows your injury in greater detail than an MRI without it. It also can show brain tumors, help diagnose multiple sclerosis, stroke, dementia, and a brain infection.

Why do they inject dye for an MRI? ›

Some MRI scans involve having an injection of contrast agent (dye). This makes certain tissues and blood vessels show up more clearly and in greater detail.

Are spots on the brain normal? ›

Abnormalities in white matter, known as lesions, are most often seen as bright areas or spots on MRI scans of the brain. They can reflect normal aging; white matter deteriorates as people age.

Do white spots on the brain mean dementia? ›

Increased numbers and size of the intense-white spots seen on the mostly gray images of the brain have long been linked to memory loss and emotional problems, especially as people age.

Do brain lesions mean dementia? ›

Cerebral white matter lesions (WML) are common in the aging brain and are associated with dementia and depression.

Are brain lesions always serious? ›

A brain lesion may involve small to large areas of your brain, and the severity of the underlying condition may range from relatively minor to life-threatening.

Are brain lesions always MS? ›

Not all lesions seen in an MRI are caused by MS. Lesions can be caused by other diseases such as migraine or stroke, and they can also develop with age. They can be detected in MRI scans before you experience any symptoms. Sometimes, a lesion might be detected in a scan that was done for another reason.

Can stress cause white spots on the brain? ›

Increased exposures to stressful events are associated with a corresponding increase in the progression of white matter hyperintensities.

Does early dementia show up on an MRI? ›

Magnetic resonance imaging (MRI)

Repeat scans can show how a person's brain changes over time. Evidence of shrinkage may support a diagnosis of Alzheimer's or another neurodegenerative dementia but cannot indicate a specific diagnosis. MRI also provides a detailed picture of brain blood vessels.

Can high blood pressure cause white spots on the brain? ›

Hypertension may cause disturbances in the blood-brain barrier, which may cause lesions in the white matter by cerebral oedema, by activation of astrocytes or by destructive enzymes or other poisons which pass through the damaged vessel walls.

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