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Blood Vessel Damage in the Brain Is Cause of White Matter Disease

Dear Dr. Roach: I was diagnosed with white matter disease a few months ago, and I was given Depakote 500 mg to take (at bedtime). What exactly is this disease? Does it progress to dementia? My mother suffered from Alzheimer’s disease. I am in my late 60s. Are there any options for my future health care that I need to take care of? I am diabetic and also have high blood pressure and heart problems. All are under control. I take metoprolol and lisinopril. — M.R.

Answer: The brain is made up mostly of gray matter and white matter. Gray matter consists of the neurons (nerve cells), while white matter consists of the nerve fibers as well as glial cells, which support the neurons. White matter disease can be caused by many different processes, such as multiple sclerosis or migraine headaches, but one common meaning of “white matter disease” — and the one I think you probably were diagnosed with — is the damage done to the white matter by damaged blood vessels.

Apart from smoking, high blood pressure, diabetes, and high cholesterol are the biggest factors in ischemic white matter disease of the brain. Improving the control of these factors can reduce the risk of vascular dementia. Vascular dementia is similar in some respects to Alzheimer’s, and often the two are misdiagnosed by patients and families. Vascular dementia, sometimes called multi-stroke dementia, tends to be stable for a while then suddenly get worse, as opposed to Alzheimer’s disease, which is slowly progressive.

Dear Dr. Roach: I have a small cyst at the base of my left tonsil. It has been there for six years and appeared after a bad sore throat. I also would like to mention that I work with children and am exposed to a lot of germs. I have no pain and haven’t had a sore throat in years.

I did have this checked out years ago, but I thought it eventually would go away. I recently mentioned it at a checkup, and the doctor would like an ENT to check it out.

What worries me is that they may say I need to remove my tonsils, when for the most part they serve me well, because I rarely get sick. I also have heard that removing them as an adult has a much longer recovery time. I am a singer and am about to return to my job working with students. If a cyst is asymptomatic, does it have to be removed? I know I may be jumping the gun a bit, but this is causing me some anxiety. — J.P.

Answer: Go get it checked out by the ENT, an ear nose and throat doctor. A very small number of these cases are not cysts at all, but the beginnings of tumors, benign or cancerous. Cancer is extremely unlikely in your case if it has been stable for six years. It also could be a tonsillolith, a stonelike deposit of bacteria and fluid. If it is, as expected, both benign and asymptomatic, then the ENT doctor is unlikely to recommend removing your tonsils. You are quite right that removing tonsils as an adult is a much more difficult procedure than it is in children. We also remove far fewer tonsils than we used to, even in children.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.