By themselves, T2 weighted hyperintensities on brain MRI imaging are very non- specific. They are more commonly seen in patients over the age of 40, or with co- morbidities, including hypertension, diabetes, tobacco use, stimulant drug use, migraine, stroke, and autoimmune disorders. As such, without clinical context, they mean very little. It is not entirely clear that they necessarily represent pathology.
Enhancing T2 lesions are still non-specific, but far less commonly seen, as they indicate blood brain barrier breakdown. The differential is still broad, including infection, demyelination, infarction, and malignancy, but essentially they would always be considered to be pathologic in character
Similarly, T2 hyperintensity in the spinal cord is rare, and suggests demyelination, gliosis due to old trauma, infarction, malignancy, or infection.
In the context of this patient, what do they mean?