### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a 57 y.o. woman with some prehypertension, slightly elevated cholesterol, no diabetes.  I had a severe bout of depression and anxiety recently, which I am being treated for, but I have since been feeling more cognitively slow, and have some tremors in my hands at times, and some muscular twitches in various parts of my body.  I had an MRI to rule out MS (which my mother had), and they found microvascular ischemic changes bilaterally in my brain.  The neurologist said this amount was pretty average for my age.  I also recently had a cardiac calcium score done - it is 1.  Should I be concerned about this MRI?  At the height of my depression, I was in bed for 3 days with severe headaches (I also have cervical spine degeneration) but I actually felt like I had had a mini-stroke.  Has my brain had little mini-strokes, thus the ischemic changes?

### output:

Hello. I read your query and I understand your concern. Technically speaking those ischemic changes are a part of the stroke spectrum, meaning it is a case of an occluded vessel not supplying enough blood. However, it is the case of very small vessels and what your neurologist meant is that a certain amount of these changes of small vessels happens in many people over the course of years and are not responsible for your symptoms, can be found in many other people your age without any symptom at all. If these changes are markedly widespread it could be a cause for cognitive changes, I can't evaluate that without the images, but since he has told you they are average for your age I suppose he has considered that. So you shouldn't be concerned too much, although you should pay attention to blood pressure and high cholesterol to lower your future risk of stroke (a recommendation which would be given even without that MRI). I hope to have been of help.