I am not a neurologist or a radiologist, or a doctor of any kind, so my opinion is worth exactly what you are paying for it. But with that said, let me mention a few things that stick out to me in that brief description versus what your doctor said to you.

First is that the word hyperintensities in the report is plural, which is a fancy word, but being plural, it means to me that you have more than one spot visible on the scan. Your doctor may have just been referring to the one around the ventircle horn, or may have misread the report. Or the radiologist may have misspoke and there is only one spot. But reading what was written indicates more than one...which becomes more important when you go read the McDonald Diagnostic Criteria for MS. The number of spots (or lesions as they are called) and their locations is very important for diagnostic purposes, which is why a neurologist will typically want to see the actual scans and not just the radiologists report.

The second thought is that the periventricular white matter is a very common place for such spots to show up in people with MS. My neurologist specifically called out the location of one of mine around the horns of the ventricle as being "typical" for MS type lesions. That is not to say that you have MS. Just that given that location of lesion, your symptoms, and your age, MS is one of the front-runners as far as possible diagnoses.

Third, the "unusual for age" comment is just radiologist speak for "it isn't something I would expect to see in somebody in this age group". As we age, there are certain types of changes to our brains that are visible to radiologists on MRI scans. They will typicaly discount certain things by saying "blah blah is seen in this part of the brain, typical for this age group". So when they are calling out something as being unusual for the age, they are just pointing out that it isn't one of the things they would expect to see.

Lastly, regarding the LP. Some people have an easy flawless experience with them, some don't. I had one attempt that was tremedously painful and unsuccessful, and the second attempt the following morning was easy and nearly painless. My recovery was a whole other story. But long story short, mine was negative. I still have a dx of MS based on other things. I have heard it said that the bands may only show up in the spinal fluid if you have an active lesion at the time of the test. That kind of lesion will also show up on an MRI with contrast.

My advice would be to get a referral from your PCP to a good neurologist first, bring all your test results and a CD with your MRI scan on it to them, and let them decide what to do next. My guess is that the first thing they will want is an MRI with contrast, then may send you for the LP based on the result. The neurologist can also tell you what the narrowing at the base of the cervical space is about and whether it has any bearing on your symptoms.