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Family Medicine (Expert Forum)
can you help with MRI results
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
can you help with MRI results
by HUH, Jan 06, 2005 12:00AM
I’m not sure if you can help here or not. I’ve been trying to post this at the Neuro. forum for a week now but haven’t been able to get through.
I’m a 35-year-old male in good health. My symptoms that took me to the Dr. was head throbbing head pain on the top, left side of my head and the rear left side. About 3 days after I injured myself I got the worst throbbing headache at night. For a couple of hours during the headache I lost some of my peripheral vision. I took a nap and the headache was gone and normal vision back. Then later the pain started out when I would lay down on a certain side of my body. When I started getting the throbbing pain I would stand up and the headache would go away. I sometimes got the pain in the morning before I woke up but once I stood up it went away. Also a couple of times if I moved my neck a certain way it would throb for a few seconds. I went to a family doctor who ordered a CT scan in November which was normal. The head pain was becoming less frequent in November. The Dr. said I had migraines. So I went to Neuro. who ordered a MRI/MRA with & without contrast. This is what the test showed:
“Diffusion weighted images show no evidence to suggest an acute infarct, hemorg. or space occupying lesion. Flair weighted sequence images and T2 weighted seq. images show evidence for an area of decreased signal in the left occipital lobe just adjacent to the occipital horn of the left lateral ventricle. This area does not show evidence for contrast opacification. Vascular structures appear grossly unremarkable. There is also a question of focal area of very subtle increased signal involving the left cerebellar lobe adjacent to the cerebellar peduncle only identifiable on the flair sequence. This could represent a vascular structure or summation with an adjacent sulcus, however, localized demyelinating plaque cannot be excluded. Impression: MRA Unremarkable. Subtle focal areas of increased signal, including the medial aspect of the left occipital lobe adjacent to the occipital horn of the left lateral ventricle & possibly left cerebellar lobe and clinical correlation regarding possible demyelinating process is recommended. Prominent perivascular spaces or lacunar type infarct given this appearance are also considered.”
My Family Dr. is worried about MS. The Neuro. said it was normal after he and some other Dr. at a teaching hospital viewed the films. Well since the word MS came up I’ve been having pins and needles feelings all over my body. My neck, head, arms (mostly right arm), legs, back and stomach. Usually feel them all in the same day, being going on for about a week now. The feeling lasts for a few minutes then goes away for awhile then comes back again for a few more minutes then leaves. No other symptoms and headaches are better. The last throbbing headache I got was when I was laying down for the MRI. went away when I stood up. Which was 12-21-04. What does the MRI say? Is it MS?
I’m a 35-year-old male in good health. My symptoms that took me to the Dr. was head throbbing head pain on the top, left side of my head and the rear left side. About 3 days after I injured myself I got the worst throbbing headache at night. For a couple of hours during the headache I lost some of my peripheral vision. I took a nap and the headache was gone and normal vision back. Then later the pain started out when I would lay down on a certain side of my body. When I started getting the throbbing pain I would stand up and the headache would go away. I sometimes got the pain in the morning before I woke up but once I stood up it went away. Also a couple of times if I moved my neck a certain way it would throb for a few seconds. I went to a family doctor who ordered a CT scan in November which was normal. The head pain was becoming less frequent in November. The Dr. said I had migraines. So I went to Neuro. who ordered a MRI/MRA with & without contrast. This is what the test showed:
“Diffusion weighted images show no evidence to suggest an acute infarct, hemorg. or space occupying lesion. Flair weighted sequence images and T2 weighted seq. images show evidence for an area of decreased signal in the left occipital lobe just adjacent to the occipital horn of the left lateral ventricle. This area does not show evidence for contrast opacification. Vascular structures appear grossly unremarkable. There is also a question of focal area of very subtle increased signal involving the left cerebellar lobe adjacent to the cerebellar peduncle only identifiable on the flair sequence. This could represent a vascular structure or summation with an adjacent sulcus, however, localized demyelinating plaque cannot be excluded. Impression: MRA Unremarkable. Subtle focal areas of increased signal, including the medial aspect of the left occipital lobe adjacent to the occipital horn of the left lateral ventricle & possibly left cerebellar lobe and clinical correlation regarding possible demyelinating process is recommended. Prominent perivascular spaces or lacunar type infarct given this appearance are also considered.”
My Family Dr. is worried about MS. The Neuro. said it was normal after he and some other Dr. at a teaching hospital viewed the films. Well since the word MS came up I’ve been having pins and needles feelings all over my body. My neck, head, arms (mostly right arm), legs, back and stomach. Usually feel them all in the same day, being going on for about a week now. The feeling lasts for a few minutes then goes away for awhile then comes back again for a few more minutes then leaves. No other symptoms and headaches are better. The last throbbing headache I got was when I was laying down for the MRI. went away when I stood up. Which was 12-21-04. What does the MRI say? Is it MS?
Doctor's Answer
by Kevin Pho, MD, Jan 06, 2005 12:00AM
, Jan 06, 2005 12:00AM
Tough to say without viewing the films. The MRA was normal, suggesting there are no problems with the vasculature.
Regarding the MRI - the findings do not give a definitive diagnosis. Clinical correlation means that further investigation is warranted if there is suspicion of the disease in the history and physicial.
If there continues to be concern about MS, you may want to consider a lumbar puncture to evaluate the CSF fluid for oligoclonal bands that may be present in 85 to 95 percent of cases.
Evoked potentials can also be considered, which can detect abnormal CNS function that would otherwise be clinically undetectable.
You may want to discuss these options with your neurologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Regarding the MRI - the findings do not give a definitive diagnosis. Clinical correlation means that further investigation is warranted if there is suspicion of the disease in the history and physicial.
If there continues to be concern about MS, you may want to consider a lumbar puncture to evaluate the CSF fluid for oligoclonal bands that may be present in 85 to 95 percent of cases.
Evoked potentials can also be considered, which can detect abnormal CNS function that would otherwise be clinically undetectable.
You may want to discuss these options with your neurologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Member Comments (1)
by lchelsemom, Jan 06, 2005 12:00AM
About 25 years ago had MRI of brain which showed areas of plaque with a possible diagnosis of MS. Had 2 lumbar puntures that were negative (if Dr. suggests,I would recommend asking him if absolutely necessary - they are not fun). I have over the years been to different doctors and they are pretty much split 50 -50 if I have MS. Oner of the Dr.'sd who didn't think I had it, had a B12 test run and it was so low,off teh charts. B12 defiency has same symptons as MS and affects central nervous system. You might want to ask your Dr. to run B12 test.
