Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Subject: Re: Confused on MRI results
Forum: The Neurology and Neurosurgery Forum
Topic Area: Multiple Sclerosis
Posted by CCF Neuro[P] MD, RPS on March 21, 1999 at 12:43:56:
In Reply to: Confused on MRI results posted by C.C. on March 21, 1999 at 09:22:17:


Dear Doctor: Can you please help me make sense of this MRI result? On one hand, it seems to say the small spots are nonspecific and don't appear to be consistent with MS, yet on the other hand it says there are spots in areas I've read ARE consistent with MS (subcortical white matter and in the deep white matter)....this really sounds contradictory!
Report reads:
Two small nonspecific punctate areas of t2 hyperintensity in the cerebral hemispheres. One of these is in the subcortical white matter of the right parietal region. The other is in the deep white matter of the left frontal lobe adjacent to the frontal horn of the lateral ventricle. These white matter findings are not typical of the demyelinating plaques in mutliple sclerosis. These appear most consistent with the nonspecific white matter changes seen in the spectrum of normal variation.

My personal thoughts: I know it says it doesn't look like ms-type lesions, but aren't these areas where ms usually is found?? It doesn't add up.


Also, my doctor agreed to repeat it in six more months (it would be one year from original scan), but just found out I'm pregnant. Is it o.k. to have the scan done during pregnancy? If MS is what the problem is, I want to start something as soon as this baby is born.

Your advice is appreciated.


Dear CC:

The first important question is whether you are asking about the MRI because you are thought to have MS, or are they working you up for MS, or you think you have MS and your doctors are not so sure? The MRI will allow us to see if the pathophysiology of MS has or is occuring, that of demyelination. Most demyelinating diseases, the effect is seen surrounding the ventricles (in particular, the lateral ventricles). These lesions have been given the name Dawson's lines as they look like little fingers of white extending from the ventricles. Although not diagnostic of MS, it is seen frequently seen in MS. There can be area of demyelination that are not usually seen in MS that patients with MS certainly have on their MRI. However, in the diagnosis of MS, the clinical evaluation is the most important criteria for MS. One can be diagnosed with MS with a completely normal MRI, just based on the clinical exam. Most of the time the CSF analysis and the MRI will substantiate our clinical diagnosis, but NOT all
the time. If your history and clinical exam is diagnostic of MS, then regardless of the atypical MRI you would have MS. However, there are only a few who would diagnose you based on just the MRI without CSF and clinical exam abnormalities. So, the clinical exam is the diagnostic tool for MS. The MRI and CSF analysis are confirmatory to the clinical exam.

Whether your MRI could be MS or not is somewhat unclear. Certainly it is not classic for MS. However, MS does not necessarily need to have classic MRI findings and your findings are in the realm of MS (albeit, atypical). If your clinical exam and CSF findings are not diagnostic, I think I would just closely follow you and see if the clinical exam doesn't become more diagostic of MS.

I am not aware of any problem having an MRI during the latter months of pregnacy. The question would be whether a test would change the way your physician is handling the MS. Certainly, medication of high dose steroids or interferon would not be undertaken during your pregnancy. So, in the overall picture, I think I would wait until after the birth of your child (by the way, congradualtions on the pregnancy).

Best of luck,

Sincerely,

CCF Neuro[P] MD

[Neurology Forum]      [Neurology Forum Archives]

[Health News and Commentry]