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Neurology (Expert Forum)
Questions about MRI
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Questions about MRI
by notsure1965, Jan 23, 2007 12:00AM
I am 41 yrs old. In 2002 I had a 3 month episode of slurred speech, left hand tremor and difficulty walking. Saw a Neurologist and Non contrast MRI showed one 5x3mm lesion with edema in the left cerebellar peduncle thought to be possible demylinating disease. LP was pos for 2 bands not in serum. All other lab work was neg. I was offered Avonex but waited. I mostly recovered and 9 months later I had a 6 wk episode of burning pain from the waist down, worse on the left I started Avonex and was diagnosed as Laboratory supported definite MS. I accepted the diagnosis but in Dec 2005 had repeat MRI that showed no lesions and no indication of MS. It was only of the head and with no contrast. This has made me very unsure of my diagnosis. I have basically done well. 3 months ago had same burning with mild weakness in left arm (C4-8 dermatome, spared T1,). It has improved but not gone away. Now when I walk or swim for 10 min if I look down my neck and left foot buzz. I guess I have MS but my MRI really confusses me. What do you think of my MRI and diagnosis of MS, do you think the buzzing most likely is L'hermittes. Thank you for your time.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Feb 12, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story that you relate are consistent with multiple sclerosis (MS). This disease in most individuals is a relapsing and remitting disease, which means that it comes and goes. During clinical events MRI lesions are often apparent and often enhance with contrast. After the event, lesions may disappear with very little trace, or may leave a 'hyper intense' region or may leave a 'T1 hole'. I am sorry that these are all technical terms, but the point is that the lesions do not behave uniformly and having lesions on one MRI that are not seen on the next one is very possible in MS. Over time the lesions do tend to have accumulating effects that become more or less a permanent feature of your MRI. If you have not had a MRI of your cervical spine, you should. I think the sensation that you describe is likely the 'L'hermittes sign' and may be due to additional MS lesions in your cervical spine. I agree with disease modifing therapy such as avonex in your case, but remember that you can also recieve intermittent IV solumedrol (steroids) for acute exacerbations (such as the pain and weakness in your arm).
I hope this has been helpful.
The symptoms and story that you relate are consistent with multiple sclerosis (MS). This disease in most individuals is a relapsing and remitting disease, which means that it comes and goes. During clinical events MRI lesions are often apparent and often enhance with contrast. After the event, lesions may disappear with very little trace, or may leave a 'hyper intense' region or may leave a 'T1 hole'. I am sorry that these are all technical terms, but the point is that the lesions do not behave uniformly and having lesions on one MRI that are not seen on the next one is very possible in MS. Over time the lesions do tend to have accumulating effects that become more or less a permanent feature of your MRI. If you have not had a MRI of your cervical spine, you should. I think the sensation that you describe is likely the 'L'hermittes sign' and may be due to additional MS lesions in your cervical spine. I agree with disease modifing therapy such as avonex in your case, but remember that you can also recieve intermittent IV solumedrol (steroids) for acute exacerbations (such as the pain and weakness in your arm).
I hope this has been helpful.
There is probably no exact word for the buzzing. Some chalk it up to paresthesias. I have that buzzing, and, despite all of my research, my personal education, and many specialists-have never found a pat answer.
You know that you could have many things, and that, the lesions is quite non-specific.
I have only heard of the "vibration/buzzing" phenomenah within circles of patients suffering with Lyme disease.
Lhermitte's sign, from what I have learned, tends to cause buzzing patches on the neck, arms, and legs due to (in the case of demyelinating disease) lesions within the c-spine which cause disruption of nerve signals. If you have that one lesion, and have not had a contrast MRI of the c-spine (and if you have not I am amazed at your physician); you should.
You may not be aware, depending on your locale, that Lyme disease can cause lesions/plaques/sclerosis, call them what you will, in the brain and in the spine that cannot be differentiated from traditional MS markings. As well, within the spine, those patients suffering with MS or with Lyme disease will often have oligoconal bands. I am surprised as well if you have not had a lumbar puncture.
My story is one of survival and I believe in your ability to survive and to find the right answer. Would you believe that I had to diagnose myself, or rather, re-diagnose myself and it was upheld by a Yale physician? My neurologist just chalked it up to a false diagnosis of "Acute Transverse Myelitis." I never had a transverse myelitis. Not one of 4 physicians ever ordered an MRI of the c-spine until I went to Yale.
It is all in your pathogenesis, my friend. Not to mention, your age makes me suspicious that you may very well not have traditional MS.
Peace,
JCmcc.
I re-read your post. You did have the LP and found bands. Alright, but remember, those are also non-specific.
Considering LOCALE you may consider looking on google, in fact, type in the words, "Lyme Net" and see what you can find.
You may very well have definite MS and maybe you do not.
Due to some pretty serious harassment from some posting members, namely "between" and "mellycat", et al, I cannot offer too much of an opinion. They think that I want you, and others, to believe that I am a neurologist or some form of an official despite the fact that I simply give credible good commentary, and, disclaim my statements.
With that said, I cannot give you my full opinion and I am sorry.
Your symptoms are triggered by an unknown cause-I think that it could be viral. I could be very wrong.
There are many variables that I am unaware of, such as locale-to look at the many spirochetal/viral possibilities, et seq.
I truly suggest that you do the same as the prior and google the words, "Lyme Net."
I really do not have many other suggestions. I would also find a major academic center at a University and contact there Neurology department.
It is very sad that it is so difficult in 21rst Century America, sometimes, to get answers.
I think that a person on here said it best when they said that physicians are not Gods, just humans. They have a hard task and due to attitudes (many illuminated) by some of our members these very doctors are put on the defensive and are overly cautious in finding answers.
There is common patient understanding that neurologists are rude. I am in school and know many: I am starting to understand the attitude. It is a hard job and an important one.
I am sorry that I could not help you more friend. Good Luck to you.
JCmcc.