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Neurology (Expert Forum)
MRI results with two small white matter lesions - MS?!
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MRI results with two small white matter lesions - MS?!
by Tsarrio, Mar 26, 2007 12:00AM
Hello, I am a 29/M. In October I started having red/teary eye with sinus pain. PCP thought sinusitis. Later - tingling in left arm and leg, foggy state, headache on each side of head. After many CTs and MRIs and many other doctors - everything OK. Did B1, B6, B12, sinus CT, head CT, brain MRI in December, ENG in February - all negative. Finally did another MRI in March with some alarming news. Now I am freaking out because I've been referred to the MS center at UCSF. Here is the summary:
Findings:
The ventricals are normal in size and symmetric in the midline
without evidence of mass effect or shift. Cortical sulci and subarachanoid spaces are symmtric and normal. There are two tiny white matter lesions adjacent to the trigone of the right lateral ventricle, seen only on the coronal FLAIR sequence. There is no contrast enhancement of these small lesions and no other contrast enhancing lesions are identified. No other abnormal foci of increased or decreased signal intensity are seen anywhere intracranially. Normal gray/white matter differentiation.
Impression:
1. Two tiny white matter lesions adjacent to the trigone of the right lateral ventricle without evidence of surrounding edema or mass effect and not demonstrating contrast enhancement. The largest of these measures about 4 mm in size and the second measures 2 mm. These lesions are nonspecific and could represent some chronis gliosis or scarring. Early demyelinating disease cannot be entirely excluded.
2. Otherwise normal appearing magnetic resonance imaging study of the brain.
Any ideas? Thank you!
Findings:
The ventricals are normal in size and symmetric in the midline
without evidence of mass effect or shift. Cortical sulci and subarachanoid spaces are symmtric and normal. There are two tiny white matter lesions adjacent to the trigone of the right lateral ventricle, seen only on the coronal FLAIR sequence. There is no contrast enhancement of these small lesions and no other contrast enhancing lesions are identified. No other abnormal foci of increased or decreased signal intensity are seen anywhere intracranially. Normal gray/white matter differentiation.
Impression:
1. Two tiny white matter lesions adjacent to the trigone of the right lateral ventricle without evidence of surrounding edema or mass effect and not demonstrating contrast enhancement. The largest of these measures about 4 mm in size and the second measures 2 mm. These lesions are nonspecific and could represent some chronis gliosis or scarring. Early demyelinating disease cannot be entirely excluded.
2. Otherwise normal appearing magnetic resonance imaging study of the brain.
Any ideas? Thank you!
Doctor's Answer
by Forum-M.D.-SH, Apr 17, 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 small white matter lesions are frequently encountered in the MRIs of patients with headaches (especially migraines). There are other things that can also cause these lesions such as high blood pressure, traumatic brain injury, migraines, and old strokes. Each of the diseases tends to have different distributions of the lesions, but no pattern of white matter lesions is completely specific for any one disorder. The symptoms and story that you describe are most consistent with classic migraine or migraine with aura (these headaches can be associated with focal neurologic features-such as the arm tingling, and also can cause a confused/foggy state). The red teary may not be related, but there are also headaches with autonomic features that can also cause these symptoms. One caution is that a common drug used for headaches (topamax) has been associated with glaucoma (rarely) which presents with a red, painful eye that is unable to see. I would suggest that you start a headache prevenative medication such as elavil, nadolol, verapamil, topamax, etc (taken daily). I am not apposed to further testing and the referal to the MS center. Since there is not positive confirmatory test that can tell you that the spots are due to migraines, testing for MS in a extensive fashion is usually the best thing to due (to rule MS out).
I hope this has been helpful.
The small white matter lesions are frequently encountered in the MRIs of patients with headaches (especially migraines). There are other things that can also cause these lesions such as high blood pressure, traumatic brain injury, migraines, and old strokes. Each of the diseases tends to have different distributions of the lesions, but no pattern of white matter lesions is completely specific for any one disorder. The symptoms and story that you describe are most consistent with classic migraine or migraine with aura (these headaches can be associated with focal neurologic features-such as the arm tingling, and also can cause a confused/foggy state). The red teary may not be related, but there are also headaches with autonomic features that can also cause these symptoms. One caution is that a common drug used for headaches (topamax) has been associated with glaucoma (rarely) which presents with a red, painful eye that is unable to see. I would suggest that you start a headache prevenative medication such as elavil, nadolol, verapamil, topamax, etc (taken daily). I am not apposed to further testing and the referal to the MS center. Since there is not positive confirmatory test that can tell you that the spots are due to migraines, testing for MS in a extensive fashion is usually the best thing to due (to rule MS out).
I hope this has been helpful.
One thing that I have learned with diagnoses and illness is that pathology/pathogenesis is most important. Know your past, know the present and keep track of it. Such pathology and doctor/patient communication leads to a thorough diagnosis.
I think that jumping to MS is a bit out of bounds here. These lesions are non-specific and could be caused by a number of variables. These variables can also cause the same symptoms that you describe.
There is, of course, the infamous and unpopular Lyme disease. There is Vasculitis, Syphilis -all of which are commonly undetected. It would be worthwhile to look into other options.
I am 28/M. I had many lesions on both sides of the brain and in the c-spine. All round and ovoid and some which enhanced. Doc said, "YOU HAVE MS!" Well--after a nervous breakdown, and a ton of my own research-I found that I in fact had LYME DISEASE. But, in my opinion, much to be argued I am sure-Lyme is MS. So, I am now, after losing my ability to walk and over 83 symptoms ASYMPTOMATIC.
You may want to do a couple of things: 1. Google "LDN" or "Low Dose Naltrexone."
2. Go to www.lymenet.org and do some research.
3. Do not marry a diagnosis and do not let it own or consume you.
4. Remember that you are in charge and that doctors are here to help you-they do not seal the case.
5. Stand up for yourself and learn everything you can until a true diagnoses is confirmed and substantiated.
I want to make it clear that I walk now. I am as I was before with only 1 slightly annoying symptom (internal vibrating). I was numb, I was tired, I wasn't walking, I was dizzy, I was burry, malaise was my life. I had myclonus and clonus general---to name a few!
A positive outlook and being very strong and fighting for myself too helped in my healing.
You can e-mail me anytime if you want to talk about this stuff. I can tell you about my pathology system (63 pages) and how Yale upheld my self made diagnosis. It may help you out.
My peace.
In Oct. MRI showed 1 lesion.......Had follow-up MRI in Jan., it showed a total of 5 hyperintense lesions, (that was almost 3 months ago, for all I know there could be more by now)
I also have severe headaches, but what I would like to know is.......Does the headache cause the lesions or do the lesions cause the headache????????
All my other tests were basically normal, initially Neuro was thinking MS, now he says he doesn't know what it is, I have been tested for basically everything, and nothing has really shown up. Possibly Microangiopathy?
Bottom line: Try not to get all worked up over the MRI results......when I first heard that I had lesions, I almost wigged!
But after reading online, especially here, I've learned that it's not that uncommon.....apparently there are lots of us with lesions on the brain..
I'm not saying it's normal, just that there seems to be a lot of people in the same boat.......similar non-specific symptoms, with no definite diagnosis.
Hang in there!
If the lesions have anything to do with the headaches, then, the headache is the cause of the lesion or the lesion is caused by a condition where a symptom is headache