Question regarding MRI report symptoms

[heatherc]

I recently had an MRI and received a copy of the report. These are the findings:

"The ventricular system and subarachnoid spaces are minimally prominent, given the patient's chronologic age. There is signal abnormality identified within the periventricular white matter tracts adjacent to the occipital horn bilaterally. The sagittal IR images demonstrate a normally formed corpus callosum. The areas of signal abnormality appear to radiate away from the long axis of the callosum in a 'finger-like' fasion. Following the administration of intravenous contrast, significant enhancement is not recognized within the abnormalities. The midline structures are maintained and the basal cisterns are patent. The calvarium and extracalvarial structures appear normal"

The radiologist impression is:

The ventricular system and subarachnoid spaces are minimally prominent, given the patient's chronologic age. There is signal alteration within the posterior white matter tracts bilaterally. The signal change appears to radiate away from the long axis of the lateral ventricles in a 'finger-like' fashion. Abnormal enhancement is not recognized following the administration of contrast. The findings are nonspecific but given the patient's age, gender, and clinical presentation, the presence of multiple sclerosis can not be excluded.'

The symptoms I have presented began a year and a half ago - vertigo, dizziness, ringing in ears, numbness in left hand, tingling and electric shock sensations in feet and lower legs, at times, diminished or no sense of taste, occasional confusion and difficulty finding the right word, burning skin. There has also been muscle weakness, at times, in my legs and left arm. The symptoms seem to come and go, and last for as little as five minutes (with vertigo) or days (numbness). I am a 26 year old Caucasian female.

Bloodwork all came back normal, cat scan was normal. I was evaluated by a neurologist who said my reflexes and exam were normal, and when he viewed the MRI results, said they were normal, too, and he dismissed the symptoms as possibly stress related, saying that he didn't know and couldn't help me.

My family physician thought that this may be the early stages of a demyelinating disease, MS being a possibility. He thought the neurologist would order serial MRIs and evoked potential testing, and perhaps a spinal tap, but the neurologist has basically said that he's not going to do anything more and won't see me any more.

I was wondering what your opinion is, and also what do the MRI report findings mean - what does the signal abnormality mean? Is that like a lesion or a plaque? Could a signal abnormality or alteration be indicative of the start of dymelination or inflammation, or is this something that's normally seen in everybody?

What avenues should I be pursuing? Any thoughts you may have - even what you would do with a patient presenting similar findings and complaints - would be greatly appreciated.

[lchelsemom]

I was diagnosed with MS many years ago.  I had some symptoms, endured 2 negative spinal taps, and have 2small brain lesions which have not changed in years.  Went to another Dr. about 8 years ago.  Sounded funny to him and ordered B12 test which showed significantly low level that probaly had gone unchecked for 4-5 years.

I suggest to everyone who has symptoms to get a simple B12 test to check level.  Often not included in bloodwork.

[cardiogirl]

I'm the same age as you, same race, and have every symptom you stated here except the lack of taste.  I also have developed major memory loss episodes and struggle to hold a thought at times.  I'm also being evaluated for neurological disorders, such as MS and Lupus.  I'll be interested in hearing the response.  Nice (but also sad) to know I'm not alone.

[Kevin Pho, MD]

Unfortunately, the findings on the MRI mean exactly that - non-specific.  Meaning that the signal abnormality may or may not be significant for disease.  There is not enough evidence to confirm nor rule out disease.

In cases like these, another opinion may be helpful.  A second neurological opinion should be considered.  If MS is a possibility, a lumbar puncture as well as evoked potential testing can be considered to confirm or rule out the diagnosis.  

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