MRI Results

[nickels549]

I'm a 25 year old female who had an MRI done because of constant headaches and migraines.  My GP discussed the finding with me and decided it was best for me to see a Neurologist.  Here are the findings:

A 1.0cm focus of bright T2 signal is identified in the left mid pericallosal white matter. No other lesions are identified. This area is low to intermediate signal on T1-weighted images.  There is no evidence of surrounding edema or mass effect. The corpus callosum is well formed. No lesions are identified within the corpus callosum or visualized brainstem and upper cervical cord. The brainstem and cerebellum are unremarkable on axial images. The seventh and eighth cranial nerve complexes are well visualized and normal in appearance. The mastoid air cells are clear.
There is no evidence of restricted diffusion. Postgadolinium images demonstrate normal enhancement within the brain. There is no evidence of abnormal enhancement of the left pericallosal lesion. The infundibulum is midline. Homogeneous enhancement of the pituitary gland is seen. The optic callosum, orbits and optic nerves are normal. Increased T2 signal is present within the mucosa of the ethmoid air cells bilaterally.

The impression of the doctor reviewing the MRI was:
1.0cm focus of increased T2 signal in the left mid pericallosal white matter. Although this is a solitary lesion, this is suspicious for demyelinating disease. Clinical correlation and followup is recommended. Mild inflammation in the ethmoid air cells.

My concern is that one doctor reviewed the MRI and wrote this report.  When I saw the neurologist, he didn't read this report (although he had a copy), he looked at the MRI images and came back with "you could have had a stroke."

To me, those are very different diagnoses.  He gave me some medication for my headaches and told me to come back in 5 weeks.  He didn't elaborate about the possible causes of a stroke if that's what it was.  I'm only 25, I don't smoke, and I'm not overweight.  I know it's hard for you to come to a conclusion without seeing the MRI images but any insight or input will be greatly appreciated!

[nickels549]

Thank you for your response!  My original trip to the doctor this time was just because of the headaches.  But 4 years ago while I was in college, I went to the doctor because I was having trouble concentrating, I felt like my mind was fuzzy and I was being forgetful. I was also experiencing some fine tremors while doing certain activities.  The doctors I went to (including a GP, endocrinologist and cardiologist) came up with nothing.  A CT scan was also done at that time.  That test came back clear.  I haven't had any blood work done in some time, probably about 4 years.  I went to the cardiologist because of a rapid heart beat I would experience.  They found nothing.  Currently my beta blocker medication for the headaches helps control the heart issue.  I don't have any visual symptoms associated with my headaches. During the bad migraines I experience sensitivity to light and sound.

My GP ordered the MRI because of a headache I told him about that was "abnormal" to me.  It was in the back side of my head and woke me up in the middle of the night.  It got worse if I laid down and took over an hour to decrease enough for me to lay down and go back to sleep.  It was probably the worst headache I've ever experienced.

Thanks again for all your input and suggestions.  This will really help when I go back to the neurologist in a few weeks.

[Vanessa Lacuesta]

Hi,

An MRI will be able to help visualize involvement of underlying structures but it will simply guide diagnosis. As mentioned by your physician, it is important that the MRI results are to be correlated with your signs and symptoms. At this point, what were your initial symptoms aside from the headaches? Have you experienced weakness or numbness in certain parts of the body? Are there any associated slurring of speech, confusion, change in behavior or visual symptoms associated with the headaches?

The lesion noted in your MRI is nonspecific. That is it may be readily interpreted as a white matter lesion usually noted in migraineurs or a previous bleed. Since you are young, a complete cardiac work up to exclude any heart problems may help. Also have your coagulation factor levels checked to rule out any bleeding problems. Some studies show that persons with migraine headaches present with nonspecific white matter lesions on MRI.You may discuss this with your doctor.