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MS diagnosis
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MS diagnosis

My 25 year son was recently diagnosed with MS. There is family history, my brother died of complications of MS at age 54. His daughter, my niece, was diagnosed over 13 years ago. Our neurologists say that he, my son, has met all the clinical criteria and his labs, evoked potential, MRI's and spinal tap all suport MS findings. His first MRI. one in June of '08 showed 2 lesions in the white matter of his brain. After his 2nd exacerbation in Dec. '08, another MRI was done along with the spinal tap. The 2nd MRI showed at least 5 more lesions. However, his neurologist mentioned something about a black hole or a black spot that showed on the MRI. What is this? I could not bring myself to ask at the meeting we had with the neurologist. I did ask about the lesions themselves. Doc told me they were present in all 4 areas of the brain, not confined to one or 2 quadrants. He will be starting on Copaxone within the week. We are hopeful that this med will help him.  Could you tell me the sigificance of the "black hole"?
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669758_tn?1242334351
"Black holes" are T1 hypointensities.
Huh?

T1 is an imaging sequence on MRI and it is good for looking at anatomy (while T2 is better for looking at things that are not normal. FLAIR or Fluid Attenuated Inversion Recovery is even better for most MS lesions).

CSF or cerebrospinal fluid is dark (black) on T1 images (and bright or white on T2). So when an MS lesions is bright on T2 and dark (as opposed to normal grey) it suggests that there is axonal damage in the MS lesion (hypo = low or dark; intensity = the amount of brightness).

An unfortunate name for T1 hypointensities is "black holes" -- I think this is stigmatizing language and I would prefer if it did not exist.

So are these permanent -- no, not necessarily. Recent studies show that these come and go.
11 Comments
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Avatar_n_tn
Thank you soooooooo much for your quick response. I agree with you that the verbage in this instance is very frightening. I suppose I'm somewhat relieved by your explanation. We seem to go back and forth with mood elevations and lows. I know this is "normal" for those of us involved with MS issues. It's kind of like being in a very dark, unfamiliar place and there are many roads that veer off the main path. Don't know which road to follow!!  Thanks, once again........
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572651_tn?1333939396
Having these hypointensities myself, I'm wondering what is a better common name to call these voids?
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572651_tn?1333939396
Michele,
I'm so sorry to hear that your son has MS - it sounds like you have way too much experience with this disease.  I want to invite you to join us over on the MS forum that is a community of patients, caregivers, and others with an interest in MS. It's a great place to ask about others' experiences, ask questions, and vent a bit when necessary.  

Hope to see you around, Lulu
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147426_tn?1317269232
I learned something here.  thank you.  It seems to me that they should be called T1 hypointensities, just as "regular" MS lesions are called T2 hyperintensities.  I have some things to go correct.

Q
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198419_tn?1360245956
Hi Dr. Kantor,

I'm Shelly, a co-community leader on the MS forum. I am interested in the comings and goings of the black holes.

I have one large one, and thought it was here to stay. From the studies, I do understand the T2's can come and go, but thought the damage in the T1s was too great to go.

I hope it's not a lot to ask, but can you please point me to the new data on T1's coming and going.  I like to stay on top of the reading for myself, but for our educational pages too.

Thank you for your time,
Shelly
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572651_tn?1333939396
To add to the growing list of questions, I was just reading a paper at the NIH site on T1 hypointensities and it states:

"They correlate better with clinical disability than T2-weighted images, are found in patients with progressive multiple sclerosis, and can be used as surrogate outcome measures in treatment trials." - http://www.ncbi.nlm.nih.gov/pubmed/11359722 (I know it's not MLA citation form but it will have to do here!)

Does RRMS show hypointensisties or are they limited to patients with progressive forms of MS?

Thanks for raising this topic - Lulu
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572651_tn?1333939396
nevermind - I went and read the entire research and now understand that hypointensities appear in all forms but the ratio of T1 to T2 varies by type of MS, and in PPMS they vary in numbers by sex according to these researchers.  This study was from 2001, surely I can find something more current that would tell us more.  I'll look again soon Q&S and let you know. - L
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669758_tn?1242334351
Please see the results of the BECOME study by Dr. Diego Cadavid (was at UMDNJ) for T1 hypointensities that come and go.

Also a study published in the August issue of Neurology showed that Copaxone® (glatiramer acetate for injection) reduced by 50 percent the percentage of permanent "black holes" that developed in patients with relapsing-remitting multiple sclerosis. Black holes are lesions MS can cause in the brain, and these lesions, if permanent, represent areas where the most severe and irreversible brain tissue damage has occurred.
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572651_tn?1333939396
Thanks for the references. I'll be doing some library searches  on those tomorrow.
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198419_tn?1360245956
Thank you very much, Dr. Kantor.

Michellek, all the best to you and your son.  As a Mom, remember this, there is nothing you did (or him either) to cause this MS. (I've had to tell my Mom that).

Take care,

-Shelly
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