BRAIN MRI results - trying again new post anyone?

[missy142]

Hi,
I was falling to the bottom again so I thought I would try one more time to post.  Perhaps my post is too long and to laborious to read.  I realize it is alot of spine issues but my doctors are trying to r/o pathologies as well.  If it is too long to answer or too out the realm of this forum,, please tell me and I wont post it again (I wont be offended, really) ,thanks missy.

I just got my radiologist report back of my brain MRI. States "Several scattered nonspecific punctate perventricular white matter signal hyperintensities may be of incidental note".  Differential diagnosis woud include minor changes related to migraine headaches. Done on 3T machine.  I do have migraines as of late, last 3 days, vomit etc. *****.

The reason for the  Brain and thoracic MRI is I have alot of spine issues. HX: cervical herniations with ventral cord impression C5/6, C6/7, cervical spinal stenosis, foraminal narrowing, ventral cord abutment, too much to read off.   (5)  thorasic bulges pressing on thecal sac  and 1 thoracic herniation T7/8 pressing on thecal sac and L5/S1 herniation which we thought was behind all my Lower extremity issues but according to that MRI there isnt any nerve impingement.

Ortho ordered  thorasic spine and brain MRI  because he feels "THERE IS SOMETHING ELSE GOING ON".  He does not aspire to the idea apparently that cervcical herniations even with cord impression cause Lower extremity issues. Thoracic MRI which was done on .6T machine (I know NOW, no good if looking for lesions, but he never said what he was looking for or what type of MRI machine I should go to, so I went to the open ones like I always do, sitting up)  THORACIC RESULTS - stated above

HX: 3/09 my right foot went numb, following with bilateral leg pain, I woke up the next day and couldnt walk, severe muscle weakness, could barely stand, it has relented since and platead and I am able to walk about 20 mins before they become spastic, clumsy and stiff, sitting or lying down relieves the problem somewhat at this point.  I have pain in my legs, muscle aches (bad) paresthesias in groin, buttock, right foot, sometimes left, cervical area numbness now, few inches below base of skull, word finding problems bad, to the point of studdering at times,others have noticed, RLS symptoms almost constantly, never had before all this started last year.  My first ortho said I had the beginnings of cauda equina syndrome from my L5/S1 herniation and wanted to due fusion right way.  But the i was told by 2nd ortho  that that herniation is not pressing on anything so it could not be causing CES. 1st ortho is very agressive and likes to cut. He wanted to cut my neck months ago, but I had 2 epidurals for all the UE symptoms with a good deal of relief, but alas it is coming back.

My 2nd ortho and  1st orth doesnt seem to relate (or hasnt mentioned anyway) correlating  the lower extremity weakness with the 2 cervical herniations impressing on the cord, god only knows why. ( I have never had UE weakness just pain, severe radiculopathy, paresthesias) . I am to see a neuro on the 27th, neurosurgeon on 24th.  Perhaps the Neursugeon can will have a different opinion about cord compression causing LE paraparesis, paresthias etc.  I dont think it is the thoracic herniation has have no really problems in that area just some occassional right flank pain.  Once I had pins and needs across the left side of my torso but it passed.

PHEW!  ANY THOUGHTS ABOUT THE BRAIN MRI AND SHOULD I GET ANOTHER THORACIC AND CERVICAL MRI ON A 3T MACHINE TO LOOK FOR OTHER PATHOLOGIES SUCH AS LESIONS( IF THE INSURANCE COMPANY ALLOWS THAT IS)?  PART OF THIS IS ALSO WORKMAN'S COMP SO IT IS BECOMING A POTENTIAL LEGAL MESS FOR ME I THINK

THE REASON I AM SO WORRIED is that my LE weakness happend literally OVERNIGHT.  I dont know if cord compression happens like this, there was no acute trauma.  

I dont know if I have anything besides cord compression (like thats not enough) but I am FRIGHTENEND OF BEING CUT BEFORE WE KNOW WHERE THE SYMPTOMS ARE COMING FROM.  BUT I AM ALSO SCARED TO DEATH THAT THE NERVES WILL BE PERMANENTLY DAMAGED WITH ALL THE TIME THAT HAS BEEN PASSING SINCE I WOKE UP AND COULDNT WALK 3/09.  

Had a bad day today, left foot went numb on and off all day, alot of pain in legs (percocet) and gait was very stiff, clumsy and legs very weak today, felt took a step back again out of nowhere.

Thanks,
missy

I promise not to post anymore arduous posts such as this one again:)

[Salamander2]

I am not a doctor, so take this with a grain of salt :)  My MRI results sort of started like yours in regard to mentioning migraines,  but at the end it said most probably a demyelinating process such as MS.  The radiologist should be able to offer an opinion about the resemblance of your lesions to MS lesions.

It seems smart to recheck the MRI before undergoing any of surgery.  If only to alleviate your worries.  I also think you need to see a Neuro to address some of your concerns.  You have to be your own advocate when it comes to your health.  Docs sometimes seem to get on a path to a diagnosis and don't listen to new symptoms or concerns, so keep trying to get some answers.  You might have to ask for the referral to a Neuro.  Most doc's don't offer this on their own,  I don't know if it's an ego issue or what.  But keep trying and looking for answers.
Blessings,
Sally

[JonM]

Having your Cervical and Thoracic MRIs redone may not be that useful, particularly with all the spine issues that your have.  To me the Brain MRI is more revealing and should be followed up on.  The statement: "Several scattered nonspecific punctate perventricular white matter signal hyperintensities may be of incidental note".  says to me that the radiologist noticed this (a hallmark of MS) when he/she wasn't looking for it. Was the Brain MRI done with and without contrast.  If not, have the Brain MRI redone w and w/o contrast and this time looking for MS.  Also you should be seeing a Nuerologist about this and your other symptoms.

Jon

[missy142]

thanks for taking the time the read my post and answer. The Brain MRI was done without contrast on 3T machine.  But like a said in the post he said probably due to migraines?  Do they just always say that?  Also what does "w and w/o contrast" mean?  I have an another orthosurgeon today, neurosurgeon thursday and neurologist next week.

missy

[BOK2Bjan]

My sympathies go out to you for your suffering and dx confusion. I second Sally's post - and would add my 2 cents for exactly what that's worth!  You mentioned that You, plural, meaning, I assume, you and your doctor, thought your Lower Leg problems were due to the L5-S1 herniation until you got the results of your MRI.  I don't see where you mention having had an MRI that would have shown your Lumbar region.  Your Brain MRI couldn't rule out problems in your Sacral Plexus, which includes your L5-SI area.  If the 2nd Ortho said the herniation in that disk isn't pressing on a nerve, then yes, it would seem the Dr. needs to look elsewhere.  But, the Cervical herniations aren't going to cause weakness or numbness in your LEs - they would only effect the areas served by the motor neurons from that level.  You would do well I think, to take a look at a good Anatomy/Physiology book to give you a picture of the nervous system and spinal cord.  It's really helpful to see what nerves serve the areas you're having your symptoms in.  Unfortunately, with MS, the lesions are more unpredictable, especially those in the Brain, as it's very difficult to do any correlations.  Your question about the comment from the radiologist about your MRI is - there's no way to answer.  Yucky answer, but with findings from ONE MRI, no matter what they are, it's hard to say much (at least with MS that is).  He (or she) said there were hyperintinsities, they didn't say there were definite lesions- which just means there's perhaps some inflammation causing activity that showed up.  It could go on to be something, or it could just be the migraine (which isn't nothing), or it could literally be nothing.  The new machines can show anomalies that aren't explainable, I'm told.  But, basically, the radiologist is saying it isn't possible to tell at this time, from this test.  MS lesions can show up as periventricular hyperintensities in the white matter, but lesions need to be seen on at least two different MRIs at least one month apart, for the MRI to be suggestive of MS  (I assume you're wondering about MS?)  Then, of course, the clinical picture and other tests are used.  With all your spinal issues, your symptoms must be multiple and confusing.  I wouldn't let results of an MRI confuse definitive results of spinal herniation that need fixing though.  I agree with Sally that sometimes doctors get fixated on a given dx and don't look elsewhere.  At the same time, if your spinal cord needs protection - (due to injury and herniation) that's got to be a priority - and wouldn't be related to a CNS disease process

The workman's comp comment leads me to wonder what kind of injury, if any, you suffered.  How do your symptoms relate time wise?

Blessings to you, Jan

[missy142]

thanks for the comments and Sally as well, forgot to mention her.  Yes I had a lumbar MRI that is how I found out i had an L5-S1 herniation but it isnt compressing anything. so would not be the cause of the LE paraparesis and paresthisias.  I am not a doctor but I am a nurse so I do know some A&P and nerves:) not all but some certainly.  there are medical people that do think that cervical compression and stenosis  can cause LE issues including bowel and bladder.  

the ortho is the one who suggested looking for other things e. MS and other things, I guess tumor or I dont know anything before surgery, which is on the table and has been, these orthos are ALWAYS ready to cut, just say the word.  And i've got alot they could do, not just with the herniations but with the cervical stenosis, whiich I believe is playing a part as well.

Im not sure what you mean about the workmans comp questions.  There was no traumatic injury.  I am a nurse case manager working at a large hospital in NYC.  However I sit at a desk all day and talk to patients and mds and type on a computer.  that is how this all started with my neck. I never new I had the herniations, or stenosis obviously sitting didnt cause them, but exacerbated the situation to the max. It is  considered an occupational disease.  I have been out since 10/08. My lower back hurt a bit but it wasnt until 3/09 that severe weakness in legs, woke up and couldnt WALK,  paresthesias in genitalia, buttock etc. started.

thanks again

[JonM]

Those last words concern me and really need to brought to the attention of a Nuerologist.  To wake up one morning with weakness and numbeness is significant.  What would be even more revealing is if the two (or three or four) symptoms were independent of one another as to their start and end dates.  That would be more indiciative of a lesion.

The contrast is used to detect new/active lesions versus old/inactive lesions.  It is the common MRI protocol for MS diagnosis on MRI.

To rule out/rule in MS comes down to clincal presentation and history of symptoms (dates of onset and remission of the individual symptoms) and the brain MRI w and w/o contrast.  The higher Tesla machines (3T) are better than the lower older units in imaging lesions.

I should say that I am not  Doctor, just have been DXd with MS for 2.5 years.  Strongly urge you to talk with Nuerologist.  The ortho, Nuero surgeon, etc. will not DX MS or rule it out.

Jon

[missy142]

Thankyou again Jon, you dont know how much I appreciate yours and everyone else's input.  The reason I think I asked you I believe about repeating the Thoracic MRI and maybe the C-spine again as they were both done on a .6T machine and would never show any lesions. Brain was done on 3T.  This machine is an open, sit up one and great for seeing herniations but I fear not much else.  
I have to see ortho's and neuro as you can see I have mutliple spinal issues going on and in the end it will probably be found out that one of the areas is the culprit.  I do have an appt with a neuro that my ortho wanted me to see but not till next week.

Yes it is very disturbing to me and i am FRIGHTENED TO DEATH that if there is severe enought nerve root compression and that is what it is, that I am doing permanent damage and will never walk right again.  I am just very skeptical of having a disease process going on at the same time,not that its not possible but it would be sooooooo coincidental dont you think?

missy

[BOK2Bjan]

Thanks for letting me know you did have a Lumbar MRI and there wasn't an injury related to the workman's comp. It's hard to reply to posts when you don't have all the info - hence the questions.  By your response, I'm not sure what to offer, other than support and let you know people care.  

I also have spinal problems, so I guess that's why I can relate.  I have MS, SSc, and many other serious diseases, but my vertebral problems causes almost as many problems as all the rest.  It may not be what kills me, but it makes life painful!  I was recently told I have C1-C7 degenerative disc disease and my spine has exaggerated its curvature at the cervical spine, as well as thoracic and lumbar regions, plus I have scoliosis and sacroilliitis.  My C-spine hasn't progressed to myelopathy, however, as yours seems to.  I re-read your post and saw that you did have foraminal narrowing and that's really significant.  I really feel for you!  Sorry to have said it wouldn't be causing those symptoms (LE).  It just didn't register when I first read your post and thought your cervical issues were herniations - so why are you not wanting the surgery, exactly?!! I don't know, but I'm nervous with my neck - and have thought ahead to a surgical intervention.  I don't want more neurological problems than I already have with the MS.  Cord compression at that level isn't something to scoff at. My Dr said, after making quite a face, "boy, you better be really careful with that neck!"  My right arm is often numb, swollen and tingling.  But, since I also have Carpal Tunnel and MS and Sys Sclerosis which causes my hands to be swollen and the joints painful and inflamed, they can't sort it out.  Also, like you, I also have L5-SI problems (bulging disc).  My neurologist said I needed "fairy dust", and didn't know how to sort out my symptoms.  I've had a numb buttock often, and you name it. BUT - I don't have definitive cord compression.

I guess my question of you is - you posted on an MS forum, and had a brain MRI with "bright spots" that they don't think are diagnostic at this point.  You won't get anything definitive from a brain MRI at this point, so I'm wondering why you would put off doing something about the C-spine?

http://www.umm.edu/spinecenter/education/cervical_spinal_stenosis.htm

This is a link that supports LE symptoms with cervical spine stenosis.  I have a feeling you shouldn't wait to address the neck!  That's my thought for the day.  I'm concerned for you.  Let me know what you think and decide.  

Blessings, Jan

[missy142]

hi again thanks for your interest and sorry to hear of all YOUR problems omg!  The reason I havent had surgery for my cervical spine is when I got 2 epidurals the symptoms in the Upper extremeities got better(pain, radiculopathy, numbess), the last epi was abou 6 weeks ago, the symptoms are coming back, but I have never had upper extremity weakness.  So as times continues, I have this event in 3/09 of the sudden almost complete ability to stand really, the paresthesias in my legs I had had for a few months before and in the genitalia and foot, buttock etc.  
Went to a 2nd ortho because my original one said I had the beginnigs of cauda equina syndrome becuase I finally got a lumbar MRI and showed herniatin. but I belive he is full of **** as THAT herniation is not compressing any nerves, just have lumbar pain.  
THE 2nd ortho does not believe all the lower extrem problems are coming form lumbar L5/S1 herniation, says its "impossible", its not impinging any nerves.
Soooooooo
He wanted to get a Brain MRI and thoracic MRI to look for more herniations i guess in thoracic area (which there are T7/T8 pressing on thecal sac- that is what protects the cord) and multiple bulges pressing on the sac.

Also wants to see if anything else is going on besides spinal issues as he thougth there was.  So there you have it in a nutshell, i think:)

I go today again to see him with the films of the brain and thoracic which I already know the results, he doesnt know I do, but I have copies of the radiologists reports myself:)
then neurosurgeon later in week
then neurologist next week.

thanks