I was dx'd in September 2004, am on Rebif and have had evoked potentials, lumber punctures and mri's a plenty over the years. Please help me understand my recent report.
My consultant said I had arthritis of neck and something about disc in spine. He also said the original area of my brain stem had lesions but with lesions in other areas. I am medically minded, was PA myself for a Consultant of Respiratory and my Mother and Daughter are nurses - but they are not neurologists.
The report is in three parts:-
MRI Brain & Spine
Brain: Sequences Acquired: Axial T2w TSE, T1w SE, sagittal T2w TSE and coronal flair.
Whole Spine: Sequences acquired: Sagittal T1w and T2w of whole spine, and axial T2w from C2/3 to body of T1
Brain: Findings There are no previous MRI scans in possession for comparison.
Normal configuration of the cortical sulci and sylvian fissures. The ventricles are symmetrical and non-dilated. There is no intracranial mass lesion. There are a number of foci of T2 high signal intensity within the peri-ventricular white matter of both cerebral hemispheres. The cerebellus appears normal. There is also area of high signal intensity within the right side of the medulla, best demonstrated on the T2w axial images. No other focal foci of T2w high signal are indentified. The cranjo-cervical junction appears normal.
Spine Findings: Normal vertebral body height and alignment. There are Haemangiomata within vertebral bodies of the T1 & T6 verterbrae. The cord appears normal and reyurns a normal signal and there is no extrinsic compressive lesions demonstrated. Within the cervical spine there is small right central disc/osteophyte complex at the C^/7 levels however this does not cause any significant central canal sternosis and it does not come into contact with cord. In remaining areas there is no central or foraminal stenosis.
Comment I note clinical details provided. There are a few small foci of T2w high signal intensity within the periventricular white matter of both cerebral hemispheres. There is also foci of high signal intensity within the right side of Medulla. Clinical correlation is recommended.
Thanks Jon what is worrying me is the wording in the spine part - one of the words keeps coming up tumour on the internet. Also covering letter says my films are being taken to the next Neurologists Team meeting - why?
I am not a doctor, but it is my understanding that hemangiomas are usually benign angiomas (overgrowth of blood vessels). They are usually benign and people can be born with them or develop them during growth or in correlation with certain injuries/diseases. In fact, it is estimated that at least 12% of the population has one. Your cervical MRI does seem to show arthritis per the report. The osteophyte is an arthritic spur, basically, that can be a common form of osteoarthritis as we age. The good news that it does not compress the cord and that there are no signal abnormalities within the cord is good. Cord compression (from stenosis, tumour, etc.) can cause hyperreflexia and abnormal appearance on spinal MRI due to ischemia, etc. Lack of stenosis in the neuroforamina is good because it arthritis does not appear to be affecting passage of your nerve roots through the neuroforaminal openings.
We can develop benign hyperintense foci in the brain due to aging, hypertension, TIA, migraines, etc. The fact that they are in different locations in the brain can point to other problems (such as MS for an example). And, even though hemangiomas are usually benign they are sometimes watched periodically. I think they can go through a proliferation, stable, and sometimes a resolution phase. Occasionally they can start growing. Sometimes the various stages can cause problems. Often the hemangiomas cause little or no discernible problem at all. However, your neurologist will have to check you clinically to determine if any of your symptoms correlate with your pictures. They may or may not do other tests to correlate your MRI findings. I am not a doctor. This is just based upon what I believe to be known and what reading I have done. I am a little familiar with hemangiomas. They are not that unusual. MRI is considered the exam of choice for depiction of most bone tumours, although hemangiomas can sometimes be difficult to discern. The fact that there were not any extrinsic compressive lesions or abnormal spinal cord signals should be a good sign. The radiologist did not seem to denote any kyphosis. What are your symptoms? I would think that if the radiologist thought that metasasis were involved that she would refer you to another physician for more radiological studies and calcium and alkaline phosphatase testing, etc. But, as I state, I am not a doctor and most of the pertinent haemangiomata section on this computer is unavailable to me today, for some reason.
I would try not worry too much at this point about the Team meeting, aspect. It can also be good. Often interesting findings are taken to Team meetings for educational purposes. Also, it means that several doctors are looking at the films before your appointment so that many minds can come together to decide what significance your abnormalities indicate to lessen the chance that anything abnormal/wrong is missed. Mine were round-tabled a little while ago. I was sent to a neuro who told me I had MS. But, he is sending me to a team of specialists to be on the safe side. I am actually relieved that several doctors looked at my films and I finally have a diagnosis which states that this is not all in my head. Getting a diagnosis can be so frustrating.
Sometimes there are conditions which can tie all the abnormalities together, and sometimes there are different explanations/causes for the different abnormalities, as I am sure you are aware. Sometimes multiple hemangiomas are related to a bone dyscrasy or immune problems and are believed to be correlated sometimes with arthritis. I also worked with radiologists in the past and it is COMMON for them to bounce ideas off each other before the final reading. Likewise, as neurologists are also looking at these same films it is not unusual for them to do so. It is not at all unusual for other professions to do this, also. So, I would not make myself sicker with worry over the Team-meeting aspect at this point.
I would take a list of your symptoms, a timeline if you have one, and all pertinent questions you can think of. You might take a knowledgeable family member with you. It is good to have the list in case you get memory-lapse (like me) or get anxious. I believe you have lots of people rooting for you on this forum...so, keep us posted, okay. LOL.
Firstly thank you SO SO much. Your message was very very informative. Back in March I was told I had a frozen shoulder. Could not move my left shoulder at all, and even though I had x-ray (which showed no fracture) and had physio and a tens trial - I still have limited movement. It feels like a nerve thing - like something is pressing on a nerve. The pain starts at base of neck and moves through the shoulder to about T1 level and the pain radiates down my left arm to elbow level. The stiffness I am suffering from the stiffness around my neck and shoulders is immense.
In addition I have all the usual MS symptoms of spasms etc, between March and August I fell over due to loss of sensation in my left leg and began having to use a stick.
My neuro believed I had suffered a genuine relapse hense why he ordered the scan. They put me on Methyl Prednisolone 250 mg for 10 days and whilst on the steroids felt energetic for the first time in years. Sadly 2 days after stopping the steroids I woke paralysed from the waist down and for a solid week had very "floppy" legs, could not sustain my weight (too fat probably). Scared the hell out of me. MS Specialist Nurses visited every day and were very supportive. Consultant explained this as the steroids had removed "too much tone" from my body and hence the "crash".
I have now given up working, cant multi task, was dropping things due to paralysis. However my EDSS score has gone in the last 6 months from 2.0 to 6.0 and consultant says may be removed from Rebif a my next anniversary date which is February if my EDSS has not come down as he believes I will not meet the requirement.
Thank you for all your help. My main questions really are - who should I be getting referred to for the arthritis and pain and neck in my shoulder. Having examined on internet the spine etc it appears that C6/7 wherre the arthritis is - next to the T1 of the thorasic part of spine where the heamangiotamata (probably spelt wrong lol) - also the T6 is affected too. What are they likely to offer me in terms of symptomatic relief, will surgery be needed (dont want) - and after I received my dx of MS back in September 2004 after first incident in March 2003 - I understand what you mean about relief on diagnosis. In fact although I hate having MS was concerned the results meant they were doubting their own diagnosis - your thoughts on this would be really appreciated.
Forgot to ask you - since you seem pretty genned up.
Back in 2004 a Registrar attempted a lumbar puncture - I was placed in a sitting up leaning forward over a pillow. This is what happened next....
Pressure on back and then my legs (with no help from me) swung out at widest point they could go, at same time I suffered what I can only describe as massive electricity down the legs.
The registrar stopped, then pulled out whatever he put in and a repeat of the above happened. By this time I was hysterical, in pain, frightened and tense.
A second registrar attempted, appeared to get quickly where he needed to be but said it was "traumatised" - what does this mean - and what explanation have you got for what happened during procedure xxxx
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