Demyelinating lesions or Vascular lesions???

As some of you may already know this past week I was dx with Factor V Leiden mutation gene, a hereditary blood clotting disorder. The Hematologist said that I had only enherited one copy of the gene and that I only had a slight defect. The only treatment he perscribed was one 81mg baby asprin a day. My Neurologist sent for the results of this test, and said that he still doesn't think that the 10 white matter lesions on my brain MRI was caused by a stroke. He is still sticking with his origional dx of ADEM for now until MS is ruled out in time. Now, I am wondering how they can tell if lesions in the white matter are caused from demyelination or vascular causes. Does anyone know the answer to this questions? I would have ask my neuro this myself but I only talked through his nurse the other day about these results!  Any information would be helpful to me in this situation!

Santana

[Quixotic1]

I haven't found a perfect answer for this, but here's what I know.  Ischemic lesions, in general, hit specific parts of the brain, and rarely hit the spine.  They tend to follow arterial patterns and have a different shape than MS plaques.

An MS plaque tends to be ovoid or irregular.  It has better defined edges than a stoke does.  It has a more homogeneous center (not speckled or grainy),  MS plaques in their clearest configuration have their longest axis perpendicular to (pointing at) the ventricles and may actually suggest the fingers of a hand radiating out from the ventricles.

The plaques of ADEM are said to resemble MS plaques so that is why I used those.

So, the neuroradiologists, know these and many more was in which the two types of lesions tend to differ.  Remember that demyelination occurs directly in certain of the nerves, the ones called oligodendrocytes.  In ischemic lesions big enough to look like MS the problem occurs becasue a clot blocked a small artery.   Whatever tissue that artery supplied with blood and oxygen will die.  That will form a different pattern of scarring because all the cells will die.  When they do an MRA (which I think you said they did) the pattern would look very different.  A neuroradiologist could probably list 10 more ways in which the two type of lesions differ in appearance.

Also, if you had such a severe tendency to form clots, you very likely would have had multiple episodes of clotting, not just one.  Did you read my explanation of why they would know that your gene mutation would probably not affect you much?

You seem to think that a baby aspirin isn't much treatment.  It is plenty to keep all of your platelets slippery.  Aspirin is a great blood thinner and you don't need much.  Don';t let the word "baby" fool you!  There is a HUGE difference between the tiny amount needed to keep platelets slippery and the amount needed for fever or pain relief.

I know you're anxious, but it sounds like you're in the hands of a capable neurologist!  This anxiety appears to be eating you up.  I worry seeing you fret so much.

((((HUGS))))

Quix

[santana8]

Thanks for the information that you knew about the lesions. I have not had a MRA, only 5 MRI's. And you are right I am nervous over all of this.  Having one nephew already dx with the Factor V Leiden two years ago, the death of my only brother from a clot to the heart 16 years ago, and last month a first cousin died from two massive strokes after starting birth control pills, not knowing she also had a clotting disorder! And for two years the doctors still cannot decide on what went on in my brain. The reason for the worry was because of something that my neuro said to me a while back. He said this may end up being vascular!  And now, after reviewing my hematologist report, he says that he dosen't think it was stroke related. I think all of the going back and forth with his thoughts on this is what is causing my anxiety over this. Plus it doesn't help that I have a panic disorder also. So I really don't want to over worry, but seeing all of these young people in my family die and me being left with such uncertainty it is a  little hard to relax about it all!

Santana