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Do MS brain lesions look different on MRI than other lesions?
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Do MS brain lesions look different on MRI than other lesions?

I get more confused everytime I see a new doctor, every doctor seems to have a different opion and I was hoping you would have some advice. Originally back in 2009 I started getting cluster headaches around the same time I also started having balance issues, muscle weakness, extreme fatigue, cognitive/memory issues, numbness in my left foot, and loss of vision during headaches. My primary care doctor sent me for an MRI and then sent me to see a neurologist. My initial MRI in 04/2009 showed "Incidental small bright signal focus in the white matter adjacent to the left lateral ventricle. This does not enhance and is most likely a small chronic signal abnormality related to an area of gliosis. Small areas of ischemic demyelination can develop following migraine headaches. At any rate, I would consider this single focus to be of no clinical significance. The study is otherwise normal." The neurologist diagnosed me with cluster headaches and put me on Topomax (topamax). He gradually increased my dose over a period of several months. After about 6 months it seemed that all of my symptoms resolved expect for the problems with my left leg and foot, which I later found out was caused by a herniated disc (L5/S1) in my back. I had a microdiscetomy in 01/2010. After back surgery the problems with my left leg/foot seemed to resolve as well. From 10/2010 - 03/2011 I had some of the same issues return (chronic migranes (migraines), cognitive difficulties, loss of balance...) even while on Topomax (topamax), but then they seemed to resolve on their own. I later stopped taking Topomax (topamax) because I did not like the side effects and it really did not seem to make much of a difference in my headaches. Starting in about 01/2012 all the old neurological symptoms came back again, but this time there were also new symptoms and it seemed to be more severe. (All over muscle pain/weakness, Numbness in lumbs, hands, feet, face, tongue, wake myself up at night from stretching legs and give myself "charlie horses", in morning the pain in legs and feet is so bad it hurts to put my feet on the floor and I stumble for a while, Memory is horrible - forget words mid-sentence, feel exhausted all day, pain all over, my bones hurt, sudden dyslexia, strange taste - everything tastes weird all the time, no depth perception, weakness - especially in left arm/hand, coordination problems/dizziness - walk like I am drunk/stumble, walk into walls, chairs tables... lose balance and fall  or have to hold onto something to prevent falling, eye pain - both eyes - blurred vision, see spots in peripheral vision, looks like things are moving peripheral vision, see colored spots, extreme sensitivity to bright ligh, see flashes - like strobe light, itching all over, especially arms/legs, feel pricks like mosquito bites all over all the time, sometimes it feels like a bug is crawling on my arms/legs, limbs feel heavy - hard to move, twiches/muscle spasms, extreme fatigue, pulsating sensation in ear/humming sound - 1 ear at a time, urinary problems...) This time the symptoms have been constant since 01/2012 and have not gotten better. I went to my primary care doctor in April and explained what was going on, she ordered a slew of blood tests and a new brain MRI. She had a rheumatologist review the 17 blood test results and the rheumatologist said that it was Lupus. I was started on prednisone immediately. Since being on the prednisone the pain/tightness in chest, joint pain, and fatigue have improved quite a bit, but the rest of the symptoms have not. Then my new brain MRI came back and it showed: "Impression: Nonspecific scattered (about 5 total number) small, less than 5 mm, bilateral frontal lobe white matter lesions without enhancement. Differential diagnosis includes demyelinating disease such as multiple sclerosis, migraine changes, versus other process. Primary Diagnositc Code: Minor Abnormality" I then went to a new neurologist, see told me she does not normally deal with MS but said that she wanted more information before making any diagnosis. She did a cervical spine MRI and it was normal. Then she sent me to an opthamologist to make sure my vision problems were not due to anything being wrong with my eyes. The opthamologist said that my eyes were normal. My neurologist had said that my pupil reaction was abnormal but the opthamologist had already dialated my eyes and couldn't check this. Now my neurologist wants to order a lumbar punture to rule MS in or out. I guess my main question is should I have the lumbar puncture done? Do MS lesions look different on MRI than other lesions? Could this be CNS lupus? Thanks and I appologize for the long post, I just wanted to make sure you had all the inforamtion.
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Avatar_f_tn
You do have a lot going on.  Getting the full work up for MS is a really good idea.  I would also encourage you to get a Western Blot test for Lyme Disease.  Lyme sometimes mimics MS and can cause every single symptom you list.  Symptoms can be very mysterious and come and go.

Usually a Lyme patient will get worse with steroids.  I have neurologic Lyme that mimiced MS. When I was given prednisone, I felt better at first.  But then the downward spiral started and accelerated.

On your question about lesions, I can only speak for my own.  While they resembled old MS lesions in appearance, they were smaller than most MS lesions and all of them were unenhanced.  They were scattered in the white matter. Your radiology report should have mentiond Lyme in the differential diagnosis, as it is known to cause demyelinating lesions.

That being said, it is also possible that lesions come from bad headaches, especially migraines. But, Lyme is famous for causing all kinds of headaches.

You are welcome to come to the Lyme Forum to post questions and find out how to find a doctor who knows Lyme well.  In the meantime, continue with your MS workup.  You need to eliminate one or the other.
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Avatar_f_tn
Thanks for the advice. I am going back to my neurologist next week. I will ask her about Lyme.
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987762_tn?1331031553
Hi i've split up your post because many people with MS have visual or cognitive issues and are unable to read large chunks of text :o)


"I get more confused everytime I see a new doctor, every doctor seems to have a different opion and I was hoping you would have some advice. Originally back in 2009 I started getting cluster headaches around the same time I also started having balance issues, muscle weakness, extreme fatigue, cognitive/memory issues, numbness in my left foot, and loss of vision during headaches.

My primary care doctor sent me for an MRI and then sent me to see a neurologist. My initial MRI in 04/2009 showed "Incidental small bright signal focus in the white matter adjacent to the left lateral ventricle. This does not enhance and is most likely a small chronic signal abnormality related to an area of gliosis. Small areas of ischemic demyelination can develop following migraine headaches.

At any rate, I would consider this single focus to be of no clinical significance. The study is otherwise normal." The neurologist diagnosed me with cluster headaches and put me on Topomax (topamax). He gradually increased my dose over a period of several months. After about 6 months it seemed that all of my symptoms resolved expect for the problems with my left leg and foot, which I later found out was caused by a herniated disc (L5/S1) in my back.

I had a microdiscetomy in 01/2010. After back surgery the problems with my left leg/foot seemed to resolve as well. From 10/2010 - 03/2011 I had some of the same issues return (chronic migranes (migraines), cognitive difficulties, loss of balance...) even while on Topomax (topamax), but then they seemed to resolve on their own. I later stopped taking Topomax (topamax) because I did not like the side effects and it really did not seem to make much of a difference in my headaches.

Starting in about 01/2012 all the old neurological symptoms came back again, but this time there were also new symptoms and it seemed to be more severe. (All over muscle pain/weakness, Numbness in lumbs, hands, feet, face, tongue, wake myself up at night from stretching legs and give myself "charlie horses", in morning the pain in legs and feet is so bad it hurts to put my feet on the floor and I stumble for a while, Memory is horrible - forget words mid-sentence, feel exhausted all day, pain all over, my bones hurt, sudden dyslexia, strange taste - everything tastes weird all the time, no depth perception, weakness - especially in left arm/hand, coordination problems/dizziness

- walk like I am drunk/stumble, walk into walls, chairs tables... lose balance and fall  or have to hold onto something to prevent falling, eye pain - both eyes - blurred vision, see spots in peripheral vision, looks like things are moving peripheral vision, see colored spots, extreme sensitivity to bright ligh, see flashes - like strobe light, itching all over, especially arms/legs, feel pricks like mosquito bites all over all the time, sometimes it feels like a bug is crawling on my arms/legs, limbs feel heavy - hard to move, twiches/muscle spasms, extreme fatigue, pulsating sensation in ear/humming sound - 1 ear at a time, urinary problems...)

This time the symptoms have been constant since 01/2012 and have not gotten better. I went to my primary care doctor in April and explained what was going on, she ordered a slew of blood tests and a new brain MRI. She had a rheumatologist review the 17 blood test results and the rheumatologist said that it was Lupus. I was started on prednisone immediately. Since being on the prednisone the pain/tightness in chest, joint pain, and fatigue have improved quite a bit, but the rest of the symptoms have not.

Then my new brain MRI came back and it showed: "Impression: Nonspecific scattered (about 5 total number) small, less than 5 mm, bilateral frontal lobe white matter lesions without enhancement. Differential diagnosis includes demyelinating disease such as multiple sclerosis, migraine changes, versus other process. Primary Diagnositc Code: Minor Abnormality" I then went to a new neurologist, see told me she does not normally deal with MS but said that she wanted more information before making any diagnosis. She did a cervical spine MRI and it was normal.

Then she sent me to an opthamologist to make sure my vision problems were not due to anything being wrong with my eyes. The opthamologist said that my eyes were normal. My neurologist had said that my pupil reaction was abnormal but the opthamologist had already dialated my eyes and couldn't check this. Now my neurologist wants to order a lumbar punture to rule MS in or out.

I guess my main question is should I have the lumbar puncture done?
Do MS lesions look different on MRI than other lesions?
Could this be CNS lupus?

Thanks and I appologize for the long post, I just wanted to make sure you had all the inforamtion."
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572651_tn?1333939396
hi and welcome. I'm glady ou found us here.  If you can, do us the favor of breaking up your posts into smaller sections - the large block of text is difficult if not impossible for people with vision problems to read.  I know you put a lot of thought into writing this, so want to be sure you get some of your questions answered.

An LP does not rule in or out MS.  It can only add supporting evidence.  There are people who have MS who are o-band negative in their spinal fluid.  There are many neurologists who don't do an LP anymore when looking for MS for that very reason.

If I have it right, you have been diagnosed with Lupus.  It is quite possible the brain lesions can also come from the headaches.  I would recommend you make a list of your symptoms, take that to your next neuro appointment, and review them together with the doctor.

good luck in sorting it all out,
Lulu



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987762_tn?1331031553
Hi again,

Sorry i've probably missed something along the way but in a nut shell, what i do have bouncing around my pea brain, is that you have been dx with migraine, you have been dx with Lupus, and you have been dx and had surgery for a herniated disc.

Since 09 and 2012 your brain MRI has changed but not a huge change and the lesions detected are in just your frontal lobe, none of the usual MS locations (see health pages, just to the right of your screen) and they didn't detect any lesions in your spinal MRI.

MS lesions are more about their location, they're not usually described in clusters, pin pr_cks or as popcorn etc. More often than not they are oval-ish, dawsons fingers and in telling locations. If they are new or still active they will light up with contrast, though if old or inactive or not demylating lesions, they wont. Our health pages, has one on MS locations and the ones on the Mcdonald Criteria which will probably help you get a better understanding.  

LP's are not suppose to rule out MS exactly, finding enough 0bands plus other evidence will be additional diagnostic evidence but not having enough or none at all isn't suppose to rule MS out. Personally i'd hold off on the LP for the moment, its not as big a deal as people assume but it is still an invasive test and i dont think you really have enough to point towards MS.

So as it stands, i'm thinking your MRI's are not really indicating MS, quite probable that your migraine dx is the diferencial dx that explains them. You can't really map lesions to symptoms but i'm pretty sure if your sx were caused by MS, you'd have more lesions and in telling locations eg cerebellum, spine etc.

I really am thinking that your sx could be attributed to Lupus, migraine and the herniated disc. Lupus is one of the MS mimics, though Lupus is said to be the greatest imitator so it could be the other way around. CNS Lupus is incredibly rare, so just the odds alone makes it seem unlikely though nothing is ever really impossible.

My advice would be to read up on Lupus, medhelp has a Lupus forum that maybe able to give additional imput and if you really are concerned about MS then its always a good idea to see an MS specialist over a general neuro.

Hope i have been of some help!

Cheers.........JJ    
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Avatar_f_tn
Thanks for all the advice. One doctor has Dx me with Lupus but other doctors have told me that they do not think that I have Lupus since I do not have any of the skin issues that are typical of Lupus.

I have a cousin that has Lupus as well and we do have some similar symptoms but she also has the skin issues that I do not have. She also does not seem to have most of the neurological symptoms that I do have.

I will just bring all of this info to my neuro appointment next week and I will let you know.
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4999273_tn?1362116310
Hi, I had these exact symptons and tests done 13 years ago, i was MS? for a long time but didnt fit the criteria for definate MS. I was diagnosed with Fibromyalgia 3 years ago so maybe your doctor could look into this. I had 5 brain lesions that were indicative of MS but after another MRI later i had no more lesions. Fibromyalgia and MS have similar symptons. Dont give up as i know how frustrating it can be.
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Avatar_n_tn
I definitely could have written your post. It describes my symptoms almost exactly - the muscle twitching, weakness in the left side, numbness, tinnitus, hearing problems (my left ear), dizziness, balance problems, fatigue, etc, etc are all symptoms I've been having off and on for the last 3 months. I've also had problems with tachycardia and palpitations. A few months ago I wore a heart monitor for 2 weeks, had an EKG and echo. All were normal. I'm a 38 year old woman.

Had an MRI no contrast and they found 10 small 2 mm lesions on the frontal lobe (both sides). Still unknown if it's MS, TIA, or migraines. Getting a spinal MRI next week followed by a lumbar puncture. The symptoms for me have been debilitating. Did you ever find anything out with your diagnosis?
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