Head MRI report from Radiologist

Technique: Sagittal T1, 3_D FLAIR, axial T2 with Fat saturation, axial diffusion and susceptibility weighted imaging

Findings: Mild Periventricular white matter disease with multifocal hyperintense T2 and FLAIR signal lesions within the corona radiata and centrum semiovale. Most of the lesions are peripheral and subcortical in location. No abnormal restricted diffusion. No Hemorrhage.

The Ventricles, cisterns, and sulci are normal. No atrophy.

Vascular flow voids are normal. Mastoid air cells, sinuses, skull base, orbits, IAC's and Calvarium are normal.

Impression: Mild Periventricular white matter disease. Although no specific these findings most likely  represent chronic small vessel ischemic change. Differential would include demyelination and vasculitis. There are no classic MR findings for multiple sclerosis.

So does anyone think that means  I do not  have MS definately???

Thanks to anyone who can help answer this i know you do not really know just want an opinion not a diagnosis.

hugs

sarah

[jensequitur]

Are you looking for something that will rule out MS, or something that will tell you that it is  MS?

For me, the results are not enough to rule out MS.  You have a number of hyperintense T2 lesions, which I'm guessing are punctate, because they're saying that it's most likely small vessel ischemic change (meaning it's old age.)  This makes it more difficult to get a diagnosis because of your age.  The bulging discs can cause the arm and leg symptoms, but not the cognitive problems.

[monotreme]

Hopefully, your neurologist will consider your symptoms, test results, neuro exam, and MRI findings to come up with an appropriate diagnosis.  Small vessel ischemic changes and vasculitis will not explain abnormal neurological findings.  

Elaine

[essdipity]

For several years my radiology reports said small vessel ischemic disease, and the lesions were anything but small. My current neuro strongly disagrees with these readings. I think radiologists look at age and not-typical MRI and immediately write everything off to small vessel stuff, which really amounts to normal aging in the absence of other neurological factors.

But you DO HAVE other factors. You have your symptoms, at least. These may be subjective, and thus the neuro has to take your word for them, or they may be readily measurable by various tests.

Remember, the radiologist knows next to nothing about you. The neuro should have lots of other info, and should be reading your MRIs himself, not simply going by the radiology report. If your neuro fails on these factors and you still have unexplained symptoms, then it's time to get a better neuro.

ess

[Freespirit24]

Thanks for taking the time to comment i do appreciate it. I am hardly old i am only 53. I agree sometimes it is easy to write things off  to other things. I am going to Toronto MS clinic on the 12th August. So we will see what they say.

thanks

sarah

[Freespirit24]

Maybe both i do not know and what age is old age as i am only 53 and be very healthy up until these symptoms occurred a year ago, i did not even have blood pressure problems my blood pressure has always been totally normal all my life but in last 12 months it goes up and down. I am not on any blood pressure meds because it is mostly normal.

The report also says it could be demyelination so maybe that is causing the problems.
I do value your imput and monotreme's and essdipity's  and understand it is a ruling out and further investigating. I have not more tests booked till i go to MS clinic on 12th August.

[Quixotic1]

Hi, Hun, I'm afraid to say that you and I are old.  Over 50 is old in MS talk and 60 is elderly (sorry, ess!)  However, that does not mean they can dismiss all of your many lesions due to age.  Some neuro's, like my old evil one, do that as a kneejerk.  It is true that you can begin to acquire White Matter Lesions as early as your 40's, the vast  majority of people in their 40's and 50's and even 60's do not have them in the absence of a long history of untreated hypertension, impaired pulmonary fucntion, long history of migraine disease.  Smoking and high cholesterol are minimal risk factors.

That said, it is NEVER appropriate to attribute MRI white matter lesions to age in the presence of neurologic symptoms.  That is incredibly sloppy/lazy thinking.

Does your MRI radiologist's interpretation rule out MS?  NOT at all.  It isn't a classic picture of MS, but MS is NOT an MRI Diagnosis.  It must be made pulling all of the pieces of evidence together; the history and physical (looking for a relapsing remitting pattern) a very thorough neurologic exam, and then the various "paraclinical" results from the MRI and the LP, VEP, other EPs and blood work.  Before MS can be diagnosed all "reasonable alternitives must be ruled out."

By the end of the weekend my write up on the McDonald Criteria should be on the Health Pages.

When I first presented with spasticity (diagnosed by this "esteemed" neurologist) my MRI only had ONE lesion in the frontal lobe.  This is not typical of MS, but it was enough for the neuro to dismiss MS outright (that and his faulty belief that I was too old at 53).  He said this lesion was a UBO - an Unidentified Bright Object - and people got them by my age.  Well, that one lesion is still all I have in my brain.  And I do have definite MS.  (All my other lesions are in my brainstem, cervical and thoracic spine)

Hope this helps and is not redundant.

Quix

[Freespirit24]

Thanks Sweetie for taking the time again to write and yes it is most helpful.

It at least prepares me for what i need to be seeing from my Neurologist. I am going to the MS clinic on the 12th Of August.

Thanks again

big hugs

Sarah