Is it MS? Non specific white matter Lesions on MRI

[PaganMommyof2]

I have had migraines since December 2013.  2 months ago, I started experiencing stabbing pain the the occipital area of my skull.  Suddenly, my big right toe went numb, I get tingling and cramping in the arm, hand, leg, and foot; all the right side.  I also have episodic unsteady gait, where I stagger like I am drunk.  My MRI results showed (20) T2 hyperintense lesions in the subcortical region.  The distribution of the lesions is not typical of MS.  But my symptoms are not part of the migraines.  I go see a nero next friday, but would like some advice or opinions before then.

[PaganMommyof2]

Ok, second MRI shows numerous lesions on spine, none on the neck.  Chest xray was to rule out scardiosis.  My neuro says I have progressive-relapsing MS.  The only drug I am taking is SoluMedrol, due to breastfeeding a toddler.  I am slowly accepting the diagnosis.  My everyday life has changed a bit, I am slower moving around the house, can't use my right hand for much of anything small or remotely heavy.  I walk around ok, but dr ordered me a walker with a seat for when I do walk around, it will give me confidence and allow my legs to rest when they need to.  

[zerodegrees]

I am so sorry about your diagnosis.

You CAN be diagnosed quickly. I was also. It just seems that it is more common for patients to go through long periods of being followed, not listened to...etc. before  diagnosis of anything is given.

[supermum_ms]

Honestly, a neurologist who specialises in MS, which your's does, and who's been around MS for a long time, which your's has, is much more likely to recognise MS by their patients clinical signs and their MRI evidence, than a non specialising neurologist generally would. One of the reasons I usually recommend seeing a neurologist who specialises in MS, is because they are more likely to identify MS, simply from their own history of dealing with many other people with MS, your neurologist being the director of an MS centre would really have to know what MS is all about!!

The lesion pattern of MS he's talking about, would be more than the subcortical brain lesions you mentioned. There definitely is a pattern, though MS unlike a lot of other medical conditions isn't always simplistic to work out, so a criteria to help in diagnosing MS was created, it's called the Mcdonald Criteria.

According to the criteria, for clinically defined Multiple Sclerosis (CDMS), you need to have at least 2 lesions in at least 2 of the 4 identified locations, but you need to also meet the space and time aspect to meet the criteria, which is  evidence of new and old lesions. Technically, it's possible to be dx with MS with only 1 MRI or even without one and just by the patients 'clinical signs' of lesion damage, though it doesn't happen very often now a days.

To give you a 'very basic' example of MRI evidence of MS, the lesions are visible in multiple brain locations, and or the spinal cord eg peri-ventricular, corpus callum, cerebellum and spinal cord and some of the lesions light up with contrast.

MS T2 lesions usually look like small ovalish white spots, sometimes though not always there will be whats called Dawsons fingers seen. MS spinal cord lesion(s), are smaller than cord lesions caused by other conditions and can be quite difficult to see, so the strength of MRI can mean the difference between none and multiple cord lesions becoming visible. The contrast series if done during an attack or within the 30-40 days time frame, will highlight new and old evidence of the demyalination. When some of those lesions light up like tiny bright light globes, and other lesions don't, the contrast is highlighting both new and old demyalination events.

Unfortunately, at this stage they are still trying to work out what causes MS and find the 'cure', science has come a very long way but you are right so far there is no cure. The disease modifying drugs (DMS) research has shown they can slow down the disease and minimise new attacks, which can essentially allow remyalination to occur. MS is quite mysterious in many ways, sometimes lesions that have been identified on prior MRI's will have disappeared or shrunk on the next MRI but more often than not, a demyalinating lesion is still vulnerable to being attacked and shows its self again.

I'd be guessing at which of the newer DMD's he's specifically thinking would be the best one for you to go on, in the last 5 or so years, there's been a few new ones come out showing quite promising results, i really can't recall off the top of my head, which of the new ones specifically mentioning lesion shrinkage, sorry i can't even point to anything.......

HUGS..........JJ
        

  

[PaganMommyof2]

I thought it was strange he dx MS right away.  He told me the lesions showed a pattern of MS? which I wasn't aware there was a certain pattern for them.  I have copies of all my bloodwork, my MRI on the disc, and the summary sheet from the neuro, which lists MS as the diagnosis.  He is the director, and oldest dr at the MS center in Albany, NY, so I am assuming he probably has been doing it longer than the other drs at the office. The MRI of the spine and neck is in 2 weeks, plus he wants a chest xray for some unknown reason.  He also told me there is a new drug that is being used to shrink the lesions.  From what I have read, there is no cure, but IS there a way to shrink the lesions?

[essdipity]

Did the neuro talk about starting you on one of the disease modifying drugs? It's fine to try to quell the flare you are having, and to ease symptoms with various kinds of meds, but your best bet for future health lies in one of the meds that actually fights MS, by reducing the number of flares and slowing disease progression. There are quite a few to choose among now, several in pill form, and if one is hard to tolerate or doesn't seem to be working, there are always others.

Since you're a newbie at these things, as everyone here once was, I urge you to the National MS Society web site and read, read, read. Best of luck to you.

ess

[supermum_ms]

Hi and welcome to our MS little community,

From my understanding, your unilateral sx's, gait issues etc would be suggestive of MS but as with most sx's associated to MS there are many mimics, so MS is definitely not the only cause. From what you've mentioned, you do have a history of migraines and if your brain MRI showed lesions in only the subcortical area, which is connected to migraines, that would usually be enough to put migraine high, if not at the top of your list of 'possible' causation. Usually there needs to be a lot of test and clinical evidence, before a neuro is comfortable committing to a dx of MS.

I'm actually surprised your neuro has dx MS immediately, it's a lot more common when peoples test results and clinical evidence is very highly suggestive of MS, for them to still only be told that they possibly or probably have MS. It's not unusual for additional tests to be scheduled when MS is suspected, usually looking for any evidence of an alternate condition and or additional evidence to confirm MS eg repeat brain and spine MRI's using MS protocol, LP, visual field tests, blood tests etc  

I'm not sure if it helps you or nor but IF the neuro didn't find any other evidence suggestive of eg MS identified locations (see MS Mcdonald criteria) and or at least some clinical abnormal results during those neuro tests he did, there would still usually be the possibility that it's one of the MS mimics.

Forgive my pea brain if i've misunderstood, but i'm thinking you might be missing some of the information, that made the neuro sure it was definitely MS and dx you straight away, if you can i'd get copies of everything.

Hugs...........JJ

PS if you have any questions, please feel free to ask about anything. You might also like to have a read through our health pages, found at the bottom of the page :D
  




  

[PaganMommyof2]

I went to see neurologist today.  He looked at MRI, did some simple tests, and diagnosed immediately MS.  I am scheduled for another MRI of my spine and neck, a chest xray.  Next week I start IV steroids to increase my energy and stop the muscle pains

[HVAC]

You have Neurological symptoms. Are they MS it is hard to say? I get certain migraines where my whole left side goes numb and I can go blind. Sometimes I do not get a headache. They are atypical migraines. MS share symptoms with many other things. I guess the Neurologist will have to sort it out. MS is a very complicated diagnosis. No test rules MS in or out. Most likely what the Neurologist will do is take a thorough history, do an exam (reflexes and such), may be do some more tests, and possibly blood work to rule out other conditions. He might make a follow up for six months this is common. I thought it was a dismissal. Neurologist time is slower than other doctors. They seldom do thing fast.

Alex