MRI Results and next steps.

[Ticklefrom]

I have been experiencing nerve pain, palsy, vision issues, gait, and the list goes on.  I have occasional migraines, but mostly body issues.  During the process of elimination, doc ordered an MRI to rule out MS.  In the meantime, I was diagnosed with Fibromyalgia.  

MRI Results show Increased T2 W/Flair signal in the left cerebral hemisphere, one in sub-cortical left parietal white matter, and another in the white matter adjacent to the posterior aspect of the left lateral ventricle.  Additional focus is seen in the sub-cortical left frontal white matter superiorly.

Opinion - three tiny white matter lesions in the left cerebral hemisphere, non specific in nature.  Demyelination may be considered in the differential diagnosis.  Follow up with MRI as clinically warranted.

How should I proceed?  My family doctor passed me these results as I was leaving her office, she did not review with me.  

[Artanis12]

Wow. Your situation sounds like it's setting up about like mine did.  

I got my first MRI "news" from the GP that ordered it - very similar to yours - a late afternoon call where he almost barked at me that they'd found some "spots" and he'd schedule another MRI and they'd call me, click. Abrupt and terse. I was pretty freaked. I was so NOT expecting that.

I had already been seeing a general neurologist for what I thought was nerve pain exacerbated by the position I had to be in during a long surgery I had, but she was on vacation when my first attack happened, and so after the first MRI, the GP ordered one with contrast.  By this time, I suspected MS (call it my spidey-sense, which apparently had NOT been working all that well for the previous 10 years) but also suspected that the first MRI had tapped out the skills of my GP. I was very antsy for my neuro to read the results of the first and second one (first without, and second with, contrast) so I got a bit pushy with her office: "HEY! Are my MRIs going to sit until Dr X comes back? I haven't got TIME for this, guys. I may be needing my records to see if I can get in with someone SOON."  By that afternoon, the university neuro clinic had shifted me to another neuro, this time one specializing in MS.

This guy called me and chatted for quite a while about his readings of the MRIs. I appreciated this, because it was the first real Dr input of any kind that I'd had since my attack. He said MS was a possibility, so we needed to do more tests.

The first thing he ordered was a whole slew of blood tests. He was doing the "ruling out" that you always hear of. He ordered tests for D, B12, and iron levels, a test for syphillis (yeah, that's what I said), a test that shows if you might have lupus, thyroid levels, the 3-month blood test for diabetes, and a CBC, maybe one or two others.  

After those came back either negative or not pushing the hunt in another direction, he ordered a LP (lumbar puncture). The LP results - 8 oligoclonal bands - pushed him further in the direction of MS, so then he ordered C and T-spine MRIs with contrast. Nothing there (thank goodness!) so at this point, he FINALLY met me face to face and took a detailed clinical history.  It sent me over the diagnostic edge. I had thought that I was likely going to get a diagnosis of CIS (clinically isolated syndrom) since I'd only had one attack (according to how I saw it) and only had lesions in one area of the brain, but he disagreed. I have had new lesions both asymptomatic and not, subsequent to the diagnosis, so what I thought MIGHT be a bit iffy, is now rock solid for me.

That whole long tale of woe, is a roundabout way of saying, get thee to a neuro. Your GP should have let you know if she has or will, get you a referral to a good neuro who can read that MRI and take over your care from there on this issue. And MRI at a later time? She SHOULD be following up ASAP to see if they are active or not, not just acting like oh yeah, well, whenever. (If she's anything like my GP, she is uncertain of what protocol to ask for. When he sent me for the second MRI, the brain w/contrast, the tech started asking ME what we were doing - a whole repeat or just the part w/contrast? I was incredulous, and my fear that the GP was overmatched was borne out. We got it hammered out before we started, but it was a thrash. Really, most GPs haven't got a clue about MRIs, IMO.)  Since she did not do any of these things - and it sounds like she left you to swing - I'd be calling her office and saying HEY! What gives? Have I got a referral?? If not, why not?  Also, if you've gotten wind of a good MS doc in your area, and would like to see this doc, try to get a referral there.  But generally, the MS specialists are buried under, so be warned it can take a while. I would still shoot for that if I could though, because not all neuros are created equal, at ALL.

So, now - since you've had one that shows lesions, another MRI of brain with contrast and using a MS protocol

I didn't have eye issues, so I can't speak to that. Others have though.

Blood work to look for other stuff that could mimic MS. If none of those make the doc think it could be something else...

THEN, maybe a lumbar puncture, which MUST have a blood sample taken at the same time. If you ever have one of these, be SURE they take blood
at the time of the procedure, or it's worthless and you'll have to do it over. Do NOT assume everyone knows how to do their jobs. I have found
this to be a good mindset. Be civil, but question if something doesn't seem right. Anyway, blood with the LP. Important.

MRI of cervical and thoracic spine. W and W/o contrast. This is a LONG MRI - close to 2 hours. You should be able to get up and stretch or go to the toilet between sections.

THEN, I had the clinical history taken.

So, maybe that is not in some classic order, but that's what I had done, and the order in which it was done.

Hope that helps some. I would just suggest getting ready to get insistent, because it looks like your GP is overwhelmed and/or lazy.

Good luck and keep us posted!  

Karen

[supermum_ms]

Gosh! Got to love the 'care' factor of your doctor, err right, definitely changing doctors wouldn't hurt.....

Visual Evoked Potential (VEP) is one of the more common visual tests when MS is on your possible list, a VEP is used to test optic nerve function. Optic Neuritis and Nystagmus are the more obvious signs of neurological causation but there are others.  

"Visual Evoked Potential
The visual evoked potential (VEP) tests the function of the visual pathway from the retina to the occipital cortex. It measures the conduction of the visual pathways from the optic nerve, optic chiasm, and optic radiations to the occipital cortex. "
http://emedicine.medscape.com/article/1137451-overview#aw2aab6b3

The Optical coherence tomography (OCT) is being utilised as well, many optomitrists run this test for glaucoma, macular degeneration etc but it will also detect changes to the optic nerve, so if something is abnormal it will lead to further visual tests etc.

http://www.msdiscovery.org/news/new_findings/11547-optical-coherence-tomography-new-evidence-lends-support-ms-diagnosis

Keep in mind that the "vision issues" you are experiencing, depending on what it is, may not actually be related to MS at all, so if you haven't had your visual issues assessed by at least an optomitrist/pothalmologist, I seriously suggest you don't rely on a GP's opinion on visual issues but get it properly assessed.

Cheers..........JJ

  

[Ticklefrom]

Hi, Thank you for your response.  My doctor story is complex in itself.  She ordered it at my request, told me she didnt get the results but commented on my forms that she had received it and it was non specific to be followed up at a later time.  So when i mentioned it she admitted she received it... handed to me over the counter and told me in front of receptionist and another patient that I had three lesions.   There are ongoing issues.  

Can you elaborate on your Visual Evoked Potentials comment above?  

[supermum_ms]

Hi and welcome to our little MS community,

Was the doc who ordered an MRI to rule out MS, the same doctor who passed you the results with out explaining them?

Besides being an oddly dismissive thing for any doctor to do, if this was from the doctor who ordered it in the first place to "rule out MS" it doesn't instil any confidence. From that perspective alone, I would suggest arranging for a referral to an MS neurologist but additionally, unlike a lot of other conclusion comments we see, I'd also be suggesting you do that because it's not listed anything other than demyelintion which puts MS on your 'possibility' list......    

The 3 small brain lesions were found in cerebral hemisphere but unless the MRI was ordered using MS protocol which is smaller slices, with and without contrast etc, it's even possible that the brain MRI only found some but not all. Your diagnostic work up will also need to include any clinically abnormal signs, which are discovered during your neurological assessment, and because of your symptoms you could possibly need a spinal MRI, Visual Evoked Potentials, LP etc etc. which are all common tests when MS is being investigated.

Cheers.........JJ

ps there isn't enough diagnostic evidence to determine causation so you will need further tests to narrow down your list of possibilities.