I posted last week about my neurological exam results and some symptoms. I've had a brain/spine (cervical-thoracic) MRI, and here are the results. Any comments/insights/parsing etc., would be greatly appreciated.
---Several small nonspecific abnormalities. They are located in the rt frontal horn, left frontal horn, and anterior left lateral ventricle. The largest is ovoid (3x5). No enhancing lesions. Cannot exclude MS. There are no features to specifically favor demyelinating plaques. ---(She added at this point, "At times, a demyelinating plaque will have an atypical presentation.")
I've got other notes from my discussion with the neuro: "scars present." "Worrisome family hx (my grandmother has MS)." She mentioned my sensitivity to heat. Said the presentation would be highly atypical for a PNS disorder (I'd asked about differential dxs).
I've been seeing the "mouse" several times lately and will have to post about it on that thread.
She's referring me for an LP.
In addition to inviting whatever comments you might have, I also have a question, especially for our health professionals: Would it be possible for a migraine-related plaque(s) to have this presentation (oval, in those locations)?
I am no MRI expert. Quix is very good at sorting some of the terms out for us, though.
The lesions you do describe ARE consistent with MS. Yes of course you can present a lesion from migraines. But when you see "ovoid" shaped lesions and lesions near the ventricules, it is suggestive of MS lesions.
Having an LP is the best course right now. Your doctor is right on for getting this done.
The descriotion of the lesion as a "plaque" and as "ovoid" are both tipoffs that they might be from MS. It could be this radiologists habit to call all lesions "plaques" but it certainly is not the norm. I have never heard lesions atrributed to migraines described as plaques. And, typically the lesions of migraine disease are tiny, usually described as "punctate."
Also, "small" is relative. Typically they say that an MS lesion is 3mm or greater.
The classic description of an MS plaque is ovoid, with clear borders, the inside is generally homogenous in nature, and it also has a characteristic orientation in the brain. The lesion that is ovoid (resembling an oval) has a long dimension (axis) and a shorter dimension (axis). In MS the ovoid plaque will have its long axis perpendicular to the ventricles. I really wish the radiologist had described this, since he/she stated it was ovoid. Why not finish the description? Maybe you could call the rad and aks for this clarification, but do at least ask the neuro how the ovoid lesion is oriented.
Just so you know. My MRIs from the beginning have only had ONE ( counted it -1) lesion. It is in the frontal lobe, is bout 3x5mm, is ovoid and is oriented perpendicular to the ventricle. It was completely discounted by my neuro and the radiologist as benign and insignificant - "a UBO consistent with age."
Yes, it is great if there are lots of perfectly classic lesions all in the rights spots, but the reality is that they can occur pretty much anywhere. Even in a person with lots, some will be in less common spots - they are outliers. Maybe the outlying ones were there first and the diagnosis would have been missed if those were all that were initially seen.
It's a bell curve problem. Yes most people will have their lesions fall within the vast middle of the curve, but people who still below in the group make up those lowest and highest standard deviations. So, I am pleased that the radiologist is flexible enough to state, "Though these aren't classic, they certainly could be.."
I'm not trying to lock you into thinking only MS, but just describing the MRI report in the context of what it says about MS or not.
I asked about orientation of the oval. The neuro said that the neurorad didn't state. I'm inferring from the 3x5 (not 5x3) order that it's a height by length dimension. So 3 high and five long; i.e., perpendicular to the ventricle axis. The neurorad described them all as "plaques." I have not actually read the report, I just wrote down what the neuro was reading from it as best I could--I can barely read what I wrote, my writing is so bad. The neurorad apparently described them as "plaques" and stated that "scars are present." None of these was enhancing.
I have to say that my strong suspicion is MS. It just *feels* that way to me, which is hard to explain. And I think my neuro thinks the same thing, she's just being very very cautious. Plus, I'm in the "little mouse" club, and I'm thinking of writing a paper for a journal on the "little mouse" phenomenon, it's just so odd.
I'm going to call Monday to ask for my report to be mailed to me. I'd also like to see the images, since I know in some respects what I'm seeing.
Thanks for the insight (and to you also, Heather). You may have stopped your actual, physical practice, but the information you provide here continues your contributions as a physician and healer.
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