MRI...area of lesions

[Momma24rn]

I am a 48 yo female.I have had fatigue, dizziness and tongue numbness and the ED did an MRI. It showed "several supratentorial punctuate T2/FLAIR  Hypertensities. . The report mentions possible migraines (never have had one) or micro vascular disease. My question is does this mean they can tell it is NOT MS? can they readily tell? Is the area not typical for MS? Today I had trouble walking for a short time. I felt like I had several drinks. I see a neurologist, but not for 2 months. Thank you for any info you can provide.

[supermum_ms]

Hi and welcome,

Your MRI information of "several supratentorial punctuate T2/FLAIR  Hypertensities." breaks down to....

Several - unspecified number

Supratentorial - concerns four large areas ie
subcortical area, periventricular area, deep white matter area, and corpus callosum

Punctate - pin point - typically smaller than 2mm.

T2/FLAIR - MRI sequences or imaging patterns used (ie. T1, T2 or FLAIR) to highlight different types of tissue

Hypertensities - Hyperintensity on a T2 sequence MRI basically means that the brain tissue in that particular spot differs from the rest of the brain ie lesion

....which in of it's self isn't really saying anything specific enough to put MS on your list of potential causes, 'punctate' hypertensities are very tiny and typically more micro vascular and migraine related than anything else.

Tiny lesions less than 3+ mm are not usually associated with neurological conditions like MS, but MS isn't completely out of the possibilities because by not being more specific in location than 'supratentorial' it could mean these punctate lesions are located in more than one of the supratentorial areas (subcortical,  periventricular, deep white matter, and corpus callosum)....although having said that, it's likely there isn't any in the corpus callosum because of it's higher association with MS and your report should of mentioned lesions specifically in the CC if there were any.    

MS Mcdonald criteria consistent/suggestive MRI evidence; 1 or more T2 lesions in at least two out of the four MS specific location;  periventricular, juxtacortical, infratentorial, or spinal cord  

If you were able to follow my wishy washy explanation, the crux of it is that your MRI information isn't really informative enough to be suggestive or consistent with neurological conditions like MS, and whilst MS can't be ruled in or out with any confidence, your MRI results alone would more likely imho be pointing away from conditions like MS, rather than towards...

Have you had any abnormal blood test results looking for viral, vit deficiencies and other autoimmune explanations?

Hope that helps.....JJ  

[Momma24rn]

Thank you. That was an excellent breakdown. I guess my question was .....They certainly would have mentioned the possibility of MS if it was even a possibility, right?  I guess I'll find out when I get to the neurologist. I did have a lot of blood work done last week, but no results yet. They were send out tests. It's just frustrating to feel like something is very wrong and not know what it is.

[supermum_ms]

Brain MRI's are unlikely related to neurological conditions like MS when there's only punctate hypertensities, teeny tiny lesions are typically vascular and too small to effect neural pathways and are typically clinically silent, micro vascular disease is the most common explanation for punctate hypertensities...

I'd highly recommend you stay open minded and try not to focus on any specific condition at this stage....MS is a central nervous system disease, and the majority of symptoms associated with MS are more commonly related to  hundreds of other conditions.

Not knowing what's going on and waiting for months for a neurological appointment is definitely frustrating, it's quite likely you'll still need more tests to work it out so hang in there!

Hope that helps......JJ