NEW HERE PLEASE HELP MRI RESULTS

Hi I have been looking here on the Multiple Sclerosis for a few days. I'm being evaluated for MS at this time and i'm scared to death. I had nerve conduction tests done and everything was good except both peroneal nerves bilateral legs were markedly prolonged... "an incidential" then i had a MRI brain WITHOUT contrast that says increased signal seen on FLAIR in the left cerebral hemispheres 2 foci within the white matter in the left frontal lobe in the subcortical region. Is this typical of MS?? my symptoms are EXTREME fatigue,,, brain fog... numbness and tingling in lower legs also my left hand went numb for 2 days then came back also I do NOT suffer from migraines. I work full time and my legs in the front lower I have pins and needles also they feel soooooo darn heavy.At the bottom of my MRI  it said that this can be due to Migrains, which i've never had. also small vessel ischemic disease,,, Ok well i'm 37 Can you please tell me what you think LOST

I also have to say I didn't even realize I was being checked for MS till I asked why she was doing the MRI,,, then looked her up on the internet and she specializes in MS... WOW....what a shocker,,,,,,, well not really I guess deep down i've always known something was definatly not right... by "she' i mean my neurologist.  I've also had such pain in my back and it seems to happen more when i'm laying down.  this has been going on for over 7 years now.  then I remembered a few years ago I went snowmobiling with my family.  well when we got home the next morining my right hand was completely numb... I mean really like it wasent even my hand???  The doc said it was becasue it got cold and that was the hand i was using to give the mobile gas...... well i said OK,,, knowing that that was WRONG,,, I had the hand warmers on and my hand was actually sweating the whole time... well long story short my hand came back in aprox a week,,,
anyway please if anyone has any thoughts please please share with me ok???
Thank you so very much
Ray911

[spastic]

Hello and Welcome.  It is normal to be scared, you have come to the right place to ask for answers.  Please look at the health pages.  It is good that you are seeing an MS specialist, they are the best at reading MRI's and evaluating.  Others here will join in and welcome you and answer questions better than I.  Did they do an MRI of your spine as well?  With all the pain you are having in your back, I would think that they would want to see if you have a buldging disk or narrowing of the spine, either one of those can cause symptoms similar to MS.  Again welcome to our cyber family.

Your Friend,

Spastic Ada

[RAY911]

Thank you so much for your quick response,, Yes i've had Mri's on my back that said well a whole slew of things,,, I did ask the Neruologist if all these symptoms could be just my back,, she replied. "NO"  sooooooo yea thats were i'm at.

I have thought about the strange symptoms that i've been having for years and it makes me nervous because it seems to all point back to MS,, I'll explain more when I have more time.  I have to get ready for work,,,,, uggggggg,,, I'm telling you the fatigue is the worse.  I can sleep for 12 hours strait then on my day's off I sleep all day and wake up eat then sleep 12 more.  its awful.  people ask if i'm depressed the answer to that is NO i mean i've had my fair share of trials etc but all in all i'm very happy with my life. anyway again thankyou very much for your reply.  It means so much to know there are others that are out there willing to help and listen.

Ray911

[spastic]

We are always here to help and listen.  The next step will probably be an lumbar puncture, evoked potentials unless they say it is a clear case of MS.  I don't have MS but I do have lesions from migraines, well that was what I was told and I do have them.  I am not good at reading MRI's and there are some who do a great job here, I will make it a point to leave them a msg to look at your post but they will probably see it anyway.  I do know fatigue is normal with MS and a lot of them here take Provigil, Amantadine and even Ritalin for it.  
Please take care Ray, the weekend is almost here!!!  I will talk more later...

Ada

[RAY911]

Thank you Ada.  I appreciate you taking the time to talk with me.  

I was hoping that others would tell me what they think also.  I do have a follow-up with my doc next monday.  But I find peace in knowing i'm not alone.

Thank you for your time

Ray911

[spastic]

I hope others see this too.  Because your questioning MS, I would suggest watching Montel today.  But I'm not sure how real the show is going to be but I am going to watch it.

I am going to suggest writing out a timeline for your dr.  It's just a list of symptoms and when and how long it lasted.  Some look at them, some dont.  Sometimes if they see it on black and white, things start adding up.

Please keep me posted.

Your Friend.

Ada

[jensequitur]

Ray, having MS is extremely inconvenient, but it's not the end of the world.  When you're feeling bad, it's hard not to worry about it.  Anxiety and depression are common with MS.

Your MRI results indicate MS, but your neurologist is who will diagnose you.  You'll find that people can go for years without a diagnosis, yet they will have all the symptoms of MS.   We share a lot of common characteristics, like bladder problems, fatigue, numbness, vertigo, tingling, cognitive impairment, proprioperception problems, but we're all a little bit different in how we experience those symptoms.  This is why I think MS is so difficult to diagnose.

Most people are diagnosed with relapsing-remitting MS when they first experience symptoms.  This means your symptoms will go away, either mostly or completely, then  in the future you might experience another relapse, with different symptoms.

Take a look at the Health Pages section (top right of this page) and you'll see lots of helpful articles.  They can answer your questions a lot better than I can!

[RAY911]

Hi, Jenesguitar.

Yes your right.  Its not the end of the world but still scares me soooooo bad... I worked in a care center a few years ago and took care of a lady with MS and it was so sad it broke my heart.  

Yes I guess i'm questioning if it is MS,,, why did it say at the bottom of my MRI Report that this could be Migraine headaches?? when I dont have them??  I mean yes i've had headaches in the past but I can count on on hand how many. then it also said that it could be "ischemic" small vessel something or other????  It confuses me and also I think there is a BIG difference between Ischemic and Migraines. am I right????  How do they know???  I have noticed on this forum that alot of you have said that you need a MRI with contrast.  So yesterday I called my neruologist who specializes in MS and left a message that if she thought I needed one with contrast??  Well her nurse did call me back and she stated there was no need??  I DONT GET IT?? can anyone help me understand?????

Thank you all again
Ray911

[RAY911]

Hi i'm sorry one more quik question.

I was wondering about my ncs,, everything was good except I had marked prolongation in both peroneal nerves in both legs F-waves........it said "Insidential finding"

can anyone tell me what this might mean?

Please help me

Thank you
Ray911

[Quixotic1]

Hi, I'm sorry I didn't get to your question today.  I've been on and off and mainly playing around.

Lesions that are very small and don't have clear edges, located in the subcortical area seem to often be referred to as microvascular in nature.  This category includes high blood pressure and migraines.  Both cause tiny changes in the vasculature.  Did the report give the measurements of the 2 foci (spots) or refer to them as punctate? Migraines are vascular headaches which involve spasms in the arteries.  So, Ischemic/hypertension/migraine all can appear similarly on the MRI.  There is not a huge difference.

You have only two lesions that showed on the MRI.  No one can say for sure what caused them.  Anyone with a larger number will generally have more clues based on the pattern of the lesions.  Two, hardly forms a pattern.  Yes, the lesions of MS can appear in the juxtacortical region (this means they are in the subcortical region , but actually reach across the boundary to the cortex.  The boundary we're talking about is between the white matter and the gray matter of the brain.  The gray matter is called the cortex), but these are often mistated to be the subcortical area which is more typical of microvascular lesions.  This probably sounds like gobbletygook.  All, I can say is that your MRI is NOT diagnostic for MS.  It doesn't rule it out, but it doesn't strongly suggest it either.

You have symptoms that concern you a lot and are suggestive, but not diagnostic of MS.  The fatigue, the areas of altered sensation, the heavy legs.  You are seeing an MS specialist who has the task of trying to put together your history, hopefully the results of a very thorough neuro exam and the results of testing.  Do you have any abnormalities on exam?  

I agree that putting together a timeline of your  ysmtpoms and of any you think might be related is useful both for you and the neruologiost.  You'll likely need a spinal tap, which is not a huge deal. Then the neurologist needs to screen you for a whole slew of conditions that mimic MS, both in symptoms and in causing lesions on the MRI. Another set of tests that might be run would be the evoked potentials to measure the conduction times of sensory nerves, like in your affected hand, you legs and your eyes.  Did you have Nerve Conduction Studies with your EMG?

You pretty much have to move through that process.  You have several indicators that (if this is MS) you would have the most common type Relapsing Remitting.  Also most of your symptoms have been sensory and you are in the average age range for diagnosis.  All of these factors "tend" to indicate that you will have an easier course of the disease.  Also, RRMS is the type of the disease that has the best response to the MS drugs and may slow it's progression.  New and better drugs are right on the horizon.

Having seen one or some severe cases makes the fear worse.  As a physician I understand that, but this is not a disease that means you will deteriorate steadily.  The vast majority lead mostly normal lives with interruptions and problems from time to time.  Even now, less than a quarter of people with MS will end up in a wheelchair within 20 years.  Seeing celebrities on TV and reading forums like this give you a skewed idea of the severity of MS.  The majority of people don't have time to spend on a forum talking becasue they are living the lives they intended.  

I encourage you to stay with us and ask questions.  Get copies of old MRIs.  When do you see your neurologist again?  Also, the fact that she is an MS Specialist does not mean that you have MS.  Rather it likely suggests that MS came up in your doctor's consideration and the consultation was put to the MS Specialist from the very beginning to rule it in OR OUT.  This is prudent and something a lot of us wish had been done earlier for us.

I disagree from what I have read about the need for contrast, but I am not and never was a neurologist.  Only with contrast can you see very newly inflamed lesions.  So, doing the images without it will miss any lesions that are 6weeks old or less (+ or -)  Perhaps your neurologist has already decided that you do not have MS.  We'll just have to see what your next visit says.

As for your fears.  We all understand that new thought that you might not have the future you thought you would have.  That is frightening.  But, MS is nothing like ALS.  If this is MS - and we don't know -  You will live to watch your grandkids grow.  You will most likely have a normal lifespan.  It just that there are bumps in the road.  Also a lot of men believe that they are doomed to a worse course.  At your age, that is not at all clear.  So don't go buying any black crepe paper.

I hope this helped a little.  It's really late and when I answer things at 3 am, I don't always make a lot of sense.

I'm sure when you read this, you'll have more questions (hopefully more specific than "Huh?")  If need be, I'll rewrite the whole thing to be less garbled.  I just want you to see that the possibility of MS is not so dire.  And you're in a good place here.

Take care, it will be okay.  You just need some more answers.

Quix

[RAY911]

Hi Quix

Thank you so much for taking the time to write me.. First of all i'm a 37 year old female and i've been having symptoms for as long as I can remember.  From not being able to feel if the water i'm feeling is hot or cold. to not being able to write and not being able to dial phone numbers that i'm looking at right in front of me..

Does that make any sence to you???????

I did have a Nerve Conduction test and like I said everything was good except for both peroneal nerves on both legs were markedly prolonged on the F-waves.. I looked this up trying to get answeres and I did find that this can be due to a demeylinating disease.   Is this right?   My neurologist did several blood tests and she hasent told me the results.. I will ask her this at my next appointment.  she also told me I had weakness in both legs which didn't suprise me.  

When my neurologist called and told me about the two focal spots I said.  " It isn't MS is it"???  she said.  "It cant be ruled out"  so I dont understand that when I called and asked about a MRI with contrast she said it wasent needed?????

this is what my mri results said....

There are two nonspecific foci of increased signal seen on FLAIR in the left cerebral hemispheres both of which are in the left frontal lobe and subcortical white matter measuring approximatly 3.3 to 3.8 mm.  

Impression:

NO evidence for acute ischemia

There are two nonspecific foci of singal withing the white matter in the left frontal lobe in the subcortical region. this is nonspecific but atypical for demyelinating lessions these can be seen with migraine headaches and chronic vessel ischemic change.

well I do not have migraines and also i've never and dont have high blood pressure.

I hope you can help me understand this?

Thank you so very much
Ray... female uno like "RAY OF SUNSHINE"??? LOLOL
:)

[RAY911]

I was wondering about the LP   for those of you that have had one ... please tell me does it hurt???  I've heard that it does,, then i'v also heard it doesent.

Tell me what ya think ok?
  

I'm sure that is whats next for me.. also anyone want to comment on my mri or my nerve conduction??

Thank you
Ray

[spastic]

Hey Sweetie, ok when you have an LP, they will numb the area first and the only thing you should feel is pressure.  Most will say its not the most pleasant thing they have had but I will advise you to drink a bunch of caffeine and lay flat as possible afterwards.  You can get a very nasty headache.

I wish I could answer about your MRI and nerve conduction, I will see if I can find out anything about them.

Your Friend,

Ada

[6-paq]

What did the results of your l-spine MRI say?   Mine said I had some problems, but my neuro said that the issues with my legs weren't due to my l-spine issues.

I asked for PT anyway and my therapist has done wonders.  Although she's not a doc, she believes that the issues I am having (various tingling, sore hip) are due to my lower back and hip problems (stenosis, hip arthritis, si joint alignment, scoliosis) and doesn't see anything that points to MS.   She is able to reproduce my issues when working on my back and is able to make the tingling/aching so away.  Her exercises are helping to strenghen my core muscles and I have very little issues right now.

I'm not saying that I, nor you, don't have MS, but my neuro definitely said that my leg issues weren't due to my back, and I don't believe that at this point (neither does my therapist). I am getting relief.  

So, possibly your back issues could warrant PT and would help with your leg Sx while you and your doc are looking for answers.

Just a thought...

Take care!  Pat :)

[RAY911]

Thank you again, You all are wonderful.

Thank you for all the information I truly appreciate it.

I will definatly look into the PT I think it will help and i've actually thought of going for a while but with working and taking care of my children and husband well i'm sure you all know what that's like.

I do have my lumbar spine results and i'll post them, spine one that one was done just before my brain MRI,,,

I did ask my neruologist if my symptoms were from by back and she said no but if PT  can give me some relieve i'm all for it..

Thorasic spine MRI

brb

[Rena705]

bump

[RAY911]

Are evoked potentials like nerve conduction???

please i know i sound like a broken record,, but anyone else know about

f-wave tests on legs?? it can go along with the nerve conduction and anyway mine was markedly prolonged.  I looked this up at one time and it said demeylinating disease but for the life of me I cant find it again... I dont see my neurologist till Monday so I could WAIT till then but thought i'd ask.  

[RAY911]

BUMPING UP FOR QUIX AND ANYONE WHO CAN GIVE ME SOME ANSWERES

[cjacks]

Hi,

try googling

              Prolonged f-waves
              MS prolonged f-waves
              

Good luck          Jo

[RAY911]

Thank you Jo

I appreciate it

[RAY911]

I found what I was looking for and I really kindof thought so,, It means demyelinating disease,, soooo Just wanted other to let me know what they thought also...

Oh well,

If this helps anyone else i'm grateful

ray

[Freespirit24]

Welcome to the forum Ray. This is the place to get your questions answered for sure.
Sounds like you are pushing up hill with all your symptoms and working etc. I have terrible fatigue and do not know how you juggle it all. I could not hold down a job. I admire you.

I cannot shed light on your results so far but i know others can and have.

I wish you all the best and will be watching for more news on how you are doing.

Hugs

Sarah

[RAY911]

Hi Sara,

Thank you so much.  You are so sweet!!

Well todays the day,, I couldn't sleep last night I'm nervous but deep down I know that no matter what i'll be ok,  I have faith and if it wasent for that I dont know what i'd do.

Sara I also have buldging disks,,, I've been trying to find my mri results and cant find them but i'm going to try to get a copy today,


by memory i'll tell you in both my thoracic and lumbar spine I know I have narrowing of the spinal cord,  buldging disks, Degenerative Disk,  2 hemangiomas in thoracic and 2 in my lumbar.  I have osteoarthritis,, said something about dissecation,, sp??  my disks are drying out???
This is what i can remember,, funny I can remember this but not specifics about what happened yesterday????? lol

I've had back problems as long as I can remember and I've never been in any car accidents or trauma.

When I was referred to a "neruologist" I said couldn't this all be due to my back"??  meaning my symptoms,,,, Her reply was no,,, it stunned me and then I googled her and found out she was a MS specialist,,,,

My advise to you is keep asking questions and ask for a ms specialist.  I feel they look past the back pain and after a complete neruo exam from a "specialist"  it just might get the ball rolling for you.

As for working.. wheeeeeew,,, I'm telling you that its hard on me, I work 8-10 hour shifts and I truly enjoy my work,, (nurse in a medical office) but by the time I hit my car after work and the 20 minute drive home, there have been times I've been in tears due to the exhaustion and deep leg pain, not to mention the back pain.  but I do it becasue I feel that its good for me.  other wise i'd be home in bed and for me that is not good.

Sara again thank you very much for thinking of me.

Sincerely
Ray

[RAY911]

bump

[RAY911]

Allrightythen...

well this monday IS my appointment,

I pray for the best but deep in my heart I kind-of know what i'm going to find out.

Did anyone else feel that?

I worry because well like Quix said i'll see my grandkids grow etc, but, you see my daughter was in a tragic car accident leaving her paralyzed from her chest down, I'm her caregiver along with my husband, and well its a very long story and i'm sure others here are to busy . but my point is if in fact it is MS that is causing me all my problems I NEED  the medicine to keep it at bay for as long as possible,  I NEED to be able to take care of my daughter, be there for her in ALL ways and also my youngest daughter, my husband, my job,

can anyone relate?

I guess i'll find out on Monday God willing.  

Love to all of you
Ray

[Quixotic1]

My, I really have been tardy getting to you.  I'm really sorry.  I can't give you anything definitive about your MRI results.  Certainly the two lesions with measurements would be considered in the "large enough to qualify for MS status" category.  The general rule of thumb for MS is lesions larger than 3mm.  This isn't huge, but it is definitely larger than "punctate" ( which means "pinpoint")

Now, the prolonged F-waves found on your peroneal nerves;  this is considered a hallmark of "demyelination."  BUT  and listen here carefully!!!

The Nerve Conduction Studies, the NCS, ONLY test the peripheral nerves!!!  These are the nerves that have already left the spinal cord and go out to the body.)  They do not show MS, because the demyelination in MS occurs only in the CENTRAL nervous system (the spinal cord and the brain).  

There are many - really many! disorders which show demyelination in the peripheral nerves.  I couldn't go into all of them.  And for the most part they aren't awful.  So I do not know what to make of your brain lesions and your back arthritis, degenerative disc disease.  It sounds like you also have narrowing of the spinal canal, called spinal stenosis (I'm not sure of that from what you have written.)

So, you have a whole bunch of problems.  Some may be related and others not.

1) Abnormal F-waves in lower legs in peroneal nerve.  Sounds like there is "peripheral" demyelination.  this is not consistent with MS.

2) Brain lesions of a measurable size.  They are in a location that is more typical of small vessel disease as in high blood pressure or migraines, but can be seen in MS (especially if the lesions cross into the cortical border)

3) Bad back, maybe with some compressing of the spinal cord (at what levels?)

4) Arm/hand symptoms are not explained by lower or mid-back problems.

So, sense has to be made out of all of this.  I'm afraid I just restated what you told us.  I'll be very interested in what your neuro has to say.  MS is certainly not ruled out here, but you have other stuff that doesn't fit also going on.

Good luck, Quix

[RAY911]

Quix first of all Thank u for taking the time to respond.

I'm going out on a limb.. lol and ask you just one more question,,, OK?????

Your opinion,,,

I've looked up ischemic and it normally shows in MRI in the elderly.... right???
also like ive said I DO NOT suffer from migraines,,,,,
So my question to you is with all the blood test that I've had NEG,,
The neuroexam which I failed horribly
and to tell you the truth I thought and always have that I was extremely strong!!!! NOT!!

What else could the focal spots be in my brain?????

I do realize there are ALOT of things that resemble MS,,, that's why I'm here to try and get some help understanding all this.  All my blood work came back fine..

I was first sent to a ortho and he said he looked at my x-rays alone and could tell why I'm in pain.  also looked at my MRI results and said he could not fix me at this time with surgery.  He wanted to send me to a very nice lady who was a neurologist.  I said OK, and went.

It was only later that I realize she specialized in MS,,I also realize that even thow she is a MS specialist does not mean I have ms. i'm just saying it caught me off guard She did a through exam.  got all my records and stated she went threw them all.  I asked her if all the numbness, vertigo and extreme fatigue could be coming from my back she replied NO, sooooo after the NCS,,,,My mother asked her if if could be Sjorenes sp?  Because my mother suffers from this.  My neurologist said no Ray's problems are coming from her CNS not her PNS,  Yea stunned!!!!!!!!!!

So then she wanted the MRI looking for MS,,, and here I am.  getting on the Internet.  trying to help myself understand all this.  Just like everyone else here.  Trying to make some since out of all of it, and also trying to remember that no MATTER what I'll be OK.  I just want answers.

This will be my last question I PROMISE!!!!!!!!

Ray

[Heather3418]

You have received so many good responses, I don't think there is one thing that I could add.  

I hope that everything gets sorted out and I'm so glad that you have joined the MS Forum.  You are now among friends.  Many friends.

Best Wishes,
Heather