Need help with understanding MRI

[confusedinTN]

5 months ago i started getting headaches and vision loss. My vision which used to be 20/20 is blurry unless I am looking at something right in front of my face. pressure feeling in my head pressure in my ears. my eyes hurt all the time  it seems now. I get dizzy easy and have to take motion sickness pills to keep from getting vertigo. Its getting harder to concentrate on thinking, or understanding what I am reading. I went for a MRI but i don't now what it means.

MRI Brain & Stem without contrast
Findings:
Periventricular and subcortical white matter flair hyperintensities are both in the cerebral hemispheres. Double inversion recovery sequence reveals a few subtle lesions in the pone as well. Mild prominence of the lateral ventricle may be suggestive of a component of slight volume loss. No mase effect or midline shift. No abnormal extra-axia fluid collections. The cells lucid? And its contents are unremarkable. The basilar cisterns are patent. Major physiologic voids are maintained.
No diffusion restriction to suggest acute infarction. No increased susceptibility to suggest parenchymal hemorrhage.
The orbits are unremarkable. Mild paranasal sinus inflammatory mucosa changes. Mastoid air cells are clear.
Impression:
No acute intracranial abnormality.
Greater than expected metforal patchy flair hyperintensities given the patients age. These are not specific for a demyelinating process although this is not excluding one if there is any clinical concern for this CSF analysis as well as a contrast enhanced exam may be of benefit.
Other etiologies could be considered however including sequels of accelerated microvascular ischemic change ( especially as the patient reports a history of hypertension) or perhaps changes related to migraine headaches. Please clinically correlate.

[essdipity]

Well now, this radiologist possibly is extending himself a bit far into the diagnostic process, which is not his role. It's up to your neurologist to decide whether your situation warrants a CSF analysis (lumbar puncture). Also, a contrast enhanced exam (meaning another MRI, this time injecting contrast dye), would show whether any of the hyperintensities, which are spots on the MRI, are currently 'active,' but wouldn't determine what they actually are. So I think he's getting ahead of himself here. Anyway, I mention this stuff, which may be gibberish to you, as a way of saying I don't find the doctor who wrote this interpretation very confidence-inspiring.

But back to basics here. Your MRI is normal in most respects. He does see some lesions in the periventricular and subcortical parts of the brain, as well as in the pons part of the brainstem. These are areas that MS often attacks, and this is where your neurologist will be focusing. He says that these lesions are more than is expected in someone your age. (But you are 38, so none should be expected!) The lesions don't look like, to him, demyelination, which is what happens in MS, so then he mentions that you have a history of migraines and hypertension, both of which can cause the abnormalities he notes. Ultimately the radiologist is saying, 'I see some issues but am not guessing what they are, so Dr. Neuro, please investigate further,' which the neuro would do anyway.

Have you had a neurological office exam? Balance, strength, eye tracking, sensing various kinds of touches, etc.? This is not a 5-minute deal--doing it thoroughly takes time. Have you had any other kinds of testing thus far? I'm assuming you've seen an ophthalmologist (not an optician). What was the outcome of that? Pinning down what's wrong is complicated, and a lot of things have to be eliminated. There is no specific test for MS, and the MRI is just one part of the puzzle.

I am no doctor, just an experienced patient, so of course I can't tell you what's wrong. There are quite a lot of potential causes, which a neurologist is trained to investigate. I do know that eye problems in MS tend to be one-sided (as do most MS symptoms). However, a competent neuro, along with a competent ophthalmologist, should be able to help you. It could turn out that migraines are at the root of this, since migraines can be very complicated, and it could turn out that your blood pressure is contributing to your symptoms. Or it could be MS, or something else entirely.

Keep plugging at it till you get some answers, and good luck.