Aa
New MRI results - anyone?
Hey all! Hope you are doing well. I don't post often, but read all the time. Keep forgeting my password. Anyhow, I have not been doing too well. Lots of ribcage pain, head to back zaps, weakness and pain in legs and left arm and tingling in right fingers. Also pain in eye. I just had another set of MRI's and my doctor is stuck in Europe in volcanic ash and no one has contact with him. I just received the reports and need input.
So here goes...
Latest brain MRI taken 04/15/10 states -
No intracranial mass lesion, shift of the midline structures, or intracranial hemorehage is identified. No abnormal enhancement is identified after IV contrast administration. There is a 4mm bright lesion in the white matter of the inferior frontal temporal region on the right side which is not adjacent to the ventricular surface. There are perhaps two punctuate additional white matter lesions located anteriorly in the frontal white matter and there is a punctuate white matter lesion in the left parietal white matter. None of these lesions appear to be typical for demyelinating plaques of multiple sclerosis. By number and distribution, these lesions are not outside the expected range of normal for this patients age.
By the way, I am 44 years old.
Also it states that the pituitary gland appears normal in size however has a very unusual findingin it's posterial lateral aspect to the right. While the gland is not enlarged at all, there is evidence on the sagittal T1-weighted and Flair sequences of an abnormality that has a very bright signal on T! and decreased signal on T@ and Flair. This is either fat or old blood products. On the sagittal T1 images there is a linear area of bright signal representing the pituicytes which is located seperate from the lesionin question and somewhat dorsally and which most likely represents the true site of neurohypophysis. This most likely explains the well circumscribed lesion within the pituitary gland which measures 6mm by 5mm is that it represents an old area of hemorrhage into the gland.
Previous Brain MRI - taken 10/30/09:
Single high singal lesion noted in the anterior aspect of the corona radiata on the right which is non-specific. Differential consideration would include demyelinating disease.
I went from one lesion to four lesions in six months and the radiologist thinks this is normal for my age. I have MS symptoms, and a family history. I have fallen - resulting in broken bones due to numbness of legs and been stuck in a wheelchair for months. Could this really be normal for my age?
And what are the other two lesions involving the pituitary gland? They were never seen on any earlier MRI's and I also had one in July of 2009. That MRI stated that there was a single focus of increased signal in the right basal ganglia measuring approx. 4mm maximum.
Anyhow, I apologise for the length of this post, but hope someone can comment.
Thanks in advance - God Bless
Debtea
So here goes...
Latest brain MRI taken 04/15/10 states -
No intracranial mass lesion, shift of the midline structures, or intracranial hemorehage is identified. No abnormal enhancement is identified after IV contrast administration. There is a 4mm bright lesion in the white matter of the inferior frontal temporal region on the right side which is not adjacent to the ventricular surface. There are perhaps two punctuate additional white matter lesions located anteriorly in the frontal white matter and there is a punctuate white matter lesion in the left parietal white matter. None of these lesions appear to be typical for demyelinating plaques of multiple sclerosis. By number and distribution, these lesions are not outside the expected range of normal for this patients age.
By the way, I am 44 years old.
Also it states that the pituitary gland appears normal in size however has a very unusual findingin it's posterial lateral aspect to the right. While the gland is not enlarged at all, there is evidence on the sagittal T1-weighted and Flair sequences of an abnormality that has a very bright signal on T! and decreased signal on T@ and Flair. This is either fat or old blood products. On the sagittal T1 images there is a linear area of bright signal representing the pituicytes which is located seperate from the lesionin question and somewhat dorsally and which most likely represents the true site of neurohypophysis. This most likely explains the well circumscribed lesion within the pituitary gland which measures 6mm by 5mm is that it represents an old area of hemorrhage into the gland.
Previous Brain MRI - taken 10/30/09:
Single high singal lesion noted in the anterior aspect of the corona radiata on the right which is non-specific. Differential consideration would include demyelinating disease.
I went from one lesion to four lesions in six months and the radiologist thinks this is normal for my age. I have MS symptoms, and a family history. I have fallen - resulting in broken bones due to numbness of legs and been stuck in a wheelchair for months. Could this really be normal for my age?
And what are the other two lesions involving the pituitary gland? They were never seen on any earlier MRI's and I also had one in July of 2009. That MRI stated that there was a single focus of increased signal in the right basal ganglia measuring approx. 4mm maximum.
Anyhow, I apologise for the length of this post, but hope someone can comment.
Thanks in advance - God Bless
Debtea
Debtea:
Please don't feel ridiculous. You have sx and you want to know why!
I read your post yesterday and waited to see how others would respond. My take on the radiologists report was that he/she was more thorough in detail than many other reports that we have seen posted here. I say that due to "perhaps two punctuate" remark. I've rarely seen "perhaps" in a report, so I took it as this radiologist was one to give more, rather than less, information. This gives your neuro a heads up to look at things more closely and form his own opinion.
Please don't feel ridiculous. You have sx and you want to know why!
I read your post yesterday and waited to see how others would respond. My take on the radiologists report was that he/she was more thorough in detail than many other reports that we have seen posted here. I say that due to "perhaps two punctuate" remark. I've rarely seen "perhaps" in a report, so I took it as this radiologist was one to give more, rather than less, information. This gives your neuro a heads up to look at things more closely and form his own opinion.
Good Morning All.
Sorry for my rant yesterday. I guess I just lost it. I have been doing very poorly as of late and was having a moment.
Anyhow, thank you so much to Quix for the welcome - I have spoken to you before - but a long time ago. I appreciate you explaining things further to me. I guess that if they are punctuate (pinpoint) then the new lesions may not really be new and could mean nothing. I just wish I felt better.
question - my new MRI's show that there are no lesions in the cspine or the tspine; however, I am having alot of ribcage pain and zaps going from the back of my head down through my spine. I really expected them to find lesions. Why would I have these symptoms and yet no lesions present?
Thanks again for all your help and once again sorry to rany yesterday. I feel ridiculous!
Debtea
Sorry for my rant yesterday. I guess I just lost it. I have been doing very poorly as of late and was having a moment.
Anyhow, thank you so much to Quix for the welcome - I have spoken to you before - but a long time ago. I appreciate you explaining things further to me. I guess that if they are punctuate (pinpoint) then the new lesions may not really be new and could mean nothing. I just wish I felt better.
question - my new MRI's show that there are no lesions in the cspine or the tspine; however, I am having alot of ribcage pain and zaps going from the back of my head down through my spine. I really expected them to find lesions. Why would I have these symptoms and yet no lesions present?
Thanks again for all your help and once again sorry to rany yesterday. I feel ridiculous!
Debtea
Thank you so much Quix for your inut here. Right now I am just beside myself!
I need to scream or something.
I just got a call back from the MS Specialist. Some nurse assistant called and said the doctor is back and has not slept for 48 hours but looked at my MRI report. She said that they can not get me in and that I should go the regular neurologist - the guy who pretty much just told me to see the specialist but did not believe a word I said!
Anyhow, she stated to me that they were just a consult and my MRI report came back fine!
She further stated that it was typical for my age. When I tried to question her about going from 1 lesion 6 months ago to 4 now, she said bring the old MRI and have the radiologist review it again.
Meanwhile - no one is helping me. My cspine and tspine show no lesions, but I have terrible ribcage pain and zaps going down from my head - down my neck - into my back. I am so over this and don't know what to do.
As far as the pituitary gland stuff goes, she said it was some very old stuff - not to worry about it. Funny, I looked it up online and it appears that it could be the cause of me stopping my periods at 30 years old - which also created a world of problems.
Doesn't anyone want to help patients anymore?
Sorry for ranting. I usually keep myself calm, but I just can't do this anymore! I swear I NEED help!
Debtea!
I need to scream or something.
I just got a call back from the MS Specialist. Some nurse assistant called and said the doctor is back and has not slept for 48 hours but looked at my MRI report. She said that they can not get me in and that I should go the regular neurologist - the guy who pretty much just told me to see the specialist but did not believe a word I said!
Anyhow, she stated to me that they were just a consult and my MRI report came back fine!
She further stated that it was typical for my age. When I tried to question her about going from 1 lesion 6 months ago to 4 now, she said bring the old MRI and have the radiologist review it again.
Meanwhile - no one is helping me. My cspine and tspine show no lesions, but I have terrible ribcage pain and zaps going down from my head - down my neck - into my back. I am so over this and don't know what to do.
As far as the pituitary gland stuff goes, she said it was some very old stuff - not to worry about it. Funny, I looked it up online and it appears that it could be the cause of me stopping my periods at 30 years old - which also created a world of problems.
Doesn't anyone want to help patients anymore?
Sorry for ranting. I usually keep myself calm, but I just can't do this anymore! I swear I NEED help!
Debtea!
Hi, and a welcome from me. Have we talked before?
I got all agitated reading your MRI report. First, let's talk about lesions that are "normal for age." Sometime in our middle age we "do" begin to get T2 hyperintense lesions - at least some of us. And it is okay for a radiologist to note that the number of lesions could be consistent with age. HOWEVER - and this is a big HOWEVER - a radiologist should also look at the reason WHY the MRI was ordered in the first place. If the reason was a head injury or headaches it is okay to emphasize, as he did, that there are some lesions that are non-specific and could be noraml for age. It is RIDICULOUS to emphasize that the lesions are probably normal if they patient is having neurologic symptoms. Normal, non-specific, age-related lesions DO NOT CAUSE SYMPTOMS!!!
The neurologist ordered the MRI because the symptoms made him consider that therre might be lesions in the brain. And guess what???! They found some. They found the very things they were looking for. It is stupid to turn around and say, "uhh...these must be normal." While those lesions "might" be normal, one cannot assume that they are. It also does not account for the sudden increase in visible lesions unless additional and better techniques were used for the second MRI.
This is a worse mistake for the neurologist to make than the radiologist. The neuro is privy to all of your symptoms and the pattern of problems. As the neurologist is forming his assessment of what is causing your problems, he MUST keep in mind ALL the data that is available to him. This means your history, the abnormalities on exam, any abnormal test results, and an abnormalities on MRI. It is poor reasoning to exclude MRI lesions that "might" be normal. They also may NOT be normal. Since he went looking for them, the weight of their significance should be placed toward thinking that they are important and related to your problems.
Now, many MS Specialists won't count any lesion less than 3mm as indicative of MS. Punctate means "pinpoint'. So these are likely less than that. I find this practice silly, because we have plenty of evidence that significant MS lesions can be so small that they are still invisible to our best MRIs. But, they didn't ask me. However, he should be noting that the number of lesions is increasing just in the last 6 months. I hope he is not swayed by the radiologist's bias and that he can think on his own.
If the neuro tends to discount the lesions, you can ask him 1) The might be normal, might they also be abnormal? 2) Do all people with age-related lesions have severe neurological symptoms? If not, doesn't that point more towards the lesions being of significance? 3) Why the increase in lesions? Am I "aging" that fast?
I'm sorry, I don't know the meaning of the problems seen in the pituitary. It sounds like the rad is describing a hemorrhage into the pituitary gland. This could affect many organ systems. But, I really can't help you there.
I hope, too that you get a diagnosis - even if it is not MS. Something is going wrong. and not know is one of the worst types of h ell you can go through.
Welcome, again
Quix, MD
I got all agitated reading your MRI report. First, let's talk about lesions that are "normal for age." Sometime in our middle age we "do" begin to get T2 hyperintense lesions - at least some of us. And it is okay for a radiologist to note that the number of lesions could be consistent with age. HOWEVER - and this is a big HOWEVER - a radiologist should also look at the reason WHY the MRI was ordered in the first place. If the reason was a head injury or headaches it is okay to emphasize, as he did, that there are some lesions that are non-specific and could be noraml for age. It is RIDICULOUS to emphasize that the lesions are probably normal if they patient is having neurologic symptoms. Normal, non-specific, age-related lesions DO NOT CAUSE SYMPTOMS!!!
The neurologist ordered the MRI because the symptoms made him consider that therre might be lesions in the brain. And guess what???! They found some. They found the very things they were looking for. It is stupid to turn around and say, "uhh...these must be normal." While those lesions "might" be normal, one cannot assume that they are. It also does not account for the sudden increase in visible lesions unless additional and better techniques were used for the second MRI.
This is a worse mistake for the neurologist to make than the radiologist. The neuro is privy to all of your symptoms and the pattern of problems. As the neurologist is forming his assessment of what is causing your problems, he MUST keep in mind ALL the data that is available to him. This means your history, the abnormalities on exam, any abnormal test results, and an abnormalities on MRI. It is poor reasoning to exclude MRI lesions that "might" be normal. They also may NOT be normal. Since he went looking for them, the weight of their significance should be placed toward thinking that they are important and related to your problems.
Now, many MS Specialists won't count any lesion less than 3mm as indicative of MS. Punctate means "pinpoint'. So these are likely less than that. I find this practice silly, because we have plenty of evidence that significant MS lesions can be so small that they are still invisible to our best MRIs. But, they didn't ask me. However, he should be noting that the number of lesions is increasing just in the last 6 months. I hope he is not swayed by the radiologist's bias and that he can think on his own.
If the neuro tends to discount the lesions, you can ask him 1) The might be normal, might they also be abnormal? 2) Do all people with age-related lesions have severe neurological symptoms? If not, doesn't that point more towards the lesions being of significance? 3) Why the increase in lesions? Am I "aging" that fast?
I'm sorry, I don't know the meaning of the problems seen in the pituitary. It sounds like the rad is describing a hemorrhage into the pituitary gland. This could affect many organ systems. But, I really can't help you there.
I hope, too that you get a diagnosis - even if it is not MS. Something is going wrong. and not know is one of the worst types of h ell you can go through.
Welcome, again
Quix, MD
Thank you Dan...I needed the confirmation that I am NOT nuts! These doctors sure like to make us feel like we are. I welcome a diagnosis - even if it is MS, as long as I get treatment at this point! Guess that unless you are in this - you just don't understand. That is why it is so nice to have all of you.
Thanks again
Debtea
Thanks again
Debtea
Doesn't sound nuts at all, debtea. Many of us have spent what feels like an eternity in limboland waiting for some kind of credible diagnosis, hopeful that it will come with treatment options. I'd love to be over that hill, even though I might find the other side to be no picnic.
Thanks Lulu!
I appreciate the welcome back and the input! What you said about the pituitary stuff makes sense. Wish the report did...LOL! As far as the doctor goes, I hope he gets home soon too! I keep calling due to issues I am having and they can't do anything! I know this is going to sound nuts, but I am hoping they can make a diagnosis. I would like to finally know what is going on and be treated.
I will keep you posted.
I appreciate the welcome back and the input! What you said about the pituitary stuff makes sense. Wish the report did...LOL! As far as the doctor goes, I hope he gets home soon too! I keep calling due to issues I am having and they can't do anything! I know this is going to sound nuts, but I am hoping they can make a diagnosis. I would like to finally know what is going on and be treated.
I will keep you posted.
Hi and welcome back! I know what you mean about forgetting passwords... I do that all the time.
Remember that lesions in neuro lingo just means an abnormal spot. The explanation of the pituitary lesions is one is scarring from an old hermorrhage and the other is probably a blood or fat deposit that shows as abnormal. I may be totally wrong, but the pituitary lesions sound pretty benign to me. But then again remember I am absolutely NOT an expert about anything.
Now that increase in lesions in the brain is a different thing - it is always possible they were there 6 months ago but not visible in your imaging. And they could also be new.
I hope your neuro gets off the continent soon and home to take care of the patients like you who need him to read their films! LOL
be well,
Lulu
Remember that lesions in neuro lingo just means an abnormal spot. The explanation of the pituitary lesions is one is scarring from an old hermorrhage and the other is probably a blood or fat deposit that shows as abnormal. I may be totally wrong, but the pituitary lesions sound pretty benign to me. But then again remember I am absolutely NOT an expert about anything.
Now that increase in lesions in the brain is a different thing - it is always possible they were there 6 months ago but not visible in your imaging. And they could also be new.
I hope your neuro gets off the continent soon and home to take care of the patients like you who need him to read their films! LOL
be well,
Lulu
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