hyperintense FLAIR FOCUS

[natthecat]

In 2005, went thru months of excrusating face pain. I assumed teeth neglected and so dentists, endodontist, oral surgeons mislead me to have 3 root canals and then had them all extracted in the end. The pain drained my body. Being a pretty much healthy 37 year old, my primary care was the local urgent care center so took awhile really for me to end up in a neurologist and rheumotologist care. DX ended up being "atypical facial pain" and fibromyalgia..I felt really from being so drained from the pain, felt joints all over hurt, numbness. I did have double vision during this too. MRI back then showed nothing, but said inconclusive over teeth area due to have so many caps on top... HIGH doses of neurotin, lexapro, ambien and quiting my job got me out of the 5 month flair.

In 2007, flair of face pain reoccured. This time w/ trigeminal neuralgia symptoms as well. I was so bad, I was on morphine, zanac, trileptal, tried two nerve blocks and guess what. I was 40 and pregnant, thank goodness figured that out when only one week late for period. I spent the rest of my first trimester in misery and did accupuncture to tune of thousands to help me deal w/ the pain pregnant. Horrible pregnancy, low fluid, MTFR, had to take lovonox shots and do modified best rest, then strict in hospital last 5 weeks w/ mild preclamsia.

In 2009, August started w/ sinus infection, face flair again. Back to neurologist, he said, let's redo MRI and do High Def One. Here I am w/ TN Pain, numbness right side, foot so bad, I was dragging it around for two weeks, blurred vision, cognitively not sure if I am just fatigued or more. Long story short, what does this mean?

Bloodwork only showed thryoid high and low vitamin D so I am on meds now for it.
MRI reads...

-Nonspecific right subinuslar hyperintense FLAIR focus, possibly representing sequela of prior inflammatory or ishcemic process.

DO I HAVE MS? Could I have it? Where in Northern VA good to go? Hopkins? I would like real answers this time.
My PCP says trigeminal neuralgia should not cause blurred vision and all these other symptoms and this is what I was led to believe years ago, but now w/ the MRI does this show something. Neurologist I was supposed to follow up on 24th and wrote wrong time down, part of my cognitive scary stuff now, so can't get back to him until Oct. 7th...

ANY PHYSICIAN, please help w/ advice.


decided to can the neurotin and tried two nerve blocks. id two nerve blocks, and went back on all meds, but guess what, was 40 and didn't know pregnant. Spent first trimester in massive pain. Accupuncture pretty much 3 x's per week worked.

In 2009, been in a flare.

[michelleric]

I could have written a very similar post as yours. TN is one of my most painful symptoms.  Words cant even express the pain.  I too, have had it off and on for quite a few years. I had gone to my PCP in the past, and he thought I was getting an ear infection, shingles maybe a couple of times, TMJ...None of those theories proved to ring true.

It wasn't until I was in the process of getting a diagnosis, that TN was found as the "culprit" for the pain. I am 41, and was told, TN can be a symptom of MS in younger people. I am on Trileptal for it now, and recently underwent IV steroids, which helped IMMENSELY, for the flare up. It was the worst TN I have had so far.  They seem to be getting more painful as time goes on.

I also have low vitamin D levels, and have been on a RX of high dose for a couple of years. I also have MTFR, with other blood clotting problems, and am on coumadin for life.

Just wanted to welcome you to the forum here, and hope you find a good doctor. I don't know of any in your area.

Wishing you tons of luck and fewer episodes of TN...
Michelle

[Quixotic1]

I am so sorry for the h*ll you have been through!  The face pain you are clearly describing (Trigeminal Neuralgia) is known to be among the worst that a human can endure - often referred to as "The Suicide Pain."  

Let me try to rephrase the story you have given us and discuss it in the context of MS, though certainly no one here can say this is or is not MS.

2005 at the age of 37 you had the onset of face pain.  I have a question - Was this only on one side or on both?  The pain was felt as severe dental pain.  This is very common.  Any dentist or dental subspecialist with integrity and a decent education should recognize that pain of this nature with healthy teeth is TN.  You are not the only one who has had numbers of teeth extracted in a desperate (but doomed to failure) attempt to stop the pain.  TN typically strikes older patients than you.  We know now, but I don't know about 4 years ago, that TN is far (read that FAR!) more common in the MS population than in the general population.

If the TN is ocurring on both sides it is "almost" certainly due to MS.

The first line drug for TN is carbamazepine, but other are often used.  Your PCP was right.  TN does not cause double vision.  TN is a neuropathic pain caused by irritation of the Trigeminal nerve which is responsible for the sensation of the face, lips, gums and part of the tongue.  The Trigeminal nerve is a Cranial Nerve (number 5) that comes off the brainstem.  Double vision is caused by a lesion involving one of the three Cranial nerves that deal with eye motion (III, IV, or VI).  I believe that at that time you should have seen an Ophthalmologist.  SOMEONE should have realized that you had two symptoms showing involvment of the brainstem.  This should have pointed them toward a look for MS (among other things).  Sheesh!  Big miss!  Female, right age, and with cranial nerve involvment.,,,sort of a no brainer.

Question - did you have any symptoms following the birth of your child?

2007 - Symptoms recurred - ??before the onset of pregnancy??  It is unusual, though not impossible for symptoms of MS to be worse during pregnancy.

Now headed toward neurologist - good and not a minute too soon.

Labs - Thyroid problems can have many neuro symptoms so it is important to get that taken care of so the neuro doesn't send you out the door without a second thought.  The low Vitamin D is common in our society, but is almost a constant in people with MS.  I don't know of any person with MS that had a normal Vit D3 level at the beginning of their disease.  Low Vit D is felt to be ONE of the several risk factors for developing MS.  This should be treated aggressively - many doctors are using massive doses up to 10,000 IU per day or a short course of weekly 50,000IU by injection or orally.  You want a level of greater than 35 and higher is likely much better (like 50 to 60).

MRI - T2 FLAIR high signal lesion.  Given two attacks and an abnormal MRI (even with just the one lesion) MS is likely IF there has been a thorough rule out of the other diseases that can mimic MS like Lupus, Lyme Disease, certain infections and other conditions.

I hope you find a neurologist who can put the pieces together.  The diagnosis of MS looks for repeated attacks of symptoms of the kind seen in MS (and TN with double vision are certainly on the list)., along with abnormalities seen on neuro exam suggestive of damage to the central nervous system.  If those two things are positive and the proper rule-outs have been done, then even a single MRI lesion makes MS more than 80% likely.

Where to look in your area for an MS Neuro?  - Others should jump in here.  We have a lot of members that live in that region.

You need to learn as much about this disease as possible so that you can know if you are seeing a neurologist who can think freely.  Too many neuros are strict MRI lesion counters or are believers in many erroneous myths about this disease.

This is a good place to land to learn the FACTS about this disease.  I hope you stay and welcome, again.  Others will be along to say "hi".

Quix