Clinical signficance of MRI report? R/O PML

I recently had an MRI to r/o PML due to a study drug that I had taken (Tysabri) for Crohn's Disease.  The results showed:
1. No evidence for PML. NOrmal eval of white matter structures.
2. Approx 10mm asymmetric enhancement of the inferior aspect of the head of the right caudate nucleus as seen on image #6-25 of the thin section T1 postcontrast set.  this has no T2 or FLAIR representation and is of uncertain etiology or significance.

Is this a "normal abnormal"??  The neuro I was sent to did not impress me at all and would like some direction as to whether or not I should seek a second opinion on this.  I have many unexplained symptoms (joint pains, fatigue, headaches) that could very well correlate to Crohn's symptoms, arthritis, menopause, etc.  I'm a bit confused and with so much going on, don't want to over look something I should take action on.

I'd appreciate any help you can offer.
Sincerely,
Kathy S

[CCF-Neuro-M.D.-PW]

ITs difficult for me to comment specifically on your case without seeing the images

A lesion in the caudate nucleus could cause symtpoms such as speech problems and motor symptoms on the opposite side of the body. You rsymptoms as described above are likely not from this lesion.

A lesion seen on only one cut of an MRI is potientially an artifact (and not real) so this is one possibility
People with Crohns disease have a slightly increased risk of stroke or clotting, so this may be a small stroke
PML does not usually enhance, and predominantly affects the white matter (although not always) - the caudate is a gray matter structure. Nonetheless I cannot rule out PML for you
relatively new strokes can enhance with contrast, as can tumors or demyelinating disease

A second opinion may be a good idea. Also a repeat scan 1 or 2 months down the road to look for any change, or if you developed any new neurological symptoms would also shed more light.
A second radilogical opinion can be obtained at the Cleveland Clinic internet consult 'econsult' site if you can obtain copies of your films

Good luck

[lchelsemom]

I can't help you with MRI but you might want to check about fibromylagia (fibromyalgia) for your aches and pains.

Linda

[sparkyofny]

I am 44 female, suffered foot drop which became severe and affected my gait and worsened to the point of making walking very difficult, it has since returned to 98% normal but because the other tests including one to test the nerves gave no or inconclusive results they proceeded to send me to a neurologist who because of my past history of fibromyalgia and numbness sometimes rendered by it ordered an MRI to determine once and for all that I did or did not have MS. The MRI showed a white spot but not in the ususal area for MS, so he said that I needed to wait and have another in 6 months. I already have 7 months of living with the fear and no answer. This will mean more than a year of my life waiting. Any suggestions or ideas of what it might be, or how else I might procede?

I have sleeping disorder, IBS, no cause back pain, aleregies to sunlight, foot drop and fibromyalgia in my current medical situation.

[Loulu]

I have almost constant lower back pain. It becomes worsened when I am on my feet for extended periods of time. I can't walk distance anymore and even have trouble getting thru the entire grocery store unless I use an electric cart. Just to give you an idea of the distances I am referring to.
Recent MRI showed: 1. Disc desiccation and DDD L2-L5
2. Bilateral central broad-based disc ostephyte projection at L3-L4 and L4-L5.
3. Bilateral facet hypertrophy and ligamentum flavum hypertrophy seen from L3-S1.
4. Mild bilateral neural foraminal narrowing L3-L4 and L4-L5.

Even during meal preparation, I have to sit a few minutes and then get up and go until the pain becomes too much again.
I never had back pain until recuperating from a leg injury. I was in a wheelchair for over one year and had a second surgery to correct the leg problem. Since becoming mobile after the second surgery, I had the onset of the back pain. It has now been over 4 years and it just seems to be worsening. Is it possible to get beyond this or will it just worsen?