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How does one distinguish between a small vessel ischemia vs MS plaque on MRI?
I'm just wondering, how exactly can one tell the difference between a small vessel ischemia, an MS plaque, or a low grade glioma on an MRI? Back in February, I had an episode of extreme fatigue, followed by a hand contracture, weakness where my fingers fell toward my wrist, then a "vibrating" buzzing feeling along the entire left side of my body with a lip droop and the feeling of cold, novacaine-like lips, that lasted up to ten minutes, then subsided and just left me with a weak feeling for several hours. I did not seek emergency treatment (bad choice I know) at the time since the episode was short lived.
A little background, I am a 37 year old female who does not smoke, does not have high blood pressure, and whose cholesterol was 168. I underwent testing a few weeks after this episode to include Proteins C&S, Cardiolipin, Factor V (I believe), carotid dopplers, an echo and a TEE, all of which came back normal. I have an elevated high sensitivity CRP which came back at 3.74. I have a history of Grave's Disease treated with RAI, optic neuritis diagnosed in about 2002, three episodes of severe objective vertigo, and and a similar feeling in 1996 where I woke up and I actually had to pick up my sleeve to move my arm. Up until this episode, two brain MRIs from previous years have come back clean, but this one done three weeks after this episode in February shows a 6 mm area of hyperintensity in the subcortical white matter of the parietal lobe. Despite workups, we are still unsure as to whether or not this was a lacunar infarct or MS.
Thank you for your input.
Janice
A little background, I am a 37 year old female who does not smoke, does not have high blood pressure, and whose cholesterol was 168. I underwent testing a few weeks after this episode to include Proteins C&S, Cardiolipin, Factor V (I believe), carotid dopplers, an echo and a TEE, all of which came back normal. I have an elevated high sensitivity CRP which came back at 3.74. I have a history of Grave's Disease treated with RAI, optic neuritis diagnosed in about 2002, three episodes of severe objective vertigo, and and a similar feeling in 1996 where I woke up and I actually had to pick up my sleeve to move my arm. Up until this episode, two brain MRIs from previous years have come back clean, but this one done three weeks after this episode in February shows a 6 mm area of hyperintensity in the subcortical white matter of the parietal lobe. Despite workups, we are still unsure as to whether or not this was a lacunar infarct or MS.
Thank you for your input.
Janice
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and history you provide are more likely to be vascular in nature rather than MS, but there is more testing to be done. Multiple sclerosis symptoms have a subacute onset and last for several weeks on average. The spell you describe only lasted for 10 minutes (more common in stroke/TIA). Possibillities for the event you describe would be a small stroke (such as a lacunar stroke), seizure from an underlying tumor, and less likely, MS or even migraine equivalent (migraine features without the headache).
On MRI MS lesions are perpendicular to the corpus callosum (large midline white matter structure), tend to radiate out from the corpus callosum (finger like projections) and will enhance with contrast if acute. Small vessel ischemia tends to be subcortical in a random distribution and less confluent than MS lesions. Small vessel ischemia never enhances with contrast. A small stroke if imaged within 1-2 weeks will demonstrate restricted diffusion on DWI (diffusion weighted image), and may enhance with contrast if sub-acute. A low grade glioma will generally not enhance with contrast (or very little) and shows up as a T2 hyperintensity in the white matter.
Given your history I would recommend a lumbar puncture to look for inflammation (tourtelotte panel, oligoclonal bands, etc), which is a feature of MS. Given your history of optic neuritis (sometimes associated with MS) I would also get a visual evoked potential. I would also recommend an EEG (electroencephalogram-or "brainwave test") to evaluate for any seizure activity. In some cases an MR SPECT scan can be done to evaluate for signs of tumor vs demyelination (MS) vs infarct. I would definitely get a follow-up MRI in 3 months with contrast and evaluate for any changes as well. Other things that might be helpful is a aspirin daily (325mg) and possibly a trial (1 month) on a migraine preventative medication such as Elavil (migraines can also cause little white dots on the MRI). I would also make sure that you have had an MRA (magnetic resonance angiogram) or similar imaging of your blood vessels especially the basilar and the vertebrals, since many of the symptoms you describe, vertigo, paralysis, can all occur with posterior circulation problems.
I hope this has been helpful.
The symptoms and history you provide are more likely to be vascular in nature rather than MS, but there is more testing to be done. Multiple sclerosis symptoms have a subacute onset and last for several weeks on average. The spell you describe only lasted for 10 minutes (more common in stroke/TIA). Possibillities for the event you describe would be a small stroke (such as a lacunar stroke), seizure from an underlying tumor, and less likely, MS or even migraine equivalent (migraine features without the headache).
On MRI MS lesions are perpendicular to the corpus callosum (large midline white matter structure), tend to radiate out from the corpus callosum (finger like projections) and will enhance with contrast if acute. Small vessel ischemia tends to be subcortical in a random distribution and less confluent than MS lesions. Small vessel ischemia never enhances with contrast. A small stroke if imaged within 1-2 weeks will demonstrate restricted diffusion on DWI (diffusion weighted image), and may enhance with contrast if sub-acute. A low grade glioma will generally not enhance with contrast (or very little) and shows up as a T2 hyperintensity in the white matter.
Given your history I would recommend a lumbar puncture to look for inflammation (tourtelotte panel, oligoclonal bands, etc), which is a feature of MS. Given your history of optic neuritis (sometimes associated with MS) I would also get a visual evoked potential. I would also recommend an EEG (electroencephalogram-or "brainwave test") to evaluate for any seizure activity. In some cases an MR SPECT scan can be done to evaluate for signs of tumor vs demyelination (MS) vs infarct. I would definitely get a follow-up MRI in 3 months with contrast and evaluate for any changes as well. Other things that might be helpful is a aspirin daily (325mg) and possibly a trial (1 month) on a migraine preventative medication such as Elavil (migraines can also cause little white dots on the MRI). I would also make sure that you have had an MRA (magnetic resonance angiogram) or similar imaging of your blood vessels especially the basilar and the vertebrals, since many of the symptoms you describe, vertigo, paralysis, can all occur with posterior circulation problems.
I hope this has been helpful.
A related discussion, brain lesin high signal non specfic in nature but could be consistent with ms was started.
Thank you so much for responding to my question. Your response was quite well planned and very informative.
I don't know if you read follow-ups, but I have a few comments regarding your answer. By your response, "multiple sclerosis symptoms have a subacute onset and last for several weeks on average," does a feeling of unbearable fatigue and weakness prior to the event cfall into the category of subacute? I was mistakenly diagnosed with myasthenia gravis prior to this specific event due to persistent double vision, fatigue and weakness. The weakness following the numbness remained for several hours after the episode. You also noted that "a small stroke if imaged within 1-2 weeks will demonstrate restricted diffusion on DWI (diffusion weighted image), and may enhance with contrast if sub-acute. A low grade glioma will generally not enhance with contrast (or very little) and shows up as a T2 hyperintensity in the white matter," I was not imaged until a month status post this event. Does this have any bearing on the imaging results? This hyperintesity was noted in the T2 and FLAIR images. The contrast images, in my opinion, you can see a slightly darker shadow where the lesion is.
Regarding your recommendations, "given your history I would recommend a lumbar puncture to look for inflammation (tourtelotte panel, oligoclonal bands, etc), which is a feature of MS. Given your history of optic neuritis (sometimes associated with MS) I would also get a visual evoked potential. I would also recommend an EEG (electroencephalogram-or "brainwave test") to evaluate for any seizure activity," I had all three tests performed, and I was also told that with a milder case of MS or early in the disease, O-bands are not always present. All results came back within normal limits, although I have not had any further evoked potentials since the event. Would this be worth pursuing at this point?
What is the difference between an MR SPECT scan and and MRI? Do you feel this would definately be worth puruing to evaluate for signs of tumor vs demyelination (MS) vs infarct. You also commented that "I would definitely get a follow-up MRI in 3 months with contrast and evaluate for any changes as well," I had another one done a month after the inital scan (which would have been in April) should I still request another scan?
Regarding these notes, "other things that might be helpful is a aspirin daily (325mg)," I currently am taking baby ASA 81 mg, and "I would also make sure that you have had an MRA (magnetic resonance angiogram) or similar imaging of your blood vessels especially the basilar and the vertebrals, since many of the symptoms you describe, vertigo, paralysis, can all occur with posterior circulation problems," I had an MRA done last October due to 'pressure like ' feelings in my head and this came back negative. I asked my neuro if he felt another MRA would be in my best interest since he believed this was a stroke and he stated "No, these vessels (lacunar stroke area in my case) would be to small to detect any abnormalities." Not one time did anyone mention basilar or verterbral arteries. If this was a stroke, where exactly did this clot go?!?
Since my post I have actually consulted another local neuro for his opinion as well as potentially changing physicians. His belief is that I have a mild case of MS. Two out of three neuros say this looks more like MS to them--my latest consult says definately not a stroke, and the MS specialist feels my imaging is compatible with an MS lesion, but is not making the diagnosis. I still feel like I'm sitting on the fence!
I appreciate your time and your detailed responses. What a wonderful resource this forum is! All your recommendations are being very carefully considered.
Thank you again,
Janice
I don't know if you read follow-ups, but I have a few comments regarding your answer. By your response, "multiple sclerosis symptoms have a subacute onset and last for several weeks on average," does a feeling of unbearable fatigue and weakness prior to the event cfall into the category of subacute? I was mistakenly diagnosed with myasthenia gravis prior to this specific event due to persistent double vision, fatigue and weakness. The weakness following the numbness remained for several hours after the episode. You also noted that "a small stroke if imaged within 1-2 weeks will demonstrate restricted diffusion on DWI (diffusion weighted image), and may enhance with contrast if sub-acute. A low grade glioma will generally not enhance with contrast (or very little) and shows up as a T2 hyperintensity in the white matter," I was not imaged until a month status post this event. Does this have any bearing on the imaging results? This hyperintesity was noted in the T2 and FLAIR images. The contrast images, in my opinion, you can see a slightly darker shadow where the lesion is.
Regarding your recommendations, "given your history I would recommend a lumbar puncture to look for inflammation (tourtelotte panel, oligoclonal bands, etc), which is a feature of MS. Given your history of optic neuritis (sometimes associated with MS) I would also get a visual evoked potential. I would also recommend an EEG (electroencephalogram-or "brainwave test") to evaluate for any seizure activity," I had all three tests performed, and I was also told that with a milder case of MS or early in the disease, O-bands are not always present. All results came back within normal limits, although I have not had any further evoked potentials since the event. Would this be worth pursuing at this point?
What is the difference between an MR SPECT scan and and MRI? Do you feel this would definately be worth puruing to evaluate for signs of tumor vs demyelination (MS) vs infarct. You also commented that "I would definitely get a follow-up MRI in 3 months with contrast and evaluate for any changes as well," I had another one done a month after the inital scan (which would have been in April) should I still request another scan?
Regarding these notes, "other things that might be helpful is a aspirin daily (325mg)," I currently am taking baby ASA 81 mg, and "I would also make sure that you have had an MRA (magnetic resonance angiogram) or similar imaging of your blood vessels especially the basilar and the vertebrals, since many of the symptoms you describe, vertigo, paralysis, can all occur with posterior circulation problems," I had an MRA done last October due to 'pressure like ' feelings in my head and this came back negative. I asked my neuro if he felt another MRA would be in my best interest since he believed this was a stroke and he stated "No, these vessels (lacunar stroke area in my case) would be to small to detect any abnormalities." Not one time did anyone mention basilar or verterbral arteries. If this was a stroke, where exactly did this clot go?!?
Since my post I have actually consulted another local neuro for his opinion as well as potentially changing physicians. His belief is that I have a mild case of MS. Two out of three neuros say this looks more like MS to them--my latest consult says definately not a stroke, and the MS specialist feels my imaging is compatible with an MS lesion, but is not making the diagnosis. I still feel like I'm sitting on the fence!
I appreciate your time and your detailed responses. What a wonderful resource this forum is! All your recommendations are being very carefully considered.
Thank you again,
Janice
i know- they told me about the 'you HAVE to fall asleep' thing. i really dont see it happening. i just CAN NOT nap- ever. plus, i have twin 2 year olds, i mean how am i supposed to just get 3 hours of sleep and deal with them all day after the test? (which is at 8:45am). i'll do my best. they said sedation is out of the quesion- darn, a little benedryl does wonders for me.
katy
katy
If you could do the EEG while you are sleep deprived is much better , I mean sleep well in the afternoon the day before the test then sleep 1-2 hrs only beofre the test (the less night sleep the better) this will increase the senstivity of the EEG in picking up abnormal waves!!
Bob
Bob
bob--i love my little quirky neurologist, but he is about 75 yo!! i'm wondering if he is stuck on 'old diagnostics'. the test was moved up to saturday, i'll go, but i really feel it is a waste of everyones resources.
and for the other poster (sorry, your name escapes me), i really dont want to go see my dr before the test, there seems to be no point- i'll wait till he has the results of the EEG, then kill 2 birds with one stone. i'm tired of going to see him for no reason (i usually have a 'recheck' when i'm feeling totally fine and we shoot the breeze). gotta love these darn intermittant symptoms.
katy
and for the other poster (sorry, your name escapes me), i really dont want to go see my dr before the test, there seems to be no point- i'll wait till he has the results of the EEG, then kill 2 birds with one stone. i'm tired of going to see him for no reason (i usually have a 'recheck' when i'm feeling totally fine and we shoot the breeze). gotta love these darn intermittant symptoms.
katy
i have a similar concern as the original poster. i'm also a healty 32 yo female. i DO have a clotting disorder (factor V) and have had a DVT and a PE in the past.......since jan i have been having L side weakness and visual issues etc etc (ms type issues), after a couple of MRI's that didnt show anything, my dr guessed i had a TIA, so i'm on coumadin. so months have gone by, and the s/s are intermittant, ie come for a few weeks, then get better, so obviously i'm concerned that i DIDNT have a TIA and it is neuro related. (sounds MS'ish to me)
now- my question---i had a repeat MRI last week, a couple days later a hospital calls and said i need to get set up for an EEG. (it is monday). so, what are they looking for with an EEG??? are they trying to diferentiate between MS and a TIA??? my neuro wont discuss it over the phone, so i'm in the dark for probably a month until i can get back in to see him. anyone else ever had an EEG?? was it helpful/useful in terms of a dx???
katy
now- my question---i had a repeat MRI last week, a couple days later a hospital calls and said i need to get set up for an EEG. (it is monday). so, what are they looking for with an EEG??? are they trying to diferentiate between MS and a TIA??? my neuro wont discuss it over the phone, so i'm in the dark for probably a month until i can get back in to see him. anyone else ever had an EEG?? was it helpful/useful in terms of a dx???
katy
Hi Katy. I did have an EEG in my inital workup after my episode in February, but never really got a comment about it. My neuro never really mentioned it, just looked over all the results on his computer and nodded and said, "OK, OK. Good." I was mainly concerned because I knew there was something on the MRI. I have seen the EEG report and I think something brief was mentioned, but it seemed like mumbo jumbo to me, obviously nothing major, and I don't have a copy of it. I probably should. I think his original reason for ordering the EEG was because according to my neuro this episode could have been one of several things, such as MS, stroke, migraine, and seizure. For what it's worth, if my labs came back as hypercoagulable the belief was that I would be on Coumadin as well. Fortunately for me, my clotting was all within normal limits and I'm just doing the baby ASA preventatively. I personally have never had any miscarriages, PE's, or DVT's. A few years ago when I first saw a neurologist, he ran an ANA which came back positive, so I was referred to a rheumatologist at that time. She was concerned with my previous diagnosis of optic neuritis because of the concern of vasculitis. Don't know if it could be relevant or not in your case.
Good luck, I hope you get answers soon.
Be well,
Janice
Good luck, I hope you get answers soon.
Be well,
Janice
janice- so from what i concur, your EEG didnt really tell your dr anything pertenant. from what i'm reading aobut them, they dont seem very useful other than for seizure issues, which i dont have...........again, i'm not even real sure why i'm having the test. guess i sort of have a negetive attitude going into it. i'm tired of finding sitters/ finding the time and paying lots of money for tests that dont give any real answers.
katy
katy
Hi,
Its so long since we used EEG to detect a slowing of the waves over a damaged part of the brain. That was before using CT or MRIs.
My guess, the EEG is to detect any abnormal brain waves/electreicity (either fast or slow) to explain your symptomes.
Because paroxysmal symptomes are most likely TIA, Migraine related, or seizure/probensity to have seizure untill proven otherwise.
Bob
Its so long since we used EEG to detect a slowing of the waves over a damaged part of the brain. That was before using CT or MRIs.
My guess, the EEG is to detect any abnormal brain waves/electreicity (either fast or slow) to explain your symptomes.
Because paroxysmal symptomes are most likely TIA, Migraine related, or seizure/probensity to have seizure untill proven otherwise.
Bob
Well Katy, I certainly understand your frustration! I know nothing more than I did 7 months ago, all in all nothing new since my diagnosis of optic neuritis in about 2002. In essence, I feel like I'm waiting for the other shoe to drop, or some new symptom or relapse of an old problem so that I can finally find out what's going on.
From what I understand, EEG may also help identify other "trouble spots" in the brain. I may be misinformed though, perhaps someone else may hop in! I think that everyone assumes seizures to be of the grand mal variety, and that obviously is not the case. Teken directly from Wikipedia.com "a seizure can also be as subtle as marching numbness of a part of body, a brief loss of memory, sparkling of flashes, sensing an unpleasant odor, a strange epigastric sensation or a sensation of fear."
Your doctor knows why this test is being ordered, he obviously is ordering it. Call the office and let the staff know (they have the power) that you are very concerned over the results of your past testing and that you have questions and need to be seen before this test is performed. I had a similar situation and the nurse was very courteous and fit me in that same afternoon. You have the right to know. E-mail me if you'd like, ***@****
Good luck!
Janice
From what I understand, EEG may also help identify other "trouble spots" in the brain. I may be misinformed though, perhaps someone else may hop in! I think that everyone assumes seizures to be of the grand mal variety, and that obviously is not the case. Teken directly from Wikipedia.com "a seizure can also be as subtle as marching numbness of a part of body, a brief loss of memory, sparkling of flashes, sensing an unpleasant odor, a strange epigastric sensation or a sensation of fear."
Your doctor knows why this test is being ordered, he obviously is ordering it. Call the office and let the staff know (they have the power) that you are very concerned over the results of your past testing and that you have questions and need to be seen before this test is performed. I had a similar situation and the nurse was very courteous and fit me in that same afternoon. You have the right to know. E-mail me if you'd like, ***@****
Good luck!
Janice
Hi
I will try to be as brief as possible
1-Its some time not possible to tell the difference , but most of the time we depend on specific criteria to identify a lacune from a MS plaque, or even a small area of a low grade gloma (Size, location, shape , and numbers)
2-In your case it could be a lacune though you are very young , and its one lesion only, plus all your hypercoagulable test came back negative as well as a screen for vasculitis .(normal people could have some non specfic like lesions)
3- Please Verify if you had these all done?:
Protein C
Protein S (free and total)
Antithrombin III
Fibrinogen (with C-reactive protein)
Factor VIII (with C-reactive protein)
Lupus anticoagulant (LA)
Anticardiolipin antibodies (aCL)
Activated protein C resistance (APCR)-->If APCR positive: factor V Leiden mutation
Prothrombin II G20210A mutation
Lipoprotein little a
Homocysteine
some of them should be repeated after 3 months even if they are normal now
4-The following are not recommended for the majority of the patients (no enough evidence)but some very specialized centers do them
!
I will try to be as brief as possible
1-Its some time not possible to tell the difference , but most of the time we depend on specific criteria to identify a lacune from a MS plaque, or even a small area of a low grade gloma (Size, location, shape , and numbers)
2-In your case it could be a lacune though you are very young , and its one lesion only, plus all your hypercoagulable test came back negative as well as a screen for vasculitis .(normal people could have some non specfic like lesions)
3- Please Verify if you had these all done?:
Protein C
Protein S (free and total)
Antithrombin III
Fibrinogen (with C-reactive protein)
Factor VIII (with C-reactive protein)
Lupus anticoagulant (LA)
Anticardiolipin antibodies (aCL)
Activated protein C resistance (APCR)-->If APCR positive: factor V Leiden mutation
Prothrombin II G20210A mutation
Lipoprotein little a
Homocysteine
some of them should be repeated after 3 months even if they are normal now
4-The following are not recommended for the majority of the patients (no enough evidence)but some very specialized centers do them
!
lat67,
Lyme disease remains in the differential diagnoses of MS,but the classical clinical and MRI picture of MS is almost
never produced by Lyme disease. If still in doupt due to ?Prior history of a tick bite or a skin erythema migrans rash then we first do Western blot is the most definitive serology but needs to be confirmed by a better test===> CSF will positive PCR.
Bob
Lyme disease remains in the differential diagnoses of MS,but the classical clinical and MRI picture of MS is almost
never produced by Lyme disease. If still in doupt due to ?Prior history of a tick bite or a skin erythema migrans rash then we first do Western blot is the most definitive serology but needs to be confirmed by a better test===> CSF will positive PCR.
Bob
Janice,
I missed the Optic neuritis in 2002, and with the additional information you provided I'm more with ? MS and as your doctor I can't be definite at this time.
-OPtic neuritis and repeated episodes of what we call Brainstem paroxysms ==> Brief (seconds to minutes) shock-like attacks of vertigo, ataxia (balance and walking issues), sensory or spasms which are repeated many times are sort reliable signs to keep in mind.
I'm sure the MS specialist will arrange a repeate MRI with Gadilinum in 3-6 months to be able to give you a better answer
I will try to give you an idea how we diagnose MS ,or how to say definite MS==> we need
1. DIS: dissemination in space (multifocality meaning several lesions on the MRI)
2. DIT:dissemination in time (recurrent attacks, but an attack should be > than 24hr duration and should not a subjective type where you could feel it but we cant see it on exam )
3. NBE: No better explanation to account for symptoms and signs (no alternative neurological disease)thats why we do a full battery of investigations.
-Few words about SLE or lupus is actually seldom confused with MS even if ANA positive (80% of MS have ANA +ve)because its always associated with systemic manifestations
- I'm not sure about the C-ANCA or the antiphospholipid in this senario.
In brief , though still puzzling , but MS is much higher than stroke and the repeat MRI will tell more.
Bob
I missed the Optic neuritis in 2002, and with the additional information you provided I'm more with ? MS and as your doctor I can't be definite at this time.
-OPtic neuritis and repeated episodes of what we call Brainstem paroxysms ==> Brief (seconds to minutes) shock-like attacks of vertigo, ataxia (balance and walking issues), sensory or spasms which are repeated many times are sort reliable signs to keep in mind.
I'm sure the MS specialist will arrange a repeate MRI with Gadilinum in 3-6 months to be able to give you a better answer
I will try to give you an idea how we diagnose MS ,or how to say definite MS==> we need
1. DIS: dissemination in space (multifocality meaning several lesions on the MRI)
2. DIT:dissemination in time (recurrent attacks, but an attack should be > than 24hr duration and should not a subjective type where you could feel it but we cant see it on exam )
3. NBE: No better explanation to account for symptoms and signs (no alternative neurological disease)thats why we do a full battery of investigations.
-Few words about SLE or lupus is actually seldom confused with MS even if ANA positive (80% of MS have ANA +ve)because its always associated with systemic manifestations
- I'm not sure about the C-ANCA or the antiphospholipid in this senario.
In brief , though still puzzling , but MS is much higher than stroke and the repeat MRI will tell more.
Bob
Hi,
Looks like your responses are very popular...so just one quick question.
Was wondering what your thoughts were on Lyme disease and where you fit with all the controversy?`
Do you think someone who has many symptoms of MS ( neurological) but clear test results in every MS test done could have Lyme disease?
Thanks for your thoughts.
Lesley
Looks like your responses are very popular...so just one quick question.
Was wondering what your thoughts were on Lyme disease and where you fit with all the controversy?`
Do you think someone who has many symptoms of MS ( neurological) but clear test results in every MS test done could have Lyme disease?
Thanks for your thoughts.
Lesley
Please Verify if you had these all done?:
Please excuse the CAPS as I am not shouting, just trying to differentiate my responses.
Protein C YES
Protein S (free and total) PROTEIN S--NOT SURE WHICH, (free or total) ACTUALLY CAME BACK HIGH NOT DEFICIENT
Antithrombin III UNSURE
Fibrinogen (with C-reactive protein) MAYBE
Factor VIII (with C-reactive protein) I HAD ONE OF THE FACTORS DONE, I'M THINKING IT WAS FACTOR V, WAS NOT SPECIFIED WITH CRP
Lupus anticoagulant (LA) YES
Anticardiolipin antibodies (aCL) YES
Activated protein C resistance (APCR)-->If APCR positive: factor V Leiden mutation DON'T THINK SO, JUST HIGH SENSITIVITY CRP FROM CARDIOLOGIST
Prothrombin II G20210A mutation DON'T THINK SO
Lipoprotein little a I BELIEVE SO
Homocysteine YES
assuming the lesion is on the right side of the brain? this should give more of sensoy symptomes rather than paralysis unless it induced a seizure which could explain the fatigue afterward
YES--THE LESION IS ON THE RIGHT SIDE OF MY BRAIN, EXTREME SENSORY SYMPTOMS, EXTREME FATIGUE HOURS BEFORE THE NUMBNESS/BUZZING AND SENSORY OVERLOAD.
My local neuro feels it looks more like a small stroke, an MS specialist feels it is consistent with a MS plaque but is not making the diagnosis at this point, merely classifying me as a "possible MS." Of note, I did have positive antiphospholid antibodies a year ago, but they were negative s/p the episode in February. I also had a positive C-ANCA last September, this was just repeated last week and I am awaiting these results, and I have had a weakly positive ANA for several years. My neuro sent me for a rheumy consult last year because he felt I had myasthenia gravis and the history of Grave's. The rheumy ran a battery of tests and also ordered an MRA last year which ultimately came back normal.
I honestly question the possibility of MS with the other symptoms/signs I am having. I have numbness, weakness, pins and needles, crawly sensations, visual disturbances, difficulty swallowing, balance issues, a few episodes of vertigo, etc. My frustration level is very high because I really know nothing more than I did the day this happened to me. When I saw the differentials on the MRI I thought for sure MS was going to be the dx. It's just frustrating not knowing if you're having the proper treatment by taking baby ASA and Lipitor. Ironic really that no one believes cholesterol is playing a part in this scenario--it is prophalactic because of the elevated high sensitivity CRP.
Just hoping I get the right dx and treatment. I'm frightened that if this was a stroke at such a young age that I may not be as lucky next time, and if it is MS that I should be having treatments. I was offered the option of taking Copaxone but opted against it until someone can tell me for sure if it is indeed MS.
Thanks for your response, I really appreciate it!
Janice
Please excuse the CAPS as I am not shouting, just trying to differentiate my responses.
Protein C YES
Protein S (free and total) PROTEIN S--NOT SURE WHICH, (free or total) ACTUALLY CAME BACK HIGH NOT DEFICIENT
Antithrombin III UNSURE
Fibrinogen (with C-reactive protein) MAYBE
Factor VIII (with C-reactive protein) I HAD ONE OF THE FACTORS DONE, I'M THINKING IT WAS FACTOR V, WAS NOT SPECIFIED WITH CRP
Lupus anticoagulant (LA) YES
Anticardiolipin antibodies (aCL) YES
Activated protein C resistance (APCR)-->If APCR positive: factor V Leiden mutation DON'T THINK SO, JUST HIGH SENSITIVITY CRP FROM CARDIOLOGIST
Prothrombin II G20210A mutation DON'T THINK SO
Lipoprotein little a I BELIEVE SO
Homocysteine YES
assuming the lesion is on the right side of the brain? this should give more of sensoy symptomes rather than paralysis unless it induced a seizure which could explain the fatigue afterward
YES--THE LESION IS ON THE RIGHT SIDE OF MY BRAIN, EXTREME SENSORY SYMPTOMS, EXTREME FATIGUE HOURS BEFORE THE NUMBNESS/BUZZING AND SENSORY OVERLOAD.
My local neuro feels it looks more like a small stroke, an MS specialist feels it is consistent with a MS plaque but is not making the diagnosis at this point, merely classifying me as a "possible MS." Of note, I did have positive antiphospholid antibodies a year ago, but they were negative s/p the episode in February. I also had a positive C-ANCA last September, this was just repeated last week and I am awaiting these results, and I have had a weakly positive ANA for several years. My neuro sent me for a rheumy consult last year because he felt I had myasthenia gravis and the history of Grave's. The rheumy ran a battery of tests and also ordered an MRA last year which ultimately came back normal.
I honestly question the possibility of MS with the other symptoms/signs I am having. I have numbness, weakness, pins and needles, crawly sensations, visual disturbances, difficulty swallowing, balance issues, a few episodes of vertigo, etc. My frustration level is very high because I really know nothing more than I did the day this happened to me. When I saw the differentials on the MRI I thought for sure MS was going to be the dx. It's just frustrating not knowing if you're having the proper treatment by taking baby ASA and Lipitor. Ironic really that no one believes cholesterol is playing a part in this scenario--it is prophalactic because of the elevated high sensitivity CRP.
Just hoping I get the right dx and treatment. I'm frightened that if this was a stroke at such a young age that I may not be as lucky next time, and if it is MS that I should be having treatments. I was offered the option of taking Copaxone but opted against it until someone can tell me for sure if it is indeed MS.
Thanks for your response, I really appreciate it!
Janice
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