MRI Assessment

[Jerry3]

My wife was diagnosed with MS after a bout of Optic Neuritis last June.  Her MRI at that time mentioned multiple periventricular white matter lesions.  She has had no other symptoms or flairs since and is on Rebif since then.  Her follow-up MRI taken in January mentioned the following.

The focus of parenchymal enhancement in the left frontal lobe white matter is new.  The previously noted focus of enhancement in the right temporal lobe and in right parietal lobe are no longer evident.  Corresponding FLAIR signal hyperintensity in the right parietal and temporal lobe are less prominent, with increased prominence of FLAIR hyperintensity in the corresponding left frontal lobe.  The multiple periventricular white matter lesions appear generally stable in size and distribution.  Under findings, the following:
There are multiple periventricular with scattered subcortical white matter T2 hyperintense lesions. Several appear oriented orthogonally with respect to the lateral vetricular axis.  One marginates the rostral body of right lateral ventricle.

The impression strongly suggests Multiple Sclerosis.  After reading this assessment, my questions are --- 1.  Is there anything in the description about the location of these lesions that should be more concerning?  The ones oriented orthogonally?  Do lesions go away as described?  

Her neuro's assessment that it was a good report with a minus 2 lesion result in her mind.  Knowing that location of lesions are important as far as symptoms, what are your thoughts on this assessment?  

Thanks in advance.

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

My advice is limited without seeing the actual images but I will make some comments on what the report says in general

the location of the lesions is typical for MS - the orthogonal orientation is also typical as the lesions typically are in the same direction as the small veins in the brain white matter - these veins are orientated perpendiculalry to the ventricles.

Even though there are no clinical attack of MS, we know that new lesions on MRI can occur over time, although this is reduced by disease modifying treatment ie Rebif and the other interferons. The natural history of a MS lesion on the MRI scan is initially a bright spots that lightens up with contrast, then in a few days it loses its enhancement with contrast and remain as a 'white spot'. As times goes on these may fade away and become invisible to MRI (although a small scar may still be there that the MRI scan cannot see). More severe lesions result in a visible area of brain loss called a 'black hole'.

MRI is a useful tool in assessing the disease burden in MS and the response to treatment - an unchanged or improved scan is a good result in general.

[kara_with_ms]

she is on Rebif?  I think it would mean the medicine is working, the reduction of lesions is good. I took Rebif also, I was in a wheelchair for a long time, but the medicine helped. I could not handle the flu-like symptoms and switched to Copaxone. Sounds to me like her MS is being maintained very well by the Rebif. As long as it helps, stay on it.

[Deedee36]

I have been diagnosed with fibromyalgia for a long time. The dr. ordered an MRI to rule out ms. I run 3 to 4 miles a day and am muscular. The MRI showed minor plaque. Now he wants to do more tests to rule out ms. Is it possible to have minor plaque in the brain and nothing terrible be wrong? Help!!!

[Deedee36]

I did not really go into how worried this makes me.  I hope the Dr. will answer me.  My dr. said the MRI showed a few plaques, not many. He did not know why and said if i would older it could be related to aging. He also said, could be related to high cholesterol, which I do not have, so then, I worry about ms.  I have been on line and did read one article that said sometimes there is no reason for placque. Does that make any sense at all or do I have to not only worry about ms, but impending stroke...I don't understand. Please help me.

[erpatti]

I was dx with fibromyalgia 13 years ago after ruling out MS. Symptoms waxed and waned got better slowly . Was treated for lyme even though everything was neg. Now my symptoms are back , my mri showed a few lesions which are the same as plaque i think. Neuro did a spinal tap which was neg for MS, being treated for lyme which is still neg.What are your symptoms?

[Deedee36]

Hi erpatti,

Right now, I have zero symptoms, but every once in a while (and it happened from Nov - Jan this year) every joint, muscle hurt, not a little but very, very painful...first one knee hurt as if it had bad arthritis, then it was gone and the other one hurt, then spine(tailbone), the hips, bottems of feet were burning, hurt all over like a serious case of the flue, sometimes worse then others...then, just like that...all is gone. In the past, many, many years ago, I had very stiff muscles in the legs; and had tests for m.s. (cat scan and nerve tests) all negative; so the dr. now just wanted to rule out ms and diagnose me with fibromyalgia and then I had those little spots...not many he said..

So, do you know if it is ever normal to have plaque in the brain. It does not seem like it would be.

Thanks for responding.

[erpatti]

By plague did he mean lesions?? they can be caused by things other than MS , my neuro said CNS lyme even migraines can cause lesions. Your lucky you feel ok. I have so many symptoms its crazy. Have you been tested or treated for lyme??I am a nurse , I work in an ER I hope I can go back, been out 2 months

[Deedee36]

Hi erpattie,

I am so sorry that you feel bad.  I said I don't have symptoms, but what I mean is that they are my normal. I suppose I have had some weird feelings for a long, long time. I had a bad bout of something for 3 mos. It happens periodically and then I get back to my normal.  I have been misdiagnosed with Lupus and told i was dying when I was very young. I don't want to get diagnosed with ms and then be depressed about it. I can't imagine that there is any good reason for placque. Is this common? He said small amounts.  I am to have some kind of an eye, checkboard test tomorrow for ms and won't get those results for a few days. No, I have not been tested for Lyme. Is it common?
Thank you so much for caring and responding.

[kat44]

Hello - I have been suffering with tinnitus for the past 3 months and severe depression.  The neuro ordered MRI.  I am 44. He said there were too many white spots, that someone my age should have 1 or 2 and "I have alot".  I also have two very white, large spots near my lateral ventricles(?).  I am having an echocariogram in the am and several other tests - related to a possible heart condition.  The neuro said they see this in MS too.  I'm not really having in other symptoms - physical changes - other than the tinnitus and I felt like I wanted to cry all of the time - then was put on Zoloft.  Could this be linked to MS?  My step dad who is a retired GP said the ones near the lateral ventricles were problematic.  Does anybody know?  It's very scary.  Thanks for listening....