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Neurology (Expert Forum)
MRI Report?
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MRI Report?
by pjchatter, Apr 30, 2004 12:00AM
I am a female and symptoms began at age 48. Symptoms are typical of MS, but could be something else? My main concern is dimentia (dementia). I would like to know what your interpretation of these two reports would be?
1st MRI results:
1.Multiple foci of increased signal within periventricular and subcortical white matter (T2 weighted images). These are nonspecific but more numerous than usually seen in patients of this age. Question whether patient has any symptomatology suggestive of multiple sclerosis.
2nd MRI results:
1. Non-specific supratentorial white matter disease is present in both cerebral hemispheres. There is no involvement of the posterior fossa structures at this time, and no indication of abnormal parenchymal or leptomeningeal hemorrhage. Differential diagnosis, in this age group, is most strongly considered for small vessel ischemic vasculopathy such as that related to hypertension or diabetes, vasculopathic changes that could be related to inflammatory vasculitis such as Lyme’s disease, for example, or idiopathic multifocal demyelination. On the basis of the history, small vessel ischemic vasculopathy does not appear to be a strong hit. The possibility of demyelination with an idiopathic, viral mediated, or related to similar systemic infection, needs to be raised in the differential diagnostic consideration. Because there are fairly profound symptoms that appear to have affected both sides of the body with weakness, the possibility of spinal cord imaging could help to further differential diagnosis.
Thank you in advance for your opinion.
1st MRI results:
1.Multiple foci of increased signal within periventricular and subcortical white matter (T2 weighted images). These are nonspecific but more numerous than usually seen in patients of this age. Question whether patient has any symptomatology suggestive of multiple sclerosis.
2nd MRI results:
1. Non-specific supratentorial white matter disease is present in both cerebral hemispheres. There is no involvement of the posterior fossa structures at this time, and no indication of abnormal parenchymal or leptomeningeal hemorrhage. Differential diagnosis, in this age group, is most strongly considered for small vessel ischemic vasculopathy such as that related to hypertension or diabetes, vasculopathic changes that could be related to inflammatory vasculitis such as Lyme’s disease, for example, or idiopathic multifocal demyelination. On the basis of the history, small vessel ischemic vasculopathy does not appear to be a strong hit. The possibility of demyelination with an idiopathic, viral mediated, or related to similar systemic infection, needs to be raised in the differential diagnostic consideration. Because there are fairly profound symptoms that appear to have affected both sides of the body with weakness, the possibility of spinal cord imaging could help to further differential diagnosis.
Thank you in advance for your opinion.
Doctor's Answer
by CCF-Neuro-M.D.-CS, May 03, 2004 12:00AM
Without seeing the scans, I can not provide an accurrate opinion. Based on the statements you have provided, it appears that both MRI's are showing the same results. There is no mention of contrast which would be useful is differentiating between demyelination and vascular causes. Based on these MRI's alone, since there is no clinical history, an evaluation for demyelinating diseases (for example MS), vascular risk factors, vasculitis, and inflammatory disorders of the CNS should be evaluated. Nothing described on these scans would specifically point to dementia. You should discuss this with your neurologist who will be able to review the films and provide more specific answers. Good luck.
Other Tests: EEG and ECHO normal; Cerebrovascular Exam is Grade I carotid disease bilaterally. Thyroid nodule needle biopsy rare macrophages, few benign appearing follicular cells, small amount of colloid are present in a bloody background. The amount of cellular material is suboptimal for proper evaluation.
History: Gallbladder removed, hysterectomy, ear mastoidectomy.
Symptoms: Double Vision, Wavy vision, Right Eye Black blind spot and Gray blind spot, Right-sided weakness, right leg and arm numbness, pins and needles, dizzy, falling, ringing in right ear sometimes sounds like someone laying on a car horn, Memory bad, constipation, diaria, incontinence. These symptoms over the past three years; however, last few months left arm shooting pain and numbness. Heavy feeling in both arms. Extreme fatique and depression (though I think the depression is over not knowing what in the world is happening to me).
Not on any medications. Two separate family doctors advise that it appears to be possible MS. I have no insurance so these results are from when I had insurance. I’m waiting financial screening to go to Richmond MCV.
Is there anything in these results that would rule out MS?