Aa
MRI Results-confused!!!
I am a 40 yr old female with PMH of fibromyalgia. I have had a lot of strange neuro symptoms the last few months: numbness, tingling, memory loss, migraines, blurred vision, severe depression, personality changes, etc... Was referred to a neurologist. Neuro exam quoted as "normal". Labs and MRI brain and c-spine orderd. Phone call from nurse two weeks later: Vit D was very low at 8.2. Was started on 50,000u 3x week for that. Was told that can cause a lot of "weird neuro stuff". Was told MRI was "fine". No follow-up appt ordered. Follow up with primary physician. Saw PCP the next week. He ordered MRI images and reports from the hospital. He is very concerned about MRI results. Wants me to see another neurologist. Here is what the brain MRI showed: "Small punctate foci of abnormal signal in the deep white matter of both cerebral hemispheres- most likely minimal old small vessel ischemic changes. Were not present on previous study in 2001. Two small 5mm diameter rounded structures are noted in the right and left parotid glands and most likely represent small lymph nodes. These are unchanged from previous study." I am only 40, have no history of hypertension, diabetes, CAD, etc. What does all this mean and should I be concerned for anything like MS or something like that?? I am very worried and confused. HELP!!!
Thank you for your very detailed response. I have never smoked, so I guess the most logical explanation for the plaques would be my migranes, though that doesn't provide any explanation for my neuro symptoms-numbness and tingling, ringing in ears, visual changes, depression, etc. Maybe the Vit D deficiency is responsible for those other symptoms. I think, for starters, I am going to find a new neurologist. Thank you so much for you time!
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.
There are multiple causes for so called white matter changes in the brain. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented.
Other causes of white matter changes in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance.
Other causes of plaques on MRI can usually be distinguished based on history and symptoms, such as symptoms of neurologic deficit (for example arm weakness or difficulty walking etc). These can also be distinguished based on the MRI appearance. These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.
In your case, the likely causes could be due to either the migraines, and are therefore likely inconsequential, or they are due to chronic small vessel disease if you smoke, since you state you don't have high blood pressure, high cholesterol, or diabetes. If you do smoke, it is imperative that you stop smoking.
MS is an inflammatory demyelinating disease that affects the central nervous system. To make the diagnosis there are specific criteria, in which objective neurologic findings are present affecting 2 or more locations in the nervous system in 2 or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and needed as it helps determining the presence of white matter lesions in 2 or more locations, however there are multiple conditions producing MRI changes that could be mistaken for MS, and the MRI should be reviewed properly and correlated to the symptoms. If someone has several lesions on the brain MRI, but they have not had distinct episodes of neurologic symptoms, or they have specific findings on neurologic examination, then a diagnosis of MS can not be made.When the diagnosis is in doubt, LP to study the CSF is helpful, and if there is still some doubt, there are other tests such as evoked potentials that can help.
It is difficult for me to determine if you have MS without being able to get a detailed history, without being able to examine you, and without being able to see the MRI. I think that you should discuss with your neurologist if he thinks that you have MS or not, and if he has still doubt, if he considers that you should be seen by an MS specialist or not.
Hope this information helped. Best of luck.
Without the ability to obtain a history from you and examine you, I cannot comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.
There are multiple causes for so called white matter changes in the brain. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented.
Other causes of white matter changes in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance.
Other causes of plaques on MRI can usually be distinguished based on history and symptoms, such as symptoms of neurologic deficit (for example arm weakness or difficulty walking etc). These can also be distinguished based on the MRI appearance. These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.
In your case, the likely causes could be due to either the migraines, and are therefore likely inconsequential, or they are due to chronic small vessel disease if you smoke, since you state you don't have high blood pressure, high cholesterol, or diabetes. If you do smoke, it is imperative that you stop smoking.
MS is an inflammatory demyelinating disease that affects the central nervous system. To make the diagnosis there are specific criteria, in which objective neurologic findings are present affecting 2 or more locations in the nervous system in 2 or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and needed as it helps determining the presence of white matter lesions in 2 or more locations, however there are multiple conditions producing MRI changes that could be mistaken for MS, and the MRI should be reviewed properly and correlated to the symptoms. If someone has several lesions on the brain MRI, but they have not had distinct episodes of neurologic symptoms, or they have specific findings on neurologic examination, then a diagnosis of MS can not be made.When the diagnosis is in doubt, LP to study the CSF is helpful, and if there is still some doubt, there are other tests such as evoked potentials that can help.
It is difficult for me to determine if you have MS without being able to get a detailed history, without being able to examine you, and without being able to see the MRI. I think that you should discuss with your neurologist if he thinks that you have MS or not, and if he has still doubt, if he considers that you should be seen by an MS specialist or not.
Hope this information helped. Best of luck.
Sorry....I just noticed this was an expert forum...I am sorry I should have posted this in the other forum...I hope a neurologist answers you soon.
Upfront I am not a radiologist, but I have transcribed radiology reports for 30 years. You have looked it up. Usually these changes are related to age and/or hypertension, diabetes, etc. If my scan showed this, at the very least I would have my PCP have another radiologist reivew my scan (preferrably a neuroradiologist) and/or have a repeat scan with and without gadolinium contrast, and/or have the images sent to a large university school of medicine for review.
Usually when I type on a patient with MS....there is something said about
"consistent with a demyelinating disorder (MS) plaques, brightening, etc.
Try not to worry. I have a friend with MS and usually the neuro exam is positive...tuning fork, etc. It sounds like your PCP is spot on in following up with this, if for no other reason than to ease your mind. Just a thought: Imaging has become so sensitive over the years, which is good, but it is so sensitive it often shows minor things which over a lifetime may have little or no consequence. For instance, just about everyone over 60 who has a MRI or CT of the lumbar spine wll have degeneration or a bulge or disc in their lower back. Do ALL of them need to rush out and have surgery..no..just part of aging for most part. Hope this is of some help.
Best of luck to you...
Usually when I type on a patient with MS....there is something said about
"consistent with a demyelinating disorder (MS) plaques, brightening, etc.
Try not to worry. I have a friend with MS and usually the neuro exam is positive...tuning fork, etc. It sounds like your PCP is spot on in following up with this, if for no other reason than to ease your mind. Just a thought: Imaging has become so sensitive over the years, which is good, but it is so sensitive it often shows minor things which over a lifetime may have little or no consequence. For instance, just about everyone over 60 who has a MRI or CT of the lumbar spine wll have degeneration or a bulge or disc in their lower back. Do ALL of them need to rush out and have surgery..no..just part of aging for most part. Hope this is of some help.
Best of luck to you...
You are reading content posted in the Neurology Forum
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
