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MRI Results
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MRI Results

Hi, I'm new here and 36 years old.
About 2 months ago, I began having tightness and weakness in my right hand/arm and though it might have been from computer over-use. The following week, my left side of my body began feeling off balance, like being pulled toward my left side and also pulled back, feeling wobbly walking, and my hands/ arms began to feel clumsy, awkward. Now both of my arms and legs feel really weak, shaky, although I can walk (though my calves and thighs feel weak) and do tasks with my hands(though they feel clumsy). At some point then I began having swallowing issues, which got pretty bad, but now seem to be waxing and waning.  I still have all the symptoms above going on 2 months now and have been dreading all the worst diagnosis.

Saw neurologist: blood tests, all negative. Just got Brain MRI w/contrast results and am stressed:

Findings: "mild punctate scattered FLAIR hyperintense signal changes present within the periventricular deep white matter. No evidence of abnormal enhancement. No surrounding mass effect or midline shift." Everything else was normal.

Impression: "Slight increase in scattered punctate FLAIR  hyperintense signal changes within the periventricular deep white matter and subcortical regions of the frontal lobes. Findings are nonspecific. Demyelinating process is not entirely excluded. Remainder of the study is otherwise stable. No evidence of enhancing mass, CVA, or hydrocephalus"

Is mild punctate the same as an MS lesion? There are no measurements of the the "periventricular deep white matter and subcortical regions of the frontal lobes..."

Neuro feels confident that it's not MS, as he sees changes like this in younger women commonly. He does not want to put me through a spinal tap because he feels strongly that it's not MS. But I don't feel so confident, feeling the symptoms I am feeling. I feel so distressed. I am due for a C-Spine soon, but the Neuro thinks it will show nothing. Help would be appreciated...Thanks.
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Avatar_dr_m_tn
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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are multiple causes for so called plaques (or white matter lesions) 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. However, you are young.

Other causes of plaques 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.


Multiple sclerosis is a disease that primarily affects the central nervous system (brain, spinal cord, nerves from the eye, the optic nerves). Symptoms may be mild to severe, ranging from tingling and numbness to paralysis. There is not one test alone or one symptom that can diagnose MS, but there are well-established criteria that help neurologists make the diagnosis. These include taking a thorough history, doing a thorough physical exam, conducting an MRI of the brain and sometimes the spine, and sometimes ancillary testing such as lumbar puncture and evoked potentials. If an MRI of the brain and spine is normal, the diagnosis of MS becomes highly unlikely.

You should continue to follow up with your neurologist for monitoring. You may benefit from a multiple sclerosis workup including the lumbar puncture and evoked potentials.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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Avatar_n_tn
Thank you for responding. I have a couple questions.

So the "punctate" things the radiologist reported are lesions, even though it is not stated so on the report?  I was wondering why my report doesn't provide the quantity nor the size of these "punctate" things? Is that the norm, not reporting these values, as other people on this medical board report having these values? Should my neuro be counting these "punctate" things, as I personally felt my MRI report was a bit vague after I read it myself?


I know that you cannot diagnose me, but is this impression considered a normal or abnormal MRI, when it states findings are nonspecific and the demyelinating process is not entirely excluded? I would call that abnormal...?

Impression: "Slight increase in scattered punctate FLAIR  hyperintense signal changes within the periventricular deep white matter and subcortical regions of the frontal lobes. Findings are nonspecific. Demyelinating process is not entirely excluded. Remainder of the study is otherwise stable. No evidence of enhancing mass, CVA, or hydrocephalus"

My neuro doesn't seem to think a LP would be of any use(or show anything), even though I'm having these symptoms 2 months now. He thinks I should talk to a therapist or get some meds to calm down my anxiety; the only reason I became extremely anxious was because these symptoms came on suddenly and I had to wait for a Neuro appointment for nearly 4 weeks, I was extremely anxious by then of course. I hate the fact the Neuro may be pointing me another direction, while there are changes in my brain and symptoms. I want to be taken seriously and not go down a psych road with medications. Please, any advice in this area?

Should I at least press for evoked potentials (which type, as I read there are 3 types)? Should I seek another opinion anyway if I get the EP, the results are normal, and the Neuro keeps saying it's anxiety causing this. How do I find a specialist is MS and other demyelinating processes, and how do I approach them in a consult, do I tell them who treated me first & that Neuros opinion, all the tests I've had and the results? Do I bring in my brain MRI's for the consultation right away?

Last question, what are other demyelinating diseases, and can vasculitis cause symptoms that mimic MS/ demyelinating diseases?

Again, thank you and sorry this is so long, but these questions feel really important.





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Avatar_n_tn
I'm going through a similar situation as you. I had an MRI of my brain done as well and they found 2 spots and 2 puncate spots as well. My neurologist who is an expert, actually he is the clinical director for MS clinic at a major Canadian University, he is also an expert on MS MRI's. He stated that puncate spots are not significant, and the location of my other two spots were not consistent with MS. MS Neuro's will look at the number and size of the spots and where they are located before they assume white spots mean MS. My neurological exam was normal except for one reflex in my bicep which is the arm I have a pinched nerves so to speak. I also had a LP which came back normal. I don't know if I have MS or not but my Neuro said his gut feeling tells me I don't. Because of this whole issue I've been having I have seen a lot of Dr.'s, and every single one has told me that some white spots on an MRI are not uncommon at all.


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