MRI questions - follow up previous

MRI of 6/14

Examination:  MRI OF THE BRAIN WITHOUT AND WITH CONTRAST

Clinical Information:  Multiple sclerosis.  Comparison is made to previous examination 11/24/2009 from Capital Imaging.

Technical Factors:  MRI of the brain was performed according to routine department protocal.  This included sagittal T1, axial T2 and axial FLAIR, axial diffusion, pre and post contrast axial and post contrast coronal sequences.  Contrast agent 15 ml of Magnevisit.

Findings:  There are about 30 or so perventricular and mostly subcortical white matter changes in the frontoparietal regions.  There is no significant change compared with the prior examination allowing for significant differences in the scanner technique/acquisition parameters.  There is a small focus of enhancement in the left parietal subcoritcal white matter measuring 4 mm corresponding to an enhancing plaque.

There is mild mucosal thickening of the maxillary sinuses.

Impression:   There are numerous, about 30 or so, mostly subcortical white matter changes and multiple perventricular white matter changes.  There is one plaque that enhances in the left parietal region posteriorly and superiorly.  Aside from the enhancing plaque there are no other changes compared with the prior study.

MY QUESTION IS...DOES THIS MEAN THAT THE DIAGNOSIS IS MS OR WHAT COULD IT BE?  Thanks so much!  Any help would be so appreciated.  

[Dr Sharma]

Hi there. These MRI findings are suggestive of multiple sclerosis. MS is a chronic demyelinating disorder where the disease phase is characterized by active phase and remissions. It has multiple symptoms and signs and is a diagnosis of exclusion. The symptoms of multiple sclerosis are loss of balance, muscle spasms, numbness in any area, problems with walking and coordination, tremors in one or more arms and legs. Bowel and bladder symptoms include frequency of micturition, urine leakage, eye symptoms like double vision uncontrollable rapid eye movements, facial pain, painful muscle spasms, tingling, burning in arms or legs, depression, dizziness, hearing loss, fatigue etc. The treatment is essentially limited to symptomatic therapy so the course of action would not change much whether MS has been diagnosed or not. Apart from clinical neurological examination, MRI shows MS as paler areas of demyelination, two different episodes of demyelination separated by one month in at least two different brain locations. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons, transmit nerve signals slower than non-demyelinated ones and can be detected with EP tests. These are visual evoked potentials, brain stem auditory evoked response, and somatosensory evoked potential. Slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI in addition, a spinal tap. Therefore, it would be prudent to consult your neurologist with these concerns. Hope this helps. Take care.

[Missy1018]

I appreciate that you answered my question.  Is there a chance that you think it could be something other than MS?  Are there still things that should be ruled out?  Missy