MRI

I have posted before and you preferred to know exactly where my brain lesions were to give a more informed opinion.

"A few small foci are identified involving the right centrum semioval, left and right corona radiata, extreme right capsule and left forceps minor.  No foci are identified in the corpus callosum, brainstem or cerebellum.  None of these lesions enhance.  These are old lesions.  The ventricle and sulci are normal.  The posterior fossa, pituitary fossa and the nasopharyngeal are normal.  There is no mass or midline shift."

Impression:  The findings are non-specific, could be small ischemic changes, vasculitis, lyme or other etologies.  The size and distribution is not typical for a demylinating disease, however, clinical correlation is needed for full evaluation.

This MRI was taken almost 2 years ago. I have had follow-up MRI's the most recent being in JAnuary of this year and the MRI remains the same with no changes.  I have also had the entire spine imaged which did not show any lesions.  

Once again, serial testing of all evoked potentials, EEG, Spinal Tap and numerous clinical exams by 3 neuros have all come up normal.  All 3 neuros say this isn't MS but I am left undiagnosed.  What else could present like this?  Any more thoughts would be greatly appreciated.

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

I have to agree with the radiologist's impression in that scattered changes in the above areas are (although nonspecific) more suggestive of disorders such as small vessel disease or migraines rather than MS.  Small vessel disease refers to changes in the brain as a result of insufficient oxygen supplied by very tiny blood vessels related to the presence of stroke risk factors such as high blood pressure, cholesterol, heart disease, diabetes, smoking, etc...

As for clinical correlation, I'm afraid I don't recall your symptoms and have no access to your previous post on my current screen.  If you add a comment, I'll be happy to answer again as a comment on this string.  However, what I can tell you is that these changes may be clinically silent (meaning it doesn't produce any symptoms) depending on how small they are.  In addition to the radiologist's suggestions, inflammatory diseases such as Sarcoids can present with similar MRI findings.  Again, leave a comment regarding your symptoms and I'll get back to you.

[Halash]

This all began I believe 2yr ago with a dry hacking cough with night sweats.  This grew into severe asthma (which I have not had since early childhood-I'm 41F)along with hives on my abdomen and lips, and an off and on pain in upper left quadrant of abdomen. (Gallbaldder removed '92)  Went to ER-CBC, chest x-ray, Liver function-normal.  Treated for asthma.  Sym. slowly resolved over several month. I also would have off and on mild pain/sensation under right arm.  Mammogram-normal.  A few months later I received a mild whiplash(which may be completely unrelated to all this) Around this same time my tongue became swollen, coated (sick-look) along with a horrible taste in mouth, had migrain with aura and slurred speech for a brief second (have had this since highschool) and then travelling numbness all over my body.  The numbness would never stay in one area more than a few minutes.  My neck pain from injury seemed to worsen. Went to ER-CT scan, CBC, Neuro exam-normal.
Went to Neuro-neuro exam normal.  Had MRI's which showed the results above along with disc disease in spine with one disc slightly pressing spinal cord in thoracic.  Neuro said the brain lesions were old, thought migraine due to history of such, but wanted to rule out anything serious.  Ran all EP's, EEG, LP.  Everything was normal except lyme essay of positive, but western blot-neg (At this time I did live in a community with losts of deer that would come up to our back fennce and I would also hike in the hills where they live) Now neuro thought lyme, but infectious disease consult said "no" due to neg. western blot.  Now I became a big "?".  Symptoms have never completely gone away. I also have periodically (4 times I can recall) had this strange red streak appear (like when a spider bites you and the poison travels from the site)  on my upper chest, under left arm and on my thigh (these did not appear all at once and went away in 1 day.  Over the last year or so have had numerous nero exams, blood tests, etc. as stated above and all 3 neuros I've consulted cannot come up with a diagnosis.  The neuros have entertained ADEM, and they don't think this is MS.  I did read about a type of vascultis called Churg-Strauss that begins with  severe asthma but I would assume I'd be pretty sick now.  As you can see this is all really strange and no one seems to know what this could be.   By the way, I live in Orange County, CA and these neuros are some of the best so I know I'm in good hands. Thank you so much for your opinion.  This is a wonderful site.

[Halash]

I forgot to mention-too many symptoms-I'm beginning to forget:
I also have periodic muscle fasciculations, a funny feeling in right chest area as if when I breath I can feel a small area of my lung(chest x-ray is normal), had a heat feeling appear on my lower left hip that went away in a few hours, arthritic pain in right elbow along with occasional stiff shooting pain in middle finger. I did lose approx. 10 pound over a 6 month period that goes along with my somewhat loss of appetite, but that has stablized. I do not have any loss of strength, balance, vertigo, etc.??????????????

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

The lesions on the MRI do not appear to correlate with your symptoms.  However, a few things that stand out from your history are the weight loss, night sweats, and progressive respiratory problems.  I know that you have various neurological symptoms, but those things I pointed out may represent a more acute problem that needs further evaluation with things like a CT of the chest and abdomen, bloodwork, and possibly a pulmonary consult.  SOmetimes, systemic problems (disorders that affect the body or blood/lymph system) can give vague neurological symptoms that can masquerade as a primary disease of the nervous system. Talk to your internist about your symptoms. Good luck.