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Migraine Headaches, Abnormal CT Scan and MRI Findings - Possible MS?
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Migraine Headaches, Abnormal CT Scan and MRI Findings - Possible MS?

I am a 37 year old white female, who has suffered for years with chronic migraine headaches.  To date, these episodes have been moderately controlled with medications such as Maxalt, Imitrex, Relpax, Zomig, etc.  However, my migraines have been increasing lately and becoming more severe, to the point that medication does not always alleviate my pain.  I went to see my family doctor, who ordered a CT scan, which was abnormal, and subsequently sent me for an MRI W & W/O contrast.  The findings of the MRI are as follows:  

"There are extensive bilateral punctate areas of signal abnormality in the deep white matter which number greater than 20 bilaterally.  No enhancing lesions are seen.  Normal flow voids are seen within the internal carotid and vertebrobasilar system.  No brainstem lesions are identified.  IMPRESSION:  NUMEROUS (GREATER THAN 20 BILATERALLY) PUNCTATE AREAS OF SIGNAL ABNORMALITY IN THE DEEP WHITE MATTER WHICH ARE EXCESSIVE FOR PATIENT'S AGE.  THESE CAN BE SEEN WITH DEMYELINATING DISORDERS.  HOWEVER, CLINICAL CORRELATION IS REQUIRED."  

I am quite concerned, especially since the neurologist they have referred me to see does not have an appointment available until September 27, 2006.  My headaches are continuing to worsen, and now I am experiencing intermittent vision changes where I am having episodes of double vision.  I am quite worried and a bit scared, and I am wondering if these are possibly early signs of MS?  Any information you could provide I would greatly appreciate.  Thank you very much.  
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Avatar_n_tn
I cannot give you a formal medical opinion unfortunately as this site is purely educational

In general, headaches are not a presenting feature of MS, and while isolated double vision can occur, it is more often with other signs of brainstem dysfunction such as clumsiness or vertigo.

This type of MRI finding can also occur in patients with migraine - and would suggest that your migraine needs to be treated more aggressively and comprehensivly with medications both to prevent headaches and treat acute headaches.

There are also other less common causes of this MRI appearance such as high blood pressure with mini-strokes, vasculitis, sarcoid, and some rare genetic diseases that [predisopse to blood vessel problems. Your doctor should be able to sort these out. The appearance of the dots on MRI can be helpful to decide (ie shape and distribution), and an MRI of the cervical spine that is abnoraml also might suggest an MS-type disorder.

Other tests to confirm or refute a diagnossi of MS include a spinal tap, visual evoked potentials and somatosensory evoked potentials - you could ask your doctor about these tests also

Good luck
7 Comments
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Avatar_f_tn
Chronic uncontrolled migraines could cause you to have these white matter changes.   But having double vision is concerning.  Don't jump to conclusions just yet -- go back to your neurologist, and have them check you for MS, just in case.  However, double vision which is short-lived (like a few minutes) may be just a sign of poorly controlled migraine -- go to a good pain / headache specialist in your area.
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Avatar_n_tn
I've been diagnosed with possible complicated migraine as MRI was normal, and so ruled out MS. I get severe migraines that more often than not, don't include the headache. I naturally have done alot of research into this and things that I have found out that may be relivant to you are as follows:
blurred and Double vision doesn't neccessarily just happen for a few minutes during the Aura - Auras usually only last this long for most, but they can go on for days or months - I supposedly had one for 3 months. - Look up basilar artery migraine in particular.
Migraines can get worse and become complicated migraines - increasingly without headache as we get older - I am also 37 and have noticed a major increase in severity and frequency in the last few years. I am assured by my neurologist that this is very common in people with a history of migraine.
As the above poster said - the spots on the MRI can be caused by migraine episodes. The radiologists are saying that your results need to be compared with clinical findings - you have not mentioned any other common MS symptoms other than visual changes which can be caused by migraines - try not to worry too much as this will only make your condition worse and it may be all for nothing. I went through 5 weeks of hell waiting for MRI results as my specialist said that I most likely had MS ( I had a whole lot more symptoms of it than you) And then found out it was all for nothing. I know its hard to stay calm, but I'd say the chances that its MS are pretty low - I'm no doctor - just going by what I've read. Best of luck to you.
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Avatar_n_tn
I've made an appointment with a neurologist in my area but cannot get in to see him until September.  My family doctor has been very concerned about this, especially because I am having to wait for so long, and even went so far as to call the neurologist's office to see if I could have an earlier appointment.  Unfortunately, it didn't help.  

As far as my vision symptoms, I don't have double vision as an aura of a migraine.  I have had episodes of double vision intermittently, sometimes with a migraine present and sometimes with no headache at all.  I also have very bad vision in my left eye, to the point that I am legally blind in my left eye.  I think the last time I checked my left eye vision was 20/400.  I used to have 20/20 vision in my right eye, which made up for the deficit in my left, and so I didn't really need to wear glasses other than to correct astigmatism.  However, now I am at the point that my right eye is still functioning, but I cannot see very well without my glasses on at all, and this has been a major change in just the last year.  Before I could see without glasses without really experiencing difficulty unless I was doing a lot of fine print type of reading.  

In regard to the headaches, I have been tried on Amitryptylene and also Topamax to help decrease the number of migraines, but neither of these treatments have worked.  Currently, I just take the migraine medication as soon as I feel my headache coming on and pray it will work without me having to either take more medicine or go to the emergency room for relief.  

The only other symptom that I can think of is that my memory has seemed to be affected.  I used to be very keen and sharp in terms of staying on top of things, and now I find that I routinely forget places I've put things, or events I was supposed to attend, etc.  I had initially blamed the memory loss on the combination of being under a high degree of stress as well as just getting older, but now with these other things I am beginning to wonder if I should be more concerned that they are signs of something more serious.  

Back to the neuro appointment - I live in Kentucky, and if anyone knows of a good neurologist in this area who could possibly see me before September, I would really appreciate it if you could pass along the information.  I would really like to see someone sooner if I possibly can at all.

Thanks so much, I appreciate your responses.  :-)
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Avatar_f_tn
Sorry, don't know anyone in KY.  Try looking up your major hospital's website to see who's around.  You can also call up their Neurology dept and they could direct you to someone local.  

As far as your worsening vision, while it may not be related -- you should _definitely_ go see an eye doctor to check it out.  It may be aging but it shouldn't affect just one eye so asymmetrically, make sure there's nothing else going on.

hope you feel better and see someone soon.
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Avatar_n_tn
HI to All.
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Avatar_n_tn
Hello Everyone,

I just came back from the Radiology and I had an MRI done for the pituitary prolactinoma because I have a high prolactin in my blood test.

My results state that I have a pituitary gland measuring 5mm and most consistent with a microadenoma. It also states that I have a giant cisterna magna or arachnoid cyst which measures 4cm.

The impression also stated:

1. MRI finding most consistent with a microadenoma in the right side of the pituitary gland which measure 5mm.
2. Suspected arachnoid cyst versus giant cisterna magna in the posterior fossa with a measurement of 4cm.

I am concerned about the results and I thought I could have someone explain to me the finding in simplest terms. I hope it isn't anything to worry about. Thank You
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Avatar_n_tn
A related discussion, what is a giant cisterna magna was started.
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