Possible MS

[Hernandez602]

I am a 38 yr old woman who had Optic Neuritis last year. I was given an MRI and received a 3 day solumedrol treatment. The MRI only showed that the optic nerve was elongated and swollen at that time. At the 6 month follow up everything seemed fine. A few months later I started to have painful intermittent legs spasms that lasted over a period of a few weeks. After that subsided, My right arm started to have the painful spasms. I went back to the doctor for my 1 year follow up and had a new MRI. The MRI showed "Diffuse T2 prolongation within the subarachnoid space diffusely on FLAIR sequences." I have had new bloodwork and an additonal MRI done. I am now waiting for my next appointment, but wanted to get some feedback as to what other may have expeienced. Any info would be greatly appreciated.

[DrNoopurMD]

Hi,

Overall your MRI report is normal with no sign of ischemia or tumor or raised ICP. There is however diffuse enhancement of the subarachnoid space which may be due an artifact or can be due to an infection like meningitis or is due to a chronic demyelinating disease like MS.
One of the symptoms of MS is muscle spasms which you have, therefore MS cannot be ruled out completely.
However a thorough neurological exam will help in making the diagnosis. Please keep in mind that this change in your MRI could be an artifact also.

[Hernandez602]

The findings were:

There is subtle increased intensity on FLAIR weighted sequences within the subarachnoid space diffusely. This is equivocal within the posterior fossa but seen over both cerebral convexities. There is no abnormal signal intensity within the ventricular system. This abnormal signal intensity does not demonstrate restricted diffusion. There is no enhancement of the meninges. There is no inherent T1 shortening within the subarachnoid space. There is no susceptibility seen on gradient echo weighted sequences. There is no focus of restricted diffusion to suggest acute ischemia. There is no intracranial hemmorhage. There is no mass. Cerebral and cerebellar morphology and signal intensity are within normal limits. There is no abnormal enhancement. The skullbase and skull are normal. The paranasal sinuses and mastoid air cells are clear.

Impression: Diffuse T2 prolongation within the subarachnoid space diffusely on FLAIR sequences may be artifactual from incomplete water saturation. Further clinical correlation is required. Differential considerations include proteinaceous material within the subarachnoid space from chronic granulomatous infection, granulomatous inflammation or possibly a demyelinating disease.


What does all of this mean? Again, I am still waiting for my follow up appointment with my neurologist. I appreciate your insight.

[DrNoopurMD]

Hi,

The enhancement of the subarachnoid space is seen in bacterial meningitis due to collection of exudates in the subarachnoid space. Another cause can be hydrocephalus due to increased CSF pressure in the brain.
Was there any other positive finding in the MRI? Please elaborate.