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Significance of mri result???

I had an episode at the beginning of the year with a constant headache and visual impairment.  The mri showed several lesions, increased signal activity of the brain stem, and some demylenation. After a course of IV cortisone the symptoms got better.  Between follow up appointments I had a 3 week history of very weak knees which resolved on its own.  I have just been for a 4 month follow up and the mri results showed that a couple of the lesions have partially resolved however there was an increase in the signal activity of the brain stem compared to last time.  My neurologist is reluctant to make any sort of diagnosis at this stage as he wants to see if a pattern is emerging before committing himself.  However this does not help me! If anyone could explain what all this means maybe I could relax a little! :)
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147426 tn?1317265632
It is likely that the Stress incontinence is more related to the obstetrical history.  I think MS is high on the list of probabilities.  Yes, Get Thee Informed and push for the diagnosis.  Quix
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Avatar universal
Wow - thank you for taking the time to write! I am just copying my first blurb that I wrote here at the beginning of the year as it answers most of your questions.
Hi - was wondering if anyone else has experienced the same symptoms and what the outcome was. I have had a headache for 6 weeks, went to the ER and went for a CT brain scan which showed swelling. I was admitted and an LP was done which revealed high intra cranial pressure. The Brain MRI showed 3 UBO's,increased signal activity in the brain stem, chronic ischemic changes and demyelination. I was also told by the Opthalmic surgeon that I had optic neuritis. I was treated with IV cortisone and discharged on a reducing dose. My sight has improved slightly but the headache has come back since getting down to 10mg. I am a 39 year old female with 3 small children. I was diagnosed with fibromyalgia 6 months ago but am now concerned that may it is more likely to be MS? My neuro said there is a possibility that this could be once off incident or could be the start of something else. I am going for a follow up on 2/3/07 but am beside myself! Please - any info would be much appreciated!

Initially he said there was a 20% chance it could be MS but that should I have other 'episodes' obviously this percentage would go up.  I was in a bit of a state when I went to see the neurologist and I forgot to tell him a couple of things .... don't know whether they are significant or not! 1. My memory is really bad....maybe its stress! 2. My feet are permanently cold.... 3. I am quite clumsy with my right hand, forever spilling the sugar when trying to manoever the spoon to the mug, I did mention this to him last time and he said it was a side effect of the cortisone but I am not on it anymore and it still happens and last of all I get pins and needles in my right hand and often wake up with it completely dead! I have also just been to see the gynae for an annual check up and have been put on a tablet for stress incontinence.  I had to have a hysterectomy after my last child due to complications.  My neurologist said the stress incontinance was most likely to be an anatomical defect and not a neurological impairment.  As long as they can get it right ..... I am too young for this!!!!
I have quite a positive outlook on all this-as long as its not cancer or something terminal, it might be debilitating but as long as I can see my children grow up I think I can deal with it.  The biggest thing is not knowing and I get frustrated that I can't go forward at this stage! I am due to have another follow up on the 4th of September so I suppose I must just take it one day at a time!

Thank you for all the info am off to go and get 'informed'!  Take care of your self and look forward to hearing from you :)
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147426 tn?1317265632
This is just my opinion (I am a retired pediatrician with newly diagnosed MS).  From what you told us you have already established a pattern!  I don't know why your doctor isn't proceeding with that information.  Is this a neurologist that's holding off? If it is MS, and it well could be, it is important to "label" the patient, that is make the diagnosis, as early as possible.  In the majority of cases of MS, the most common type is called Relapsing-Remitting  and this can usually be treated with Disease Altering Medications.  These meds (usually a form of Interferon) have been shown to slow the progrssion of the disease and to slow the rate at which you accumulate disability.  They don't treat or improve problems that are already established.  They take several months to begin having an effect, so MS specialists try to begin them as soon as possible after establishing a diagnosis.

The diagnosis of MS can be difficult to make, but it isn't always.  Some people have very classic presentations and can be diagnosed shortly after their first symptoms.  When you had your visual problems was it diagnosed as "optic neuritis?"  Were you examined by an Ophthalmologist?  If so, this is the single most classic presentation of MS.  It is treated by IV steroids.  You also can have optic neuritis without having MS.

The diagnosis of MS requires evidence that there have been attacks on the white matter (the myelinated part of the nervous system) in at least two different places and that attacks have occurred at at least two different times separated by at least a month.

You describe the attack of visual problems which resolved.  (one attack in the visual nervous system, the optic nerve - maybe)  the next "attack" was of leg weakness. Was this both knees?  Bilateral symptoms are less characteristic of MS, but not impossible.  That problem also went away or "remitted."  If the weak knees "attack" was more than a month apart from the eye attack it could be counted as two attacks in different areas, separated by time.

Then there is the MRI with lesions both in the brain and the brain stem.  Two other different sites of attack, and there was a change with increased lesion activity in the second MRI which may indicate that this was merely an evolving lesion (not a new one) or a new one right beside it.  AND the MRI's indicate the lesions look like areas of demyelination.  That is what MS does - it attacks the nervous system causing demyelination.

Do you have any abnormalities on your neurologic exam?  Sensation defects, reflexes, balance problems, etc.  A neurologic defect provides even more evidence of an attack in even other locations.

Depending on the answers to some of the questions I think you might have already established enough criteria to make the daignosis, especially if that first attack was daignosed as optic neuritis.  If no diagnosis was made then you should have an evaluation by an opthalmologist called "Visual Evoked Response."  This test can determine if there was a prior episode of optic neuritis.

Finally, if someone EXPERIENCED in diagnosing MS is still unsure, the next appropriate step is a spinal tap, which can provide confirmatory evidence of MS or other related diseases.  People are often afraid of spinal taps and there are people here on this forum that have had problems, but ten's of thousands of taps are done every day and it is the small, small minority that have difficulty.

Have you had all the blood tests to workup "myelopathy?"  This is necessary because the diagnosis of MS also requires that no other disease is causing the symptoms.  This should be done immediately, if it has not been done.

There is a very nice website, that a non-MD has written about MS for people who need information.  It explains this information in more detail.  Copy and paste this link into your browser:

http://www.mult-sclerosis.org/

If you would like to, I would like to hear the answers to someof the questions I've asked.  I hope this post has not frightened you.  I looked at it like this during the two + years that I was losing function and couldn't get a diagnosis - I knew that SOMETHING was really wrong.  I wanted to know what.  Not knowing (but having a strong suspicion) was far worse than getting the diagnosis.  Then I at least had something to deal with.  Less than 25% of people with MS ever end up in a wheelchair.  It is not a death sentence.  AND I am not diagnosing you with it.  I can't.  I'm just putting together your information.  Also here is the blurb that I wrote up about my road to diagnosis.

http://www.medhelp.org/forums/Multiple-Sclerosis-Support/messages/23.html

Please write me back, Quix
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