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What will an MRI show?

Good morning, doctor,
     I am a 41 year old female, 5'5", 128 lbs.  I have been undergoing neurological tests for 5 years in search of a diagnosis.  My main symptoms are muscle fatigue. muscle weakness predominantly on my left side, Most noticeable in my arms, hands and legs. I also get a very intense burning sensation on my skin, predominantly my back arms and legs. I have dizzy spells that sometimes start with my eyes rolling back in my head.  I feel like I am being knocked over from behind although I don't fall.  Except for a grand mal type seizure last November. Because of this my Neurologist ordered an EEG which was apparently normal  and and MRI which will be done in March.
     Exercise seems to bring on the muscle fatigue very quickly. I am still able to swim, but not do aerobic activity without getting dizzy and weak in a matter of minutes.  My neurologist originally thought I might have a mitochondrial myopathy or calcium channelopathy. He had ordered MRI, EMG, spinal tap, bloodwork and muscle biopsy (Right upper leg).  The muscle biopsy did not show the ragged red fibres he was looking for.
      I was later sent to Montreal Neurological Institute for further testing and the only thing they came up with was that I had myodenylate deaminase deficiency, Which as far as I can understand could cause muscle fatigue, but not the rest of the symptoms.  I can remember reading on the Montreal neurologist report that she found "clonus" and "cogwhheeling rigidity".  
     My husband feels that my dizzy spells look like seizures.  Can you tell if a MRI would provide evidence for mitochondrial disorders, channelopathies, siezures or MS.  What exactly are the neurologists looking for on an MRI? I am currently on 20 mg. of Prozac and 400mg. of amantadine daily, both of which help my fatigue and the burning sensation.Any input would be appreciated.  Thankyou!
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Avatar universal
Dear Thelma:

Sorry that you have had such troubles and profound symptoms.  The combination of focal weakness, parasthesias, muscle fatigue with exercise, seizures, but also clonus and extrapyramidal symptom of cogwheel rigidity is difficult to sort out as all these symptoms are almost incompatible with a single etiology.  In the majority of cases, with multiple seizures an EEG should show something.  There is the chance of a frontal lobe etiology that can have a normal EEG but your symptoms do not sound like they are frontal lobe in origin.  Profound weakness and clonus are usually not seen together.  Usually spasticity and clonus indicate upper motor neuron signs, and the extrapyramidal sign of cogwheel rigidity indicates insult to the extrapyramidal tracts involving the basal ganglion, like in Parkinson's.  However, weakness is not a large compliant in this disorder.  Mitochondrial disease could give muscle weakness, fatigue, and extrapyramidal ridigity and also seizure-like events.  The muscle biopsy would not have to present with red ragged fibers as we usually do not see this except if specific types of mitochondrial diseases.  We usually, but not always find increased mitochondrial numbers in the EM of the biopsy.  However, you labs should have shown some abnormalities in serum and urine amino acids and/or organic acids.  The deficiency of myoadenylate deaminase might induce fatigue with exercise but certainly not give you profound muscle weakness or clonus or rigidity. What did the EMG show?  So, I am alittle confused about what your symptoms might be indicating.

Anyway, the MRI will show structure, changes in these structures and vessel blood flow.  These can be looked at by using various acquistions of the radiofrequencies.  So, if you have MS, one should see demyelination lesions in characteristic patterns.  Sometimes mitochondrial diseases will give you changes in the basal ganglion and maybe some changes with the MRS (if this is obtained).  Epilepsy can give you a completely normal MRI, but in some cases we can find areas of sclerosis (hyperintensity in the hippocampal regions) or neuronal migration abnormalities, or other known etiologies of epilepsy or seizures.  Unless, there is a structural lesion the MRI will likely not add to the diagnostic query.

Sorry, I am not much of a help.

Sincerely,

CCF Neuro MD

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Avatar universal
It sounds like alot going on here and while I can't begin to sort it I Encourage you to take a second look at the seizures if your husband thinks they are seizure in nature they could very well be and just because the EEG hasn't picked it up doesn't mean much either. Are you on any Meds? I HOPE YOU FEEL BETTER.
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Jay
I have been having the same symptons for 5 months now.  I have started seeing a neurologist and go back for my second visit this  week.  My regular physician gave up after many blood tests, two CTs and an MRI of head and neck.  I am having burning tingling spots all over my body, sparatic right side face numbness and almost a swelling feeling in my right nostril and ear that will go along with complete disorientation and not being able to think or  even forgetting where I am.  Constant left side body aches and burning, sometimes spasms and tightness, and a generally tired out feeling really quick if I exert myself and mucsle soreness in the morning when I really didnt do anything the day before.  I have seen a few sites on MS and it describes my problems to a "T";  although the doctors have not said I have it.  The problems I have will come and go where I will be bothered with it for 2-3 weeks and then it  will go away for 1-2 weeks and I feel great and then it comes back again.  Also my problems go away while I am asleep and come right back an hour after I am up and moving.  Is this common with  MS??..  Just wondering if my neurologist should look into this more.  When my MRI was done I dont think they were looking for MS, I think he was looking for more of a stroke related or nerve thing.  Even if he was not looking for it would MS still be  visible in the MRI or do they have to have the equipment set up to be looking for certain things?  I was sent to a physciatrist for the anxiety all of this has been causing me.  She said anxiety is normal when you do not know what is going on with your body, but she also said that anxiety would not cause all of these lingering symptons I have and gave me a prescription for clonopin to calm my nerves some and ended it after only two meets and said I really need to seed a neurologist about this.  The funny thing is the clonopin really helps some with the burning sensation also, not just the anxious and scared feeling. It never makes it go away but it does make  it feel better.
Any help on these questions would be so thankful.
Jay
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Avatar universal
Dear Jay:

The MRI is not diagnostic of MS.  It only helps in the diagnosis.  Although MS can present with parasthesias the symptoms would not as frequent as you describe without any MRI changes.  However, one never knows and there are a few patients who present with parasthesias and no MRI findings, but they usually have an abnormal CSF, with increased MBP, oligo clonal banding etc.  Yes, MS would show areas of demyelination on the MRI whether one is looking for stroke, headache, vascular malformation etc.  Usually, the parasthesia are in a pattern that is focal.  This would mean that the tingling would be in the legs or arms but not all over the body as that would mean that your whole sensory cortex is being affected and certainly the MRI would be positive in that case.  I would favor that this is not MS, but your neurologist can tell you after the neurological exam and his/her assessement that would be much better than my internet feelings.

Sincerely,

CCF Neuro MD
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Avatar universal
Jay
Thanks so much for your input.  Last question, I go back to the neurologist this week.  A month ago he gave me a prescription  for migranes thinking that is what is causing it, even though I do not have headaches.  Does that make any sense to you?  The prescription did not make any difference on my symptons.  
What do you think about how my problems do not bother me in my sleep, only when I wake up and start moving around?
I know you cant really make a diagnosis by reading this but by your experience and what I have told you what do you think it may be? What direction do you think I and the neurologist should be looking to find something?  Its getting to me not knowing.. I had another bad episode today of my right side of my face feeling numb and swollen, and very disoriented today.
Thanks again for your time.
Jay
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Avatar universal
Thank you for your reply, Doctor.  
     The 1st EMG was done in May, 1995.  I was told by my  neurologist that the EMG was normal.  He referred me to my 2nd neurologist. The 2nd EMG was done in Aug. 1995. The report to my doctor reads "detailed electrophysiological studies, including assessment of neuromuscular transmission was normal, with no evidence of either pre or post synaptic transmission defects."  
After a year of clinical assessment and several normal blood tests, She referred me to MNI. She did not find clonus in her examination in Aug 1995.  In October 1996 the 3rd neurologist(at MNI) noted the clonus and cogwheeling rigidity. I have not had any more EMG tests. The first muscle biopsy (May '95) showed selective atrophy of type 2 fibres, and that the ends of the fibres were angulated and there was no evidence of inflammation and no necrosis.  I am sorry this is all I can remember from seeing the report. The only thing I know about the 2nd biopsy (Jan '96) from my upper left arm is that she said it indicated MAD deficiency.  As far as I know all serum tests and urine tests were normal. During the May 95 testing the levels of pyruvate and lactate were opposite of what they were expecting, but I don't know if they were out of the normal range. The 24 hr urine tests have included 5HIAA, Free cortisol, 17-ketogenic steroids, aldosterone and arsenic I believe.
     I really don't feel much worse, than 5 years ago.  Certainly the Prozac and amantadine have helped my energy levels and burning skin sensation.
     I have a few more questions. Do clonus and cogwheeling rigidity ever go away on their own or are they something that is permanent? Could they change from one day to the next?  i.e. would they always appear from now on during a neurological exam?
     I have a few more recent signs? _ well I am not sure if these are sign or strange habits.  My left arm on its own goes into an odd position of being bent at the elbow, parallel to my waist and my left hand hangs down as if it is limp but it isn't.  Then I move it back to a normal position, but it does this several times a day.  It does not hurt at all.  The other one is that my left hand goes into a claw like position with the fingers and then the hand stretches backwards.  It reminds me of a hawks claws sitting on a perch.  It doesn't hurt either but I thought maybe I was doing it subconsciously to relieve tension.  Are either of these actions indicative of anything in particular?  Than you again for your time!
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jan
Dear Thelma,
Hi, it's me, again.  Weds. night I had the wave feeling again.  This time the knock down part was a little stronger or I was just more in tune(?) and I think maybe it is almost passing out or falling asleep (like a terrific drowsy feeling).  It's hard to explain, it's like being drawn, almost into unconciousness, after being pushed.  I think that is why I swayed the first time. (I would be afraid to tell anyone who doesn't experience these waves this,it sounds crazy).  Would you agree that is part of the sensation?  Maybe, if it is almost passing out,it would fit in with the neurocardiogenic syncope.
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Avatar universal
Hi jan.  When I have the waves I almost feel that I am temporarily paralyzed.  I can still hear what people are saying, but I can't talk or move my head.  It is as though i am stuck or frozen in position, I don't think I sway, but I do feel like I am being pushed from behind.  I feel like it starts in my head and travels down the rest of my body. My neurologist looks at me strangely when I describe it. I know that sometimes my eyes roll back in my head because people tell me.  Today i had some at church, after a lunch, during an annual general meeting and I almost felt like I was losing consciousness, or falling asleep.  This is why I wondered if eating had anything to do with it, it seems to happen at mealtime a lot.  My MRI is now less than 3 weeks away and I'm hoping (possibly in vain) that it may provide some clues.  
     At any rate the dizzy spells have not been as overwhelming for the last 2 weeks but the weakness in my left leg has been very frustrating. Hope you are doing OK!   Bye for now,   Thelma
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Avatar universal
I have what I've been describing to my doctor as intense, wave-like rushes in my upper chest. They seem to radiate from the top of the breastbone and go right up through my head making my eyes feel like they want to roll back.It only happens for a fraction of a second but they are happining more frequently now. I also experience a rigidity in my muscles that makes them want to tense up all the time. I've also noticed that it feels like every bit of cartilage in my body is drying up (sounds crazy) because every joint in my body is starting to crack, pop and seize up along with little muscle tics in my arms and legs.
I'm 29, just had my gallbladder removed (after being misdiagnosed for over a year for everything from reflux to panic disorder)and I still feel very "strange". I've had several tests: thyroid, ECG (heart), bone scans, x-rays on spine and ribs, 3 or 4 ultrasounds, nerve conduction studies... I feel like I'm losing my mind and hope, I know my body and there is definitely something "not right". The biggest problem for me is living in Canada where CAT/MRI scans are extremely difficult to get. Maybe I'm fearing the worst but I hope this isn't MS. I'm tired of our Vancouver, BC  doctors' condescending attitudes and generally telling me I'm over-reacting. I practically had to beg for the test that determined my polyp-covered, 3 stone, strawberry gallbladder hence my total lack of faith in my healthcare system. Any comments, suggestions anyone?
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jan
Dear Thelma,
Now that I think of it, it does happen often at dinner time, like Weds., but dinner time isn't always a consistent time and yet that's a time it happens.  This is why one of the first tests I had done was for blood sugars, it was negative, but often I feel better after I eat.  Yes, I , also, feel like I am being pushed from behind and like I said, I ,too feel like I am going to lose conciousness or just immediately drop off to sleep (like an overwhelming drowsiness).  I don't feel like the wave travels down my body, just from back to front of my head.  The only time I have ever experienced weakness with my limbs (arms) was Thurs., but not with the wave, just feeling terribly nauseated.  This past week I have had the wave (Weds.), Nausea and arm weakness (Thur.), and (Fri.) a mild pain in the center of my chest and just about blacking out. I think it must be from the neurocardiogenic syncope, why my medicine isn't helping is a mystery.  I do hope you get some answers with the MRI, let us know!  Have you had a Tilt Table Test?
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Avatar universal
Hi Jan.  I have not had a tilt table test.  I had never heard of it until I started reading on this forum.  I will ask my doctor about it.  The dizziness and waves are back and driving me nuts, and the leg weakness is worst later in the day, this is one of the more fatiguing weeks I've had in months.  Not that I am doing any more, it just seems to come and go that way.  Thank God it's only 2 more weeks until the MRI.

     Note to Tammy: I know how frustrating it is to wait for tests, I live in Ontario. I have been waiting 3 months for an MRI. (after a seizure).  I haven't had to "beg" for any tests but the waiting lists have been hard to take, and there were times I thought I might go crazy. I knew several months before the doctors did that something was wrong.  My body just wasn't working like it used to.  However I had a baby and 2 year old to look after, it wasn't easy.  My husband is very supportive, but it's hard on him too.  I don't want to sound like a psychiatrist, my neurologist suggested prozac which at first I didn't want but within 2 days of taking it the waves of dizziness lessened and my skin stopped burning so intensely. However in the meantime (3 years) I also tried the following which offered no relief: benadryl, cimetidine, zaditen, tegretol, Tylenol 3, amitryptiline, voltaren, pemoline, ibuprofen and other pain medications. So don't give up. My life is better now than 5 years ago, although it has never been what it used to be and I have never felt like I used to.  I am also on another medication to treat fatigue called amantadine. I am wishing you the best of luck. I have found that the teaching hospitals are quite thorough.   Bye from Thelma
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Avatar universal
thank you for your comments.

CCF Neuro MD
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Avatar universal
This sounds so classic for temporal lobe epilepsy. Read up on it! EEG is not always great at dx'ing TLE. Your neuromuscular-type condition might be unrelated...
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thanks for the comments.

CCF Neuro MD
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Avatar universal
Hi jan! I had the MRI 2 nights ago and will probably get results nest week.  My left side has been a lot better for the last weeek and also a lot less dizzy spells.  The best week in the last month. I looked up some info on temporal lobe epilepsy and to me it didn't really sound like it but who knows, the MRI technician said the requisition sheet said Seizures, but I guess they look for everything on the MRI.  It is really a relief to not feel as weak and dizzy for awhile.  How are you doing?
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jan
Hi Thelma,
Glad to hear you have been feeling better!  I remembered about your MRI and said a prayer for you.  I am sure you are very anxiously awaiting the results.  I am feeling better, too.  My Dr. thinks I had something viral going on that was causing breakthrough episodes.  Have you asked your dr. about a tilt table test?  I will be watching the forum for your MRI results. God bless. Jan
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Avatar universal
thanks for your comments.

CCF Neuro MD
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Avatar universal
Thelma,
The hand clawing sounds like Dystonia. It can be induced by certain medications Like amytripteline.
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thanks for the comment.

CCF Neuro MD
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Avatar universal
Hi! I got the results from the neurologist's office that the MRI was "unremarkable".  I will see my G.P. mid April and be able to read the report then.  It seems as though it is not providing any new information. The last three weeks haven't been bad in terms of the waves but the fatigue has been overwhelming a lot of days, at least half. Which means I cut down on the amount of stuff I do and increase the amount of sleep to include 2 daytime naps , atleast while my daughter is in school ( 3 days a week). My left leg ia the most bothersome at the moment, I went on a short (1 1/2 hour ) field trip to a sugar bush with her kindergarden class yesterday and managed being on my feet for about an hour, which is a long time for me.  But it was the best day I 'd had in awhile and I almost felt like I looked like any other normal parent until another mother asking me why I was limping.  I actually thought it wasn't noticeable to anyone, because it felt as close to normal as it has felt in years. So life goes on.  How are you doing?  I hope well, take care!
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jan
Dear Thelma,
I was so concerned because it's been awhile since you posted and you had said you expected the results the following week.  I was hoping that, like me, you thought you would have the results by then, but these things don't happen as fast as we'd like.  I know it's disappointing to be told "unremarkable", but finding something could've been worse.  I am glad to hear you are feeling better (except for the fatigue, which I know is enough all by itself).
The last 2 weeks I've been kinda sluggish, I wish I had told my cardio., but I was afraid he'd increase my medicine (then I would really feel fatigued).  Because my pulse rate has recently gone up to as high as 136 he is talking about adding a calcium channel blocker to my betablocker. Thrills. :o
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Avatar universal
Thanks for the comments.

CCF Neuro MD
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Avatar universal
Hi! How are you doing?  I had 3 fairly good weeks, then got a very bad dizzy spell playing junior monopoly with my kids 9 days ago.  i went to bed for an hour and felt better after the nap.  I saw my GP the next Monday and talked about the dizzy spells and seizure from last Nov.  He said based on my description and what my husband described he would have had to take my license away.  So if it happens again I will lose my license, which would be difficult as we live out in the country(in a small village).  I read my neurologists report which said it could have been a tonic clonic seizure and that he elected not to treat me at this time.  My GP thinks it is probably because the medication might cause more side effects than it is worth.  At any rate, after we get our videocamera fixed, my husband is going to videotape the dizzy weak spells to show my GP and neurologist. I had another very bad dizzy spell on Wed. and my left side is weak again.  But I am coping OK.  I will post again to let you know how I am doing in a few weeks.  I hope you return to this post and I hope that you are doing well!
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Thanks for your comments and keeping tabs on one another.

CCF Neuro MD
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