other explanations

I am a 31 yr. old woman, that has had many symptoms for over 15 months, rt. sided weakness, memory  and thinking problems, rt. eye pain and swelling in upper eyelid(eye exam normal) fatigue, and tingling mostly in toes and legs.  None other the symptoms are constant except fatigue which is better now.  I had MRI in Oct. '07, 5mm lesion deep in white matter of the left frontal lobe superiorly at the level of the corona radiata, abnormal bright T2 signal along with two adjacent tiny focal areas of smaller signal abnormality in the deep white matter of the right lobe superiorly, whatever that means, the radiologist thought MS but my Dr. doesn't think so. I have had all the labs done for lyme, B12, and all the typical tests all normal. Spinal negative.  If not MS then what else would cause the lesion to be enhanced?  I live in extreme S. Illinois and no MS specialist near-neuro I am seeing practices sleep apnea disorders-should I trust her opinion or look harder for second opinion? Any help appreciated

[Godofredo MD]

Hi.

Multiple sclerosis is a clinical diagnosis and, as such, is extremely difficult to determine in many cases.

White matter lesions can be suggestive of specific diseases if they are found in certain locations of the brain, but they are not specific for these diseases and can also occur in other conditions. Some disorders that could result in white matter lesions include migraines, multiple sclerosis, hypertension, and can also sometimes be age-related.

If you are hesitant to rule out multiple sclerosis right away, there are other tests that could help in determining or ruling out this differential diagnosis. Some of these include visual evoked response (VER), somatosensory evoked potentials, brain stem auditory evoked responses, and cerebrospinal fluid analysis. You could ask your doctor about this.

If you feel strongly about getting a second opinion, then you could opt to have one if you are not satisfied with the way your doctor may be handling your case.

Hope this helps you in any way.

Good luck.

[TERESA217]

Thanks for your response, I pray whatever is going on in my body is something easier than MS.  My blood pressure is normal, no migraines, and I am only 31, my spinal did come out normal though. I am having another MRI at the end of January to compare to prior done in Oct.  Does it mean antyhing that the largest lesion was enhanced while the other two weren't?  And does it mean anything if there are no changes on next MRI?  Thank You, Teresa

[Godofredo MD]

Hi.

It is good that your CSF analysis came out unremarkable. This means that it is less likely that multiple sclerosis is present.

Signal enhancement on MRI is meant to delineate areas that are not normal brain tissue, therefore the greater enhancement of the larger lesion basically means that the lesion is much more significant than the other two.

If repeat MRIs do not reveal any changes, it basically means that the lesion may be due to a non-progressive or very slow-progressing condition.

Go ahead with the follow-up MRI and let us know what happens.