MRI question about lesions after unilateral Babinski and ankle clonus
Hi, My pain specialist found I have hyperreflexia, both ankle clonus, and Babinski sign in my right foot only. I've had EMG and nerve conduction I have no pinched nerves but some slowing of my nerves. This question is about a my MRI (w contrast) report.
The rest of the report is easy with statements such as "There are no definite space occupying lesions seen within the calvarium". "no evidence of acute infarct":
"The brain architecture is grossly unremarkable. There are no definite white matter lesions appreciated within the corpus callosum. There are some mild scattered periventricular and subcortical white matter changes bilaterally. These are best seen on images 27 throught 31 of the axial FLAIR images. None of these lesions demonstrate enhancement. There is no definite evidence of abnormal enhancing mass appreciated within the visualized brain parenchyma. There is no evidence of significant cerebellar atrophy appreciated. The double inversion recovery images do not demonstrate evidence to suggest heterotopic gray matter. Susceptibility-weighted images also do not demonstrate evidence of significant hemosiderin deposition within the brain parenchyma."
Under the "IMPRESSION" section there is this that appears to be an interpretation of the above paragraph. Is that true?:
There are a few scattered nonenhancing regions of periventricular and subcortical white matter signal change. There are no white matter lesions appreciated within the corpus callosum. Findings are nonspecific but can be seen in the setting of sequela due to migraine headaches, old viral etiology, or old trauma, In this age group (~50) other etiologies such as vasculitis (including collagen vascular disease) chronic hypertension, can also have this appearance.
Are there lesions or aren't there??? I'm confused. If I have a unilateral Babinski and ankle clonus and no lesions or tumors, then what next? I've had a blood tests, too. So hard to wait for a diagnosis. *pout*
Dear, we should first of all rule out MS via a lumbar puncture. high IgG monoclonal bands level means a multiple sclerosis, we still improving the definition of this entity knowing better its etiology and dividing it to autoimmune and post viral, in my opinion both of them are post viral but one very early and one late.
migraine is less probable to leave sequelae in a form of Babinski...
please start with a cerbrospinal fluid study and never with useless electrical studies
I assumed the next step is lumbar puncture if there were no MS lesions found in the MRI. I will see what the results of my blood work were and what he says. The lumbar puncture might be exactly what he orders next.
Thank you so much for your time and for sharing your expertise.
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