Where should I look for help ?

[vanhawk48]

Short  medical  history
Female 52 year old , history of rheumatic fever in early  childhood .
Never dx  with  with rheumatic heart , but  in early 20 , developed
supraventrical  tachycardia . Clear from tachycardia after
Radio - frequency Ablation in 2000. Since  early 30 es , I have
had 4 - 5 bouts of vertigo .
Last vertigo
prompted my first MRI which findings are : There is  approximately  
1 cm  irregular focus of FLAIR and T2
hyperintensity in the deep left frontal  white matter lateral to the
caudate head . The location is not typical of multiple  sclerosis ,
although the size and shape is atypical of chronic small vessel
ischemic change . There is contiguous extention of this  into
the anterior  aspect of the left external capsule . There is a pun -
ctate , nonspecific  , rounded focus in the mid left centrum  se -
miovale just at the upper margin   of the left lateral ventricle .
Another punctate , nonspecific focus in the left frontal subcortical
white matter of the superior frontal  gyrus is noted.
The brainstem and cerebellum  are free of significant  lesions .
Minimal faint subinsular focus is noted on the right .
Comparison is made to the prior images dated 10 / 28 / 08 .
Allowing for minor variations in slice position , no significant
change  is noted since that time .
No spinal lesions detected by radiologist , but couple
found by neurologist by looking into the MRI images .
One lesion in cervical , one in thoracic .

My  question is : what direction should I go from here ?
Just recently  I have read about  " Rheumatic brain disease " ?
Is  it possible that  my brain  lesions are of rheumatic origin ?
Is it possible  it is MS which causes some changes in Autonomic
Nervous System ? I have , stomach ulcer and bladder problems
( periodical  retention , periodical urgency) .
I have many neurological symptoms but no answers .
MS specialist doesn't know what it is .
Regular neuro doesn't know either .
Please  help  me  out .

[Kevin Pho, MD]

As you suspected, the MRI does not give any conclusive findings.  It does mention the possibility of MS, and if your neurologist suspects this, further tests like a spinal tap can be considered.

Regarding the vertigo, you can obtain an evaluate by an ENT specialist, to exclude vestibular disorders that can lead to persistent symptoms.

If there continues to be concern about MS and other neurological causes, a second opinion can be obtained, preferably at a major academic medical center.

Regarding the possibility of rheumatic fever being involved, this is not a typical presentation.  That doesn't rule it out completely, but I would consider other neurological causes first.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd

[vanhawk48]

Thank you dr Pho.
If I  may  add to this my journey with possible MS started in Oct.2006 . Since than I have been seen by MS specialist , who gave me three answers ; - possible MS , MS , probably not MS since you have not had additional lesions load in last two years .  The same MS specialist who said , he would see me on oral MS drug , as soon as they are on the market . This specialist left the town , so I found  another Neuro  who  is not MS specialist . During my second visit and presentation of clinical history , he said regardless what my June MRI shows , I would like to discuss DMD . Now  this neuro received  the above (posted in my first question)  radiologist reading  and we are back in square one .
I did have major MS test done  2 years ago . CSF      negative , Lyme disease negative , all rheumatologic factor excluded ,BAEP - at treshold , VEP -normal ,
SER normal . MS specialist during initial examination : positive Romberg , nystagmus , anisocoria , and he also told me : there is no question  that there is something neurological going on . In   ENT specialist opinion my problem is neurological .Current symptoms include : L'Hermitte , insomnia , bladder retention , fatigue , heat sensitivity . Also radiation caused  was excluded , at that time I lived about 1000 miles from   Chernobyl catastrophy .
What would be typical presentation for Rheumatic Brain Disease ?
Please help ? I would like to know what's wrong with me .
Thank you very much .