Brain Lesions

[larandsandy]

Hi, I am a 44 year old female that has had vascular migraines since I was 10 or so.  I have both aura and non-aura headaches.  My last MRI 3 years ago stated that I had multiple brain lesions with the T2 signal.  They were not ovoid in shape or tranversely oriented.  It also stated that with the history of migraines they were probably caused from that.  Can you tell me the difference between lesions from migraines and lesions from MS?  I am having problems with ear pain that I just had a CT scan for but haven't received the results yet.  There is nothing upon examination wrong looking with my ear, so the pain is a mystery.  Whenever I am outside and if I am not wearing a hat, I get a bad earache that evening.  It is only in the one ear and hurts enough to have to take Advil for the day or so.  The ENT ordered a CT scan which we are waiting for results, but I think she is thinking maybe MS.  Your thoughts are appreciated.  

[CCFNeuroMD JT, MD]

Dear larandsandy,

Thank you very much for your question. I am happy to address the issues that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.

Indeed, as you may have come across on previous Medhelp postings, people with migraine headaches may in fact have T2 MRI changes evident in the white matter.  Distribution of white matter lesions in migraine are non-specific, although some studies indicate a tendency for these lesions to be most common in parts of the frontal lobe and a region known as the centrum semiovale.  We do know that MS lesions often have a characteristic appearance, although lesions may be scattered throughout the brain.  The most common locations for MS lesions include parts of the brain around the ventricles, cerebellum, brainstem, and spinal cord.  "Textbook" lesions are somewhat oval in shape, oriented perpendicular to the lateral ventricles in a configuration known as Dawson's fingers.

As far as your ear pain is concerned, this is not a typical manifestation of multiple sclerosis, although I agree that you should probably see your physician to have the ear pain evaluated.  From the history you relay, there are no clear red flags that indicate obvious multiple sclerosis.  If you have not done so already, you might benefit from seeing a neurologist who can take a look at your MRI and do a through exam. He or she may opt to perform a lumbar puncture to check the spinal fluid for abnormalities consistent with MS.

Thanks for your question, and good luck!

Best,
JBT, MD

[bktiner]

A related discussion, wanting another opinion about possible MS was started.