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Can anyone explain this MRI, in layman’s terms? MS has been suspected for years.

Impression

Findings most consistent with a poorly visualized chronic demyelinating lesions
involving the dorsal and right aspect of the spinal cord at the T7 level and the
ventral aspect of the spinal cord at the T10 level.

Narrative
INTERPRETED BY:  Richard Blair, M.D.

STUDY:  MRI OF THE THORACIC SPINE WITHOUT AND WITH CONTRAST

DATE OF EXAM:  6/6/2019 10:21 AM

HISTORY:  Lower extremity numbness and tingling.

TECHNIQUE:  Thoracic spine MRI: Sagittal T1-weighted, sagittal T2-weighted,
sagittal STIR and axial T2 weighted images were obtained. Postcontrast sagittal
fat-saturated T1-weighted images were obtained.

CONTRAST:  10 mL of Gadavist were administered intravenously.

COMPARISON: Thoracic MRI from May 24, 2018. Lumbar spine MRI from April 24,
2018. Cervical spine MRI from May 24, 2018. Brain MRI from August 10, 2017

FINDINGS:

Bone:  The vertebral bodies are well maintained and normally aligned.  The bone
marrow signal intensity is normal.

Intervertebral discs:  Small disc space osteophytes at multiple levels without
mass effect on the spinal cord.

Neural foramina and spinal canal:  The neural foramina and spinal canal are
widely patent.

Spinal cord: The thoracic spinal cord appeared heterogeneous on the sagittal
STIR images from May 24, 2018. That heterogeneity persists . The findings are
most consistent with similar poorly visualized nonenhancing T2 hyperintense
intramedullary lesions. One lesion involves the dorsal and right aspect of the
spinal cord at the T7 level. The other lesion involves the ventral aspect of the
spinal cord at the T10 level. There was similar subtle increased signal

Conus medullaris: The conus medullaris ends at the L1 level and appears normal.

Enhancement:  The pattern of enhancement is normal without abnormal
leptomeningeal or intramedullary enhancement.

Additional findings:  None.
2 Responses
987762 tn?1331027953
COMMUNITY LEADER
Hi and welcome,

If MS has been suspected for years you'll know your Thoracic MRI was specifically looking for spinal cord lesions, which seems you do have, one at T7 and one at T10 but i honestly can't tell from the language if the report is referencing them as being seen in your 2018 MRI as well. The "poorly visualized nonenhancing T2 hyperintense" is basically just saying they are very hard to see, which from my understanding isn't uncommon with Thoracic lesions because the spinal cord gets narrower and the lesions are also smaller.

I can't give you much more than that sorry, it's late over my side of the globe and my brain is mushy peas at the moment but i'll have a look in my research files tomorrow to see if there is anything specifically about Thoracic spinal cord lesions that you might be helpful to you.

Do you know why your neuro hasn't committed to diagnosing you with MS, there is usually a reason but it's not always a good reason and IF you do have enough diagnostic evidence to meet the minimum required for the MS Mcdonald diagnostic criteria it might be worth considering getting a second opinion with an MS specialising neurologist if you haven't already that is..

Hope to have more information for you tomorrow......JJ

4 Comments
Hi and thanks.  I do have a new neurologist.  She is a specialist and did this new MRI.  She’s really good and I’m waiting for a call from her now.

I don't know why my last neuro didn't diagnose me, I've got to think it's because the lesions on my brain were either non-specific, or he'd say they were in the wrong place, or too small or from getting older.  I'm 53 now.  

I’ve been waiting and suffering for 15 years now so this could be quite a breakthrough for me....

I have a positive babinski and my primary care doctor was the one that suggested I see a specialist that she recommended, so I did and I love her.  I feel much more confident with this new doctor, as she's also the head of neurology.

Thanks again I will await your response.  I’m actually going to email my doctor tonight and see how f I can get her to call me sooner...
This is just a selection i have, some may be more informative than others, if you want more i'll put them up tomorrow :D

"T-1 through T-5 nerves affect muscles, upper chest, mid-back and abdominal muscles. These nerves and muscles help control the rib cage, lungs, diaphragm and muscles that help you breathe.

T-6 through T-12 nerves affect abdominal and back muscles. These nerves and muscles are important for balance and posture, and they help you cough or expel foreign matter from your airway.

The thoracic spine is built for stability and helps keep the body upright. It connects the cervical spine, which is located in the neck, and the lumbar spine, which is located in the lower back."
https://www.shepherd.org/patient-programs/spinal-cord-injury/thoracic-spine-injuries

https://www.nature.com/articles/sc2014238

"Spinal MS is often associated with concomitant brain lesions; however, as many as 20% of patients with spinal lesions do not have intracranial plaques. Contrary to the white and gray matter in the brain, white and gray matter can both be affected in the spine. "
https://emedicine.medscape.com/article/342409-overview


"Typically when people think about multiple sclerosis (MS), the brain is usually the focus. It's not uncommon with MS, however, to discover multiple silent brain lesions on magnetic resonance imaging (MRI) and find a person afflicted with only spinal cord problems due to the disease. Sometimes the symptomatic spinal cord lesions are more difficult to identify on scans than some clinically quiet but MRI evident brain lesions. About 90% of those with MS find that their spine is involved at some point."

"There are several symptoms that show signs that there is damage in the spinal cord. In the spinal cord the nerves that deal with the whole body run very close together down the cord. A single lesion can cut across an area that affects a large section of the body. One good sized lesion can essentially "cut off " the body below it as if the spine had been severed. This is the worst case scenario of the lesions of transverse myelitis, however, most lesions are not that large. The areas that deal with the motor functions on one side, all run together and the part of the cord that handles the sensory input is all on a different section from the motor.

As the cord runs down the back, the nerves branch off and leave the cord, thus becoming peripheral nerves. The nerves to the arms leave the cord in the cervical spine. The nerves that control the muscles of the torso leave in the lower cervical spine and the from the thoracic. The nerves to the legs travel on through the cervical and upper thoracic to leave the spinal cord lower down. Many of them stay in the spinal canal below where the spinal cord ends as a loose-floating bundle of nerves called the "cauda equina" or horse's tail. These nerves exit through the vertebra in the lumbar spine.

The greatest concern is the fact that the spinal cord is basically a bundle of wires that are very small and compact. A single lesion in this area will affect many nerves and the systems that they control. Unlike the brain where the damage is more specific or precise, in the spine it essentially is more widespread. "
https://my-ms.org/anatomy_spine_damage.htm


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184558/

Glad to hear you have a new neurologist you are confident with, it definitely helps......JJ
Wow, this is SO informative, thank you!  Right now my main problems are balance, hip/back/leg stiffness and awful burning pain and numb sensation in right foot/ankle.  My left leg feels numb from the knee down ALL the time.  Brain fog is also a biggie along with fatigue.

I have many other strange symptoms, cramps, stabbing pains, tremors etc., but the above are my worst and won’t go away.  I’ve had bowel problems also, soooo awful!!

Hopefully this neuro will help me, I just wasn’t sure if this MRI was saying they’ve finally confirmed lesions on the spine.  Fingers crossed for some long awaited treatment..,.

Thank you again...
Supermum, my doctor called today.  She said the MRI confirmed what she thought, that she feels it's MS.

She said the two lesions on my spine were missed in 2018 bcuz they're on the thoracic spine, a hard place to see them, like you said, but she did see them and confirmed them with this MRI.

Next step, to diagnose me, is to do a lumbar puncture to check for O-bands in my spinal fluid, or if I didn't want to do that, she said we can go back though my history, from when this all began to check for other lesions.  She can put me on Baclofen for my stiffness/spasms but she said the nerve pain and damage is too late to fix.....

She didn’t want to talk too much on the phone and wants to sit down with my husband and I to talk about next steps, any possible treatment etc.

Can they sedate me for an LP?  Should I get it done?  Any suggestions on meds?  Is there anything they can give me for being off balance all the time?  I can't believe there's nothing they can do about the numbness sensations and tingling.  What does everyone else take, and does it help with whatever symptoms they're having?

Oh well, I'm very anxious, as you can tell.  Thanks for listening...

Sharon

p.s. I read your profile, and felt like I was reading my story.  We think my son has aspergers too...
987762 tn?1331027953
COMMUNITY LEADER
Well it sure is a small world, way back i use to call my place Aspie central because we've got 4 altogether (both my brothers, and both children, daughter and son) hmm DD is pregnant with our first grand baby so it could actually be 5 soon :D

Getting diagnosed with MS even when it's not totally unexpected can still be very scary but one thing i've learnt over the years is that even though everyone is dx with MS, each MSer is unique because no two can ever be exactly alike....

Disease modifying treatments targets the disease to slow down and or minimise relapses, and on top of that there are different types of symptom medications, physio, orthotics etc etc etc which helps you manage or improve function etc for all the different specific issues you have.

Technically nothing can undo the damage a lesion or lesions has already caused but and there is a big but, both brain and spinal cord lesions can actually shrink, remyelinate, heal partially-fully, disappear etc etc as well as cause intermittent or permanent symptoms. Spinal cord lesions are more predictable than brain lesions because the brain has millions of neuron's and might not even cause a symptom and or with 'brain plasticity' the brain with focused help can rewire around the road block the lesion is causing. um that might be a tad confusing sorry but the point is that lesions don't always cause permanent damage and if or when it does, you do have treatment options...

"I can't believe there's nothing they can do about the numbness sensations and tingling.  What does everyone else take, and does it help with whatever symptoms they're having? " You are right because there are a lot of different symptom treatment options depending on the type of issue, location etc and what works for one person may not work for another but there will definitely be 'something' that helps YOU function better!

Whether of not you should have a lumber puncture or not you honestly need to discuss with your neuro more,    you may already have enough MS specific diagnostic evidence to diagnose you with out it but you may still require additional diagnostic evidence too. You can i believe be sedated but that would be unusual, personally the idea of it and the horrible experience stories you'll read about online if you go looking are pretty much chalk and cheese from the reality of having the LP done, i was expecting it to be terrible and it honestly wasn't.

I am happy to talk and listen any time you need, no question is off the table here, hugs..........JJ
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