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Can someone please explain this MRI, in laymen’s terms?
I have had symptoms for quite a few years now, and recently I went back to my neuro because I was having bladder/bowel incontinence and my right foot and lower leg feels encased in cement, and tingling/numbness, along with being off balance and extreme fatigue. He ordered an MRI w/wow contrast, but I don’t know if anything’s significant or not. He keeps looking for MS, why? Shouldn’t that have been ruled out by now?? I don’t have migraines and I am 51 years old. I started having symptoms in 2006, starting with L’hermittes in my leg and foot. Sorry for the “book” but I’m confused.
FINDINGS: Examination of the sagittal midline T2 FLAIR sequence
demonstrates normal pituitary sella. No suprasellar lesion.
No abnormality at the foramen magnum.
Multiple bilateral corona radiata white matter FLAIR signal foci are
demonstrated on images 16 through 25 of series 8. No cerebellar or
brainstem FLAIR signal abnormality. No focus of restricted diffusion.
No enhancing intra-axial mass or midline mass effect.
Normal ventricular system.
Normal cerebellopontine angle cisterns. Normal internal auditory
canals. Normal T2 weighted flow related major intracranial signal
voids.
Normal globes and retrobulbar spaces.
Normal T2 weighted flow related major intracranial signal voids.
IMPRESSION: Nonspecific bilateral multifocal cerebral white matter
FLAIR signal pattern. Differential considerations include multifocal
microangiopathic leukomalacia, demyelination and multifocal gliosis.
White matter FLAIR signal foci can be observed in the setting of
migraine disorders and infectious processes.
FINDINGS: Examination of the sagittal midline T2 FLAIR sequence
demonstrates normal pituitary sella. No suprasellar lesion.
No abnormality at the foramen magnum.
Multiple bilateral corona radiata white matter FLAIR signal foci are
demonstrated on images 16 through 25 of series 8. No cerebellar or
brainstem FLAIR signal abnormality. No focus of restricted diffusion.
No enhancing intra-axial mass or midline mass effect.
Normal ventricular system.
Normal cerebellopontine angle cisterns. Normal internal auditory
canals. Normal T2 weighted flow related major intracranial signal
voids.
Normal globes and retrobulbar spaces.
Normal T2 weighted flow related major intracranial signal voids.
IMPRESSION: Nonspecific bilateral multifocal cerebral white matter
FLAIR signal pattern. Differential considerations include multifocal
microangiopathic leukomalacia, demyelination and multifocal gliosis.
White matter FLAIR signal foci can be observed in the setting of
migraine disorders and infectious processes.
Hi! I concur with JJ, but have a couple questions. This MRI doesn't say "comparison made to" nor "no comparison available", nor anything else. A single MRI can rarely if ever dx MS. If the clinical history and single MRI are paired with ON or SP - then it's possible. T2 hyperintensities in the corona radiata are consistent with MS - just not in themselves diagnostic. The peri-ventricular area is the most common area for MS lesions - but any white matter region is susceptible - including gray/white matter junctions. All other aspects of your MRI were normal (since my Dr's license is NOT in existence - I give my lay education as validation of that reading!)
I agree that your stated symptoms are also consistent with MS - but as JJ said - all neurological disorders can have similar symptoms. Try separating head tremors from Parkinson's, MS, ET...Not easy. Plus you can have more than one thing going on - making matters even more confusing.
I hate to jump to - seek a 2nd opinion - but I have learned the hard way that in retrospect, I should have done that very thing. I suggest trying to diary your symptoms - when the happen and how long - that is often helpful. And if you do see a different Neurologist - be sure to have all your previous tests available. I wish you had best! Blessings, Jan
I agree that your stated symptoms are also consistent with MS - but as JJ said - all neurological disorders can have similar symptoms. Try separating head tremors from Parkinson's, MS, ET...Not easy. Plus you can have more than one thing going on - making matters even more confusing.
I hate to jump to - seek a 2nd opinion - but I have learned the hard way that in retrospect, I should have done that very thing. I suggest trying to diary your symptoms - when the happen and how long - that is often helpful. And if you do see a different Neurologist - be sure to have all your previous tests available. I wish you had best! Blessings, Jan
1 Comments
Hi Jan,
I’m not sure why they didn’t do a compare to my MRI back in 2006, maybe it was too old? Not certain.
Anyways, here is the 2006 report, my first brain MRI because of numbness and tingling and electric shocks in my leg:
DATE OF EXAM : 05/30/2006
REFERRING PHYSICIAN : LEVY; SANFORD
PRIMARY PHYSICIAN : CLOPPER; MARVIN
MRI EXAM : BRAIN - WITH AND WITHOUT CONTRAST
COMPARISON : None
CLINICAL HISTORY : Lhermitte's syndrome
MR technique: G.E. 1.5 tesla, sagittal T1 and axial T2 FLAIR Mag
susceptibility and diffusion images of the brain were obtained. Thin
section axial and coronal T1 images of the orbits were obtained before
and after intravenous contrast. Thin STIR coronal images were also
obtained pre contrast.
FINDINGS : There is near-complete opacification of the
right sphenoid sinus, consistent with sinus disease. No othfindings of note are appreciated.
The ventricles and cortical sulci appear symmetric and normal in size
and configuration.
The brain parenchyma is unremarkable in appearance
except for mild scattered focal punctate areas of increased FLAIR and
T2 signal in subcortical white matter sites of the bilateral cerebral
hemispheres.
There is a cluster of such focal signal abnormalities in
the left frontal lobe. These are nonspecific. While they may reflect
evidence of chronic small vessel disease, in a patient of this age,
other entities may be more likely, including post
infectious/inflammatory changes, such as Lyme disease, vasculitis or
demyelination. These can also be seen in association with migraine
headaches. No other focal signal abnormalities of note are
appreciated. There is no evidence of mass, hemorrhage, midline shift,
structural anomalies or significant extra-axial fluid collections. No
diffusion-weighted signal abnormalities are appreciated.
Following intravenous contrast administration, the enhancement pattern
is unremarkable. No enhancing lesions are recognized.
CONCLUSION : Near-complete opacification of the right
sphenoid sinus, consistent with sinus disease.
Mild scattered cerebral white matter signal changes, nonspecific. See
discussion above. Cluster of these findings noted in the left frontal
lobe.
No other significant findings. No abnormal enhancement.
This report has been electronically signed by: STEPHEN BARRAND,M.D.
I was 40 years old.
I’m not sure why they didn’t do a compare to my MRI back in 2006, maybe it was too old? Not certain.
Anyways, here is the 2006 report, my first brain MRI because of numbness and tingling and electric shocks in my leg:
DATE OF EXAM : 05/30/2006
REFERRING PHYSICIAN : LEVY; SANFORD
PRIMARY PHYSICIAN : CLOPPER; MARVIN
MRI EXAM : BRAIN - WITH AND WITHOUT CONTRAST
COMPARISON : None
CLINICAL HISTORY : Lhermitte's syndrome
MR technique: G.E. 1.5 tesla, sagittal T1 and axial T2 FLAIR Mag
susceptibility and diffusion images of the brain were obtained. Thin
section axial and coronal T1 images of the orbits were obtained before
and after intravenous contrast. Thin STIR coronal images were also
obtained pre contrast.
FINDINGS : There is near-complete opacification of the
right sphenoid sinus, consistent with sinus disease. No othfindings of note are appreciated.
The ventricles and cortical sulci appear symmetric and normal in size
and configuration.
The brain parenchyma is unremarkable in appearance
except for mild scattered focal punctate areas of increased FLAIR and
T2 signal in subcortical white matter sites of the bilateral cerebral
hemispheres.
There is a cluster of such focal signal abnormalities in
the left frontal lobe. These are nonspecific. While they may reflect
evidence of chronic small vessel disease, in a patient of this age,
other entities may be more likely, including post
infectious/inflammatory changes, such as Lyme disease, vasculitis or
demyelination. These can also be seen in association with migraine
headaches. No other focal signal abnormalities of note are
appreciated. There is no evidence of mass, hemorrhage, midline shift,
structural anomalies or significant extra-axial fluid collections. No
diffusion-weighted signal abnormalities are appreciated.
Following intravenous contrast administration, the enhancement pattern
is unremarkable. No enhancing lesions are recognized.
CONCLUSION : Near-complete opacification of the right
sphenoid sinus, consistent with sinus disease.
Mild scattered cerebral white matter signal changes, nonspecific. See
discussion above. Cluster of these findings noted in the left frontal
lobe.
No other significant findings. No abnormal enhancement.
This report has been electronically signed by: STEPHEN BARRAND,M.D.
I was 40 years old.
COMMUNITY LEADER
Hi and welcome,
I'm hesitant to interpret test results at the moment, vision playing up so i may not do this justice but i'll do my best...
MS would be one of the causes of the types of symptoms you've mentioned experiencing, i'm surprised you haven't had a spinal MRI and bladder incontinent assessment to assess if there is evidence of spinal lesions and neurotic bladder though, do you by any chance know if there were any specific abnormalities show up in your neurological exam?
In regards to your brain MRI, what has shown up is an unspecified number (multiple) of nonspecific foci (lesions) located specifically on both sides (bilaterally) of the brain in the corona radiata area.
It's not always feasible to map lesions with symptoms but as far as i'm aware the corona radiata area is not associated with the types of symptoms you've listed see;
http://www.sciencedirect.com/topics/neuroscience/corona-radiata
to get a better idea, sorry i can't see the article well enough to dissect it but i hope it has some use to you.
Hope that helps.......JJ
I'm hesitant to interpret test results at the moment, vision playing up so i may not do this justice but i'll do my best...
MS would be one of the causes of the types of symptoms you've mentioned experiencing, i'm surprised you haven't had a spinal MRI and bladder incontinent assessment to assess if there is evidence of spinal lesions and neurotic bladder though, do you by any chance know if there were any specific abnormalities show up in your neurological exam?
In regards to your brain MRI, what has shown up is an unspecified number (multiple) of nonspecific foci (lesions) located specifically on both sides (bilaterally) of the brain in the corona radiata area.
It's not always feasible to map lesions with symptoms but as far as i'm aware the corona radiata area is not associated with the types of symptoms you've listed see;
http://www.sciencedirect.com/topics/neuroscience/corona-radiata
to get a better idea, sorry i can't see the article well enough to dissect it but i hope it has some use to you.
Hope that helps.......JJ
4 Comments
Hi supermum, I did have an MRI of my spine as well, before my brain, and it was clear for lesions.
I’ve been seeing this neuro for a lot of years and he has done every test “except” an LP to try and rule out MS (lupus, lyme, RA, PN, SFN, etc), all clear.
I’ve had muscle biopsies, nerve biopsies, NCV (which I couldn’t feel the needles I am so numb), all clear.
The thing that I think bothers him most is this year, the numbness hit my other side also, not just one. So I “think” he thinks it could possibly be something else. (Because MS isn’t bilateral, even though each side is completely different)
My right foot is so bad, up to my knee, that it’s getting difficult to keep driving. I now have to wear silhouettes and pray that I make it to work without having an accident.... I hate taking showers every morning and being so dizzy that I had to have a handle installed so if I close my eyes, I don’t fall. My right leg jumps every night uncontrollably and then feels like lead, when I go to try and stand up, my legs are so stiff and don’t want to move, my body goes into a tremor until I force my first step, then momentum helps me to walk...though I have to hold onto the walls because I’m off balance.
I want an LP but I don’t want to second guess my neuro, I’ve actually thought of getting a new neuro but can’t seem to find one that specializes in MS.
So, I muttle on by, “dealing” with all of this, hoping it will somehow just go away. Sorry for the little “pity party”, it’s not my style, I’m just so fed up.
If I have symptoms for years and years, and they saw white spots on my brain back in 2006, and now this MRI, are there more spots? I don’t know, because I can’t understand the MRI, does demyelination mean possibly MS?
Why can’t I get any answers. Thank you SO much for answering me and helping me, I do appreciate it very much and I’m sorry for carrying on.
I’ve been seeing this neuro for a lot of years and he has done every test “except” an LP to try and rule out MS (lupus, lyme, RA, PN, SFN, etc), all clear.
I’ve had muscle biopsies, nerve biopsies, NCV (which I couldn’t feel the needles I am so numb), all clear.
The thing that I think bothers him most is this year, the numbness hit my other side also, not just one. So I “think” he thinks it could possibly be something else. (Because MS isn’t bilateral, even though each side is completely different)
My right foot is so bad, up to my knee, that it’s getting difficult to keep driving. I now have to wear silhouettes and pray that I make it to work without having an accident.... I hate taking showers every morning and being so dizzy that I had to have a handle installed so if I close my eyes, I don’t fall. My right leg jumps every night uncontrollably and then feels like lead, when I go to try and stand up, my legs are so stiff and don’t want to move, my body goes into a tremor until I force my first step, then momentum helps me to walk...though I have to hold onto the walls because I’m off balance.
I want an LP but I don’t want to second guess my neuro, I’ve actually thought of getting a new neuro but can’t seem to find one that specializes in MS.
So, I muttle on by, “dealing” with all of this, hoping it will somehow just go away. Sorry for the little “pity party”, it’s not my style, I’m just so fed up.
If I have symptoms for years and years, and they saw white spots on my brain back in 2006, and now this MRI, are there more spots? I don’t know, because I can’t understand the MRI, does demyelination mean possibly MS?
Why can’t I get any answers. Thank you SO much for answering me and helping me, I do appreciate it very much and I’m sorry for carrying on.
"The thing that I think bothers him most is this year, the numbness hit my other side also, not just one. So I “think” he thinks it could possibly be something else. (Because MS isn’t bilateral, even though each side is completely different) "
You maybe slightly mistaken in your understanding of MS.....whilst its true MS spinal cord lesions most commonly causes the types of symptoms you've mentioned on only one side of the body (unilateral), because MS spinal cord lesions are typically small and not big enough to transverse across the cord to effect both sides (bilateral) like structural spinal issues or conditions like Transverse Myelitis (TM) that does have the larger sized spinal cord lesions.
Bilateral symptoms from something like TM can still actually develop into MS, those dx with TM who also have an abnormal brain MRI with more than two lesions, have increased odds as high as 90 percent of going on to develop MS, so technically bilateral spinal suggestive symptoms should not automatically rule out MS..
And whilst MS does more commonly present with unilateral signs, MS is basically progressive without guarantees even on disease modifying drugs and it can definitely end up effecting both sides of the body.....IF your symptoms did start unilaterally, and years later you've newly developed symptoms on the other side now too and these symptoms are not the same on both sides (symmetrical) then neurological conditions like MS would still be high on your list of potential causes.
I would suggest you get copies of all the test results you've had over these years....i'm not going to complicate things more by giving you all the reasons why MRI's and nerve tests may fail to pick up the evidence to work out what is going on....at the very least your neurological assessments should be coming up as abnormal, with notable neurological changes or new developments showing up along the way and i strongly suggest you get a second neurological opinion!
If not with an MS specialising neuro (your local MS society maybe able to help identify MS savy neuro's near you), try finding the best general neuro you can and consider adding to your evidence with specifically getting your bowel and bladder situation assessed and diagnosed....get new eyes on this!
Hope that helps......JJ
You maybe slightly mistaken in your understanding of MS.....whilst its true MS spinal cord lesions most commonly causes the types of symptoms you've mentioned on only one side of the body (unilateral), because MS spinal cord lesions are typically small and not big enough to transverse across the cord to effect both sides (bilateral) like structural spinal issues or conditions like Transverse Myelitis (TM) that does have the larger sized spinal cord lesions.
Bilateral symptoms from something like TM can still actually develop into MS, those dx with TM who also have an abnormal brain MRI with more than two lesions, have increased odds as high as 90 percent of going on to develop MS, so technically bilateral spinal suggestive symptoms should not automatically rule out MS..
And whilst MS does more commonly present with unilateral signs, MS is basically progressive without guarantees even on disease modifying drugs and it can definitely end up effecting both sides of the body.....IF your symptoms did start unilaterally, and years later you've newly developed symptoms on the other side now too and these symptoms are not the same on both sides (symmetrical) then neurological conditions like MS would still be high on your list of potential causes.
I would suggest you get copies of all the test results you've had over these years....i'm not going to complicate things more by giving you all the reasons why MRI's and nerve tests may fail to pick up the evidence to work out what is going on....at the very least your neurological assessments should be coming up as abnormal, with notable neurological changes or new developments showing up along the way and i strongly suggest you get a second neurological opinion!
If not with an MS specialising neuro (your local MS society maybe able to help identify MS savy neuro's near you), try finding the best general neuro you can and consider adding to your evidence with specifically getting your bowel and bladder situation assessed and diagnosed....get new eyes on this!
Hope that helps......JJ
It does help....thank you. You’re very knowledgeable, much more than I, maybe I should go ahead and search out another neuro, I think I’d feel better anyways about everything.
Thank you.
Thank you.
Your welcome, good luck and let us know how you get on......JJ
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