DOES IT MATTER WHERE THE LESIONS ARE?

[sandie490]

Hi
Has anyone been dxed with ms, who has any of their lesions in the Basal Ganglia area.  And what does non-specific mean about the lesions?  Thanks Sandie

[LLWB]

It sounds like your sister's neuro is a lot more on the ball than your neuro was.......so.any possibility of seeing your sister's neuro? Oabviously a neuro who isn't afraid to trust his own judgment and training.  I know all this reading and stuff can drive you crazy, so relax, take a deep breathe, and just work thru the process.  Good luck.

[Quixotic1]

I don't know if they know what the iron deposition mean, except that the tissue is abnormal.

[sandie490]

I think she thinks I'm faking.  That's what I think.  So I don't trust her anymore.  She is the 3rd neuro I've been to.  I need to move on. What got me was that she  ordered the MRI without contrast.  The radiaologist even questioned it, but wouldn't go against her.  I didn't mention my sister until the end of the consult, because I wanted them to focus on what was going on with me.   my sis was dxed with because of ON,vertigo,1 lesion, 1 pos band on LP.  Her dx was mostly cliniical, because I have more sx.  I would say I have 90% of the sx.  My sis 5%.  
So what does the iron disposition mean? I'm clueless?
Sandie

[Quixotic1]

Hmmm.....a patient comes in with neurologic symtposm and has lesions on the MRI.  Her chances (before the MRI) of having MS in the US is about 1 in 800.  She continues to have more symptoms which suggest a demyelinating process.  News Flash:  Her sister is diagnosed with MS taking the patient's chances of having MS closer to 1 in 30-50......now what should she do?  

Obviously she should immediately rule out MS as a possible cause of the symptoms and the abnormal MRI.  Sounds like solid reasoning to me.....What?

Quix

[sandie490]

Hi Quix
I did look at the cd, and it appears that it was just a regular mri.  She didn't even order any contrast, because she really doesn't believe I have ms.  What is the iron deposition mean?  You, know my neuro did originally think of parkinson's because my right eye was twitching, and I had visible twitching in my left hand.  He said it was caused by a med I was taking, but not taking the way I was supposed to.  But the twitching had calmed down, and I didn't exhibit any further twitching at that time.
Since then, every week it has been something new.  I had to stop seeing him, because I was moving out of state, but he did say that I have some kind of degenerative Basal Ganglia Disease.  That was back in may, after I moved other things started happening.  That's when I started with the ON, but didn't realized what was going on.  Then the vertigo. an so on..... In the meantime, my sister had been dxed with MS, and had the same sx as me, but I had more than her.  She has one lesion I guess where it would affect the optic nerves, and one positve band on the LP.  I went to an MS specialist in Philly, she refused to do an LP, ordered this MRI and told me that she didn't think I had ms.
When I went for the results, she said to me,..see, just as I thought, no MS.  Then she says but if you want the LP I'll do it.  I said no I'll go to another neuro closer to me in Reading.   So here I am.  But, I have been having these internal tremors, and muscle twitching under the skin, where I can feel it happen but you can't really see it from the outside.  Muscle spasms, in my leg arm and mouth and chin.  Same spots all the time. I looked it up and the Basal Ganglia is responsible for these sx.  So what do ya think?  Sandie

[Quixotic1]

Hi, after reading your question, I did some reading on MS lesions in the basal ganglia.  The answer is that, yes, they do occur, but not frequently.  Jen is also right about the SWI_MRI.   There have been some studies looking at the iron deposition in MS lesions and "suggest" that the basal ganglia are involved more often than previously thought, but this is not hard and fast.

The basal ganglia, along with the cerebellum, are responsiblbe for smooth, coordinated movements.  The classic disorder of the basal ganglia is Parkinson's Disease, which involves problems with initiating movement (among other things).

Even though we have had some neuros tell us that MS does not involve movement disorders, we know that this is hogwash.  RLS (one of the most common movement disorders) is far more common in MS than the genral population.  Also we see tremors and myoclonus frequently in MS.  So, rationally, lesions in the basal ganglia could certainly occur.

Quix

[sandie490]

Hi Jen

What's iron deposition?  I have Optic Neuritis, and she didn't even suggest doing an MRI on my optic nerves.  I'm going to another neuro.  But what is this iron all about.  I don't think it was an SWI but I'll check.  Check in on me either later or tomorrow, cause I have to check the cd they gave me, I didn't get a report yet. Thanks

[jensequitur]

Not exactly.  It's just very hard to image lesions in the gray matter, because there's not much myelin in that area - hence the gray coloring.  Myelin is white, because it's fat.  So there's probably lots of people with MS and lesions in the gray matter, but nobody knows it because we can't see them.

http:  //www.ncbi.nlm.nih.gov:80/pmc/articles/PMC2650739/

This article explains it better than I can!  Take out the spaces so it'll work.

Sandie, do you know if your MRI was an SWI-MRI?  Susceptibility-weighted imaging (SWI) shows many lesions missed with convention MRI technology, and shows iron deposition in the basal ganglia and thalamus.

[sandie490]

So, then you can't have ms and have lesions in this area?  What's the difference between the white brain matter and gray in reference to  a lesion, and the evidence of iron deposition in the gray matter?  What does all this mean.  I'm sorry, guys I'm new to all of this.  Thanks  Sandie

[jensequitur]

Well...  Kinda.  It's possible to point at a lesion and say "You have these symptoms because of that lesion."  But neuros turn that around on you - they say that "You don't have a lesion in that area, therefore you can't have those symptoms."  Which is just silly.

So my take on it is that lesion formation is simply a sign of the disease.  

The basal ganglia is actually gray matter, not white matter, so it's unusual that your MRI would have showed lesions in that area.  There's evidence of iron deposition in gray matter, however.

[Lulu54]

Hi Sandi,
here's the link to a journal piece I wrote

http://www.medhelp.org/user_journals/show/45847?personal_page_id=5829

It may make you feel better about those lesions - yes, it does matter where they are.

be well,
Lulu