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147426 tn?1317269232

How MRI's Show MS Lesions


MY QUICK AND DIRTY EXPLANATION OF HOW MRI'S SHOW LESIONS IN MS

I am going to overexplain the MRI with contrast / without contrast thing again, so that you and your husband can have it as clear as possible in your minds.

MS does it's damage by causing the nerves in localized areas in the brain and spinal cord to lose their protective sheaths, called myelin.  At first, when the myelin is being attacked, the body brings a higher blood supply to the area to fight the attack and the area becomes inflamed.  These areas, now become lesions.  At this point they are called "active lesions."   At first the nerves haven't changed much and they appear (and have the same density) as the healthy areas around them.  At this point after some time, probably months, the body CAN repair the damage and remyelinate the nerve.  This repaired nerve still won't be as good as new, but the lesion "looks" like normal brain.  Sometimes later an old scarred lesion will "reactivate" and the adjacent areas will inflame and have increased blood flow.

If the attack on the myelin sheath is too strong for the immune system to repair, more and more myelin disappears and the area of nerves eventually dies.  Then it contracts and scars.  The blood flow is decreased to that area and the area becomes "less dense" then the surrounding normal nerve tissue.  After a longer time - probably years - the scar can reabsorb and the area becomes "empty."  It's called a black hole.

When you image these lesions with an MRI you can see different things, depending on the technique,the age (stage) of the lesion, the power of the MRI, and whether contrast is used.

The first image is done without contrast.  This technique will show old lesions that are big enough to be seen by the power of that MRI machine.  WE KNOW that many lesions in MS are too small to be seen.  If the newer, more powerful MRI with a 3 Tesla magnet is used many more lesions will be seen (by at least 25%) than on the older 1.5 Tesla machines.  The classic old, mature MS lesion is a little bit oval, will have well-defined borders and will be in the white matter.  Characteristic places are subcortical, peri-ventricular and in the corpus callosum.  The classic MS lesion will also have it's long axis perpendicular to the ventricles of the brain.  Also, important and very symptomatic lesions are found in the brainstem, the cervical and the thoracic spine.  The spinal cord ends at the bottom of the thoracic spine, so there is no such thing as a lumbar spinal cord lesion in the normal spine.

These scarred lesions will show up as light, bright areas.  These are the classic, MS lesions or "plaques."

Now the very old, scarred ones that have been reabsorbed will show up as a black (empty) space or black hole.  If there are many of these empty areas the brain will contract around them eventually and show up as a loss of brain volume.  This is also know as brain atrophy.  This is particularly seen in the progressive types of MS.

However, a newly active MS lesion may not show up on a regular MRI because the area of nerves, though inflamed, is still pretty much intact and has normal brain density.  On the MRI it will look like normal brain.  Without contrast it won't show up and will be missed.

When the next phase of MRI is done the contrast is in the blood vessels.  So the large blood vessels show up, too.   Anywhere the tiny blood blood vessels are more dilated than usual, as in inlfammation, the areas will "highlight"  or "enhance."  They show up as even brighter.  So new lesions will show up as enhancing, or active.  Also, older lesions, that have undergone new attack right around them will show an enhancing rim or ring.  When you compare the regular MRI to the Contrast MRI you can see this reactivated, old lesion.

That's how some reports can call active lesions or some report no newly enhancing lesions.  Also since some new ones heal they can be compared to old films and show they disappeared.  In addition, between different sets of MRI done after a time has passed, the radiologist can see an increase in old and in new activity.

Please ask question where I haven't been clear.

Quix
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Page 4 of 4
147426 tn?1317269232
No nasty comments from real MRI techs who understand this stuff! lol. Believe me, it's a miracle!. Q
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198419 tn?1360245956
Jazzy and Harrie -
This may help w/the Lesion Healing question you posted  - it explains the demyl and remylenating process really well. . . .
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266400 tn?1193638081
bumping up for someone
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147426 tn?1317269232
This is not the MRI explanation we want to use.   There some inaccuracies (not to mention a ton of typos!). I rewrote it and added a whole bunch of stuff.  the newer, revised thread is called, "MRIs, Lesions, and Symptoms."  We've been trying to keep it near the first page.  Let's let this one drift down and disappear into fable and song.  Quix
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195469 tn?1388326488
bump for our newbies
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195469 tn?1388326488
Oh sorry Quix...didn't know you wanted this one to drop down...I am SO sorry...don't read this one Melinda, read MRI's, lesions and Symptoms
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I have just stumbled to your article through googling.  I have a 42 year old brother who has had MS for 12 years and was diagnosed relapsing-remitting.  He was doing very well living on his own, then slowly started not regaining what he was losing during an attack.  He is now living in a long-term care facility.  He has been having seizures as of late, the last episode he had a major seizure accompanied with aspirated pneumonia.  An mri was done and the specialist came and talked with us.  His words were "I am shocked at the substantial amounts of lesions he has on his brain, compared to the mri done 6 months prior to this"  Each day we see him deteriorate in some form.  His short term memory is totally gone, he can no longer stand at all, he is totally wheelchair bound and needs a lift to get in and out of bed.  I know this may seem like a cold question, but in your opinion, how long can this go on??  He is taking a drug for the seizures and we are keeping him comfortable with only pain meds, as is his wish.  I am his POA, and I am just trying to figure this all out.  I would so welcome your opinion.  Thank you for being so real!!  (It is what is missing out of our medical fields!!)  Thanks so much!!

alovingpoa
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147426 tn?1317269232
I am so sorry to hear what your brother and you are going through.  It must be terrible and, of course, you don't want him to suffer endlessly!!  It is a very normal question and not cold at all to my mind.  I am not an MS expert, but a fellow sufferer who is trying to learn about the disease.  I have not had experience with any people long-term as their disease worsened.  So, I have no words of wisdom or knowledge to answer you with.  I am sorry.

I wish you both less suffering,

Quix
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147426 tn?1317269232
This is not the best version of this discussion.  the one on the "Health Pages" is more thorough.  Please read it instead.

Quix
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Quix, could you help me out, please?
I had my first symptoms about 4 months ago. It began with shaking of the right side, and a total loss of strenght. My left leg had no strenght and my right one, whenever i could get myself up (when i try to get up off a chair i feel like an 11 month pregnant elephant!) it starts wobbling around. I can't right, so i wanna kiss whoeven invented laptops. I also felt a terrible numbness in my feet and shins. One very hot day, after enjoying a music festival in Virginia, we went home with my boyfriend and i fell to the ground, not able to move. I asked him to "take whatever it was covering my feet" and he said "you're barefoot". The worst symptoms were not able to pronounce words ans sound like a drunk idiot, not remembering words, spasms, double vision and one time i got into my car and couldn't remember how to get to the gas station. But the fatigue is impossible to bear. I'm out of breath just sitting in my car. Typing is a nightmare. I have to go back over and over again and change the words i thought i meant and ended up typing something else, sorry for the typos. I was ok during a vacation, i could walk without my pink can (hey, i'm a girl in style!) and was better with the shakes and fatigue. After i came back, my parents insisted in me getting an MRI and it came out "clear" according to the MD they wanted me to see (who suggested a shrink since i have too many tattoos and that's the work of the devil.. Catholic Hospital) when i went to see my Neurologist, he looked at the MRIs and said, well, i see a couple of things, but this worries me a little. When i got the MRI they also took pictures of stuff that look more than a thunderstorm than a brain. Sorry, i can't remember which part of the brain they are, i guess it's the top? He said there was a vain that looked ok. It kinda twisted, came back and went "back", like a tail. The opposed one was supposed to do the same, but no "tail". All i have gotten is Xanax and Clobazam for the "shakes". But i haven't been able to get out of the bed for 3 days since i can't walk. My legs won't take my weight. I'm 5'7" and about 125lbs, so it's not like i'm too fat. I have spasms again and a weird feeling in my face. Tingling in my hands and of course, the pain, needles and pain came back to my legs and knees. I'm desperate. I'm (was) a student and i used to go to class at night, i also suffer from AS and imagine the pain. But i know how AS pain feels, and this is different.
What can i do to make my Neurologist take me seriously? it seems all they want to do is pat you in the back and send you home, but i know there's something wrong. Any help?
Thanks, guys.
Farrah
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338416 tn?1420049302
Farrah, welcome to the forum!

Could you repost your question as a new thread?  Also, because many of us (including me!) have a hard time with reading big blocks of text, break up your post into several different paragraphs.  (Just putting a return every five sentences or so really helps!)
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Wow, where to begin, yet keep it concise. All my life I've suffered from severe anxiety. I'm now a 54 year old woman and I live on a disability due to GAD and Depression. I recently went through a series of psycho-vocational tests and the psychologist said that I have Asperger's Syndrome. After I read info on Asperger's, it explains just about everything all through my childhood, adolescence and adulthood. However, over the past few years, perhaps due to my ineptitutde in social gatherings and my horrible childhood, I've developed a "benign" head tremour. My husband was killed by a drunk driver 20 years ago and was burned severely. He lived for 7 hours and I was with him during his last 4 hours, although he wasn't conscious. My whole body began to tremble and tremour and it seems to subsiand come back. I'm sorry for being so lengthy about this explanation, but I've been treated for depression and GAD but my current doctor is sending me for an x-ray of my back and and MRI at the local hospital. I asked him why, but he's very terse. His reply was, "MS." That was it.  My head tremour is very evident when I'm under extreme stress, and I often have a couple of beers to get it under control. I've been a benzodiazepene in one form or another for about 30 years now, but even they don't reduce the tremour. (The reason for the seeming  misspelling of my words is because I'm a Canadian and we follow British English.)
I read in your text that there is a blood test that will exclude other things, but not necessarily show MS symptomology. I'm almost 55 years old! Isn't this rather late to find MS?
If you could add any comments to this I would greatly appreciate it.  I do hope I rememebered your username and applied it correctly.
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Hi Guys, more story is quite long but I will go into the full detail to see what people think.  I would appreciate anyones comments as I am quite depressed at the moment.  13 years ago I had some pins and needles in hands and feet, some numbness, double vision and some blurring of vision and some bladder problems.  Most of my symptoms were sensory.  I went to neurologist who did Evoked Potentials tests which the checkerboard one was abnormal.  I had a brain MRI which was normal and I was put in hospital and had predinisolone via drip (large dosage).  My optic discs were pale. I also presented with abnormal reflexes, clonus in my ankle, hyperreflexia etc.  I also had lots of burning and cramp like pains, plus some muscle twitching.  My neurologist was certain I had MS.  He repeated an MRI 2mths later and that was also normal.  The machine was very old..  I had another MRI of spine and head another 6mths later and then he said maybe it's not MS but you can't totally rule it out. So I was confused. So now 13 years on my symptoms have raised their ugly head again, I have always had some symptoms but mainly when I get tired, sick (run temp) or really stressed. I felt that my symptoms were new this time and worse, I had vertigo, some facial numbness, burning and pins and needle in my stomach and bum as well as my feet. My left leg has always been worse, it was a sort of prickly feeling.  I decided to go back to a new neurologist and get a second opinion. This guy specialises in MS.  He seemed to think it was a MS like thing and that I definately had lesions and that perhaps the new MRI machine would show old lesions.  I had an MRI done and it was clear.  I was depressed, I know that I don't want to have MS but I did want an answer as my groin and pubic area was going numb and I had suffered a few probs with my bladder etc. and the prickly feeling was driving me insane.  I was prescribed Gabapentin to take and told that it was likely to be Transverse Myletis and he didn't think that it was new but prob from 12 years ago.  Now 6mths since my last visit I have had another flare up. This time my whole left leg has gone numb, like it's dead, or gone so bad to sleep, the sensation when you lay on something funny but not pins and needles, just really heavy so it makes it difficult to to walk on and clutch in the car etc. but today it's okay.  My GP did a CT scan of my lower back as I was convinced that I had something pressing on that bundle of nerves but that was clear too and then I cried and now I'm quite depressed as I feel like I'm going crazy.. I am  otherwise healthy, I take no medication (not even the Gabapentin was was prescribed but I think I will give it a go.) Can MRI be in accurate? Why is nothing showing for the level of symptoms I have.  I know the neurologist believes that I have lesions in my spinal cord. THe MRI was a T3 machine.. brand new. Does anyone think my symptoms sound like MS?  I have good and bad days and my left leg always feels a bit weaker than my right...I did have vertigo last time when I had my symptoms and the dr reckons it was migraine caused by the lesions but I don't get headaches as such..?  but the vertigo seems to have gone away now.. along with the facial symptoms.  I only seem to have some muscle twitching in my thighs when I go say walking up the drive etc. (our drive is steep).  I am otherwise fit, I don't do drugs etc, I am not overweight.  But I must admit this time round I have found my symptoms have got to me and I know if I have another MRI and it's clear I will be depressed as I am starting to feel like I am imaging my symptoms or am just crazy.  Sorry for the long winded post, just needed to put it all out there and see what people say.  I have an appointment with the neurologist in about a weeks time.

CHeers,
Udkas

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I am glad I got this blog. I read your explanation of MS and found it to be very informative.  But, I would like to ask a question. In January 2006 I had a MRI done on my brain and the report came back saying I had lesions on the brain, possible MS. Then the neurologist (I did not like) dig a lumbar puncture and sent that off to be tested. He said that it came back ok. I am still worried about the lesions on the brain. Is there something that I should do or go from here?
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147426 tn?1317269232
Hi!  Welcome to the Forum!  Have you been reading here long?  You landed on a very old version of the MRI and lesions discussion.  the one in the Health Pages (upper right hand corner) is better.  I looked at your profile and you have an amazing number of things going on.  Would you be willing to start a new discussion and tell us about yourself?

As you know we can't diagnosis anything online - there just isn't enough info.  But, I can talk about things in the context of MS and I will answer your question.  IF the neuro (whom you don't like) was considering MS when he did the spinal tap, then he was wrong to tell you that MS was ruled out because the fluid was normal.  A normal spinal tap (especially 2 years ago) does not mean that you don't have MS.  There is NO requirement for the tap to be positive in order to diagnose MS.  In fact, there is no requirement EVEN TO DO A TAP in order to diagnose MS.  In Europe they do not use the spinal tap routinely at all.

Now the lesions could be many things.  But you should have someone tell you what they likely mean before you can just dismiss them.  I would encourage you to seek out a new neurologist.  Why was the MRI done?  What problems and symptoms have you had?

But, we would like to know more about you.  From your profile I see that you must have a very complicated medical past and see that you are on oxygen.  If you would start a new thread - just go to the top of this page and click on "Post a Question."  Your post will be lost here and people won't see you.

Welcome again, quix
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I NEED SERIOUS HELP. I AM 41 YEARS OLD SUFFERING FROM EXTREME FATIGUE,FEELING LIKE SOMETHING CRAWLING OUT FROM UNDERNEATH MY SKIN ON BOTH ARMS AT DIFFERENT TIMES, ACHY BODY LIKE FLU, LOW GRADE TEMP MOSTLY AT NIGHT, JERKY EYE TWITCH,UNABLE TO REALLY TASTE OR SMELL ANYTHING, NO SEX DRIVE, ON AND ON. BEEN TO SEVERAL DOCTORS WITH MOST OF THEM SAYING THAT IT IS FIBROMYALGIA. TESTED NEGATIVE FOR LUPUS. CANNOT FIND ANYONE WHO WILL LISTEN TO ME. HELP!!!
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HI, I AM NEW TO THIS AND WOULD VALUE ANY INSIGHT.  I AM 45 YR, WHITE FEMALE, RN, WHO WAS DIAGNOSED WITH GRAVES DX 3 YRS AGO.  I HAVE HAD INTERMITTENT LEG WEAKNESS DURING AND AFTER GRAVES TX.  I HAVE BEEN ON PREDNISONE THERAPY THROUGHOUT THE LAST YEAR DUE TO ASTHMA EXACERBATIONS.  10 MOS AGO I FOUND I WAS UNABLE TO WALK UPSTAIRS WITHOUT LEANING AGAINST THE WALL, INSOMNIA, DIFFICULTY GETTING OUT OF A CHAIR, SOME FORGETFULLNESS AND FATIGUE.    I FOLLOWED UP WITH ENDOCRINOLOGIST WHO DID LABS AND THYROID WAS GOOD BUT ANA WAS 1:320 SPECKLED.  I NEXT WENT TO RHEUMATOLOGIST FOR LUPUS TESTING.  ALL LABS NORMAL EXCEPT ANA 1:160 SPECKLED AND HOMOGENOUS. NOW I HAD INCREASING LOWER BACK PAIN .  PCP DID XRAY AND SHOWED SIGNIFICANT COLLAPSED VERTEBRAE IN LUMBAR. FOLLOWUP WITH NEW  RHEUMATOLOGIST 2 DAYS LATER. RHEUMATOLOGIST SAID NO "COLLAGEN DISEASE" AND DID LUMBAR MRI - SHOWED NO COMPRESSION AND SHOWED NO REASON FOR MY INABILITY TO CLIMB STAIRS OR INCLINES.   REFERRED TO NEURO.  NEURO CHECKED FOR MYASTHENIA GRAVIS, ALL NORMAL LABS/TESTS.  I NOTICED AN AREA OF NUMBNESS ON MID BACK LEVEL - MRI OF THORACIC WAS DONE AND ESSENTIALLY NORMAL.  -- SOME MEDIASTINAL CYSTS FOUND OF UNKNOWN SIGNIFICANCE.  NEXT  NEURO APPT TO DISCUSS TESTS AND HE STATED THAT IT WASNT MYASTHENIA GRAVIS & NO NEED FOR MRI OF HEAD, AS I SUGGESTED,  BECAUSE HE DIDNT THINK IT IS MS. ---ALTHOUGH, MY LEG MUSCLES FEEL LOCKED UP AND VERY TIGHT AND MY RIGHT LEG DRAGS WHEN WALKING.   I CANNOT WALK NORMAL FROM LEFT AND THEN TO THE RIGHT LEG.  I HAVE HAD SOME TINGLING WHEN WALKING AND FEELINGS OF WARM WATER SPLASHING ONTO CALF.  TODAY DURING HIS LIMITED NEURO EXAM, 2ND VISIT,  MY ARMS/HANDS WERE SHAKING AND MY LEG COULD NOT MOVE ONTO SHIN OF OTHER LEG. NEURO DOC SAYS HE IS SENDING ME BACK TO PCP  BECAUSE HIS MYASTHENIA GRAVIS TESTS WERE NORMAL AND ASKED IF I FELT OVERLY STRESSED.      HE DID STATE THAT HE WOULD ORDER THE MRI OF HEAD IF I WANTED IT.   PLEASE HELP!  I FEEL LIKE THIS DOC JUST BASICALLY SHOVED ME AWAY.  DO I PROCEED WITH MRI AND PCP FOLLOW UP.   THANKS FOR LISTENING, KYMME
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1253197 tn?1331212710
Hi there Kymmemar

I would suggest that you copy and paste your post into a new one. Many people will fnd it difficult to read a block of text in capitals and willl be unable to respond as they can't read it all. I never even realised this myself until I read other people's comments and realised that it applied to myself.

If  you break your writing up into smaller shorter paragraphs this will help everyone to read it more easily, and especially Quix who gets a lot of posts to digest and respond to.

Best wishes

Sarah
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Hi all,

After 5yrs of all kinds of funky symptoms, a diognosis of Fibromyalgia and arthritis. As you can imagion i am fed up.

4yrs ago i was tested for MS and after an MRI was told the symptoms were in my head and that i was depressed (if only)
Last week i was told all previous diognosises are wrong and need to be seen by a nero specialist AGAIN!.. as i have lost all reflexes in my feet, ankles and knees. and have no sensation up to my thighs. I am confussed finding it harder and harder to walk and have been told i am drunk many times. I have developed a squint, blurred vision and been told my eye twitches what ever that means.

am wondering if 4yrs on am i wasting my time trying to get the right diognosis or just give up and try to get on with life the best i can?
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1453990 tn?1329235026
MRI is only one part of an MS diagnosis.  Some docs insist on the MRI.  If you still have symptoms, forget about the old diagnosis or what was or wasn't on the MRI.  Goto a neurologist and have them check your symptoms and signs.  

Bob
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Hello,

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ok that went wrong :)

I agree the symptoms are still there and annoying/bothersome, but everytime i go for tests it seems they either disappear or don't show up in tests and then i feel stupid, am told it's in my head, i am imagioning it etc,

the irony is that Dr's find them when they are not looking for them haha.
I spose if anything i am now thinking they are taking everything from the last 5yrs and kicking out all other theorys and then i go for these test and nothing shows up again i am left where this all started with no answers and the feeling that i am infact going mad.

woozy16
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1660252 tn?1302557099
I am a 34 yr old mother of 2 and am so scared and convinced that I have MS.  All other blood tests were normal, and I go for an MRI this week.  I have have pin/needles sensation all over my body and burning in my feet that comes and gos.  Memory is declinging too, and arms feel heavy at times.  I am very fatigued and sometimes have dizzy spells.  What could this be if it's not MS, because all this signs point to it?  crazydaisy
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Hi.  I'm feeling very awkward putting this on a blog, but peace of mind is worth more than a few moments of awkwardness.  Several years ago I had some really weird things going on physically.  In short, the mri revealed 1 round spot on my brain in 2004.  Then, 2 years later there were 4.  Very small, very round.  I was told that MS lesions are crescent and these may just be "aging" spots.  I'm 46.  Recently, I've experienced nerve damage to my left foot; it has been getting worse.  I've lost range of motion.  It tingles, burns, and shoots pain up my leg.  I cannot sit on my feet without jumping from the darting warm, burning sensation that pricks as it spreads out.  I've sustained no injury to this foot, although there is a benign tumor in my big toe.  Most of the daily pain is located on the sesmoid (sp) bones which are regularly inflamed.  I've been to 3 foot doctors.  Only one has taken my "pain" seriously.  He has ordered orthodicts and I've spent 8 weeks in a walking cast.  I hadn't given those spots much thought until he told me the nerves were damaged.  Now, I'm concerned.  I should also be forthright in sharing that I probably have a conversion disorder, but I firmly believe with counseling that I am able to differentiate this issue.  It manifested itself in "seizures", and as soon as they told me what it was, it stopped and my "alert" is always on for such physical manifestations.  This is my question, should I be concerned about the foot, or should I simply brush it off as a conversion disorder manifestation?  
Thank you,
Ginger
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572651 tn?1333939396
hi Ginger and welcome.  would you do us the favor of copying what you wrote and reposting is as a new thread?

this is apretty old disccusion and few people will take the time to go back and read new comments.

Also, Quix is on leave right now, and putting this in a new thread gives others the chance to help you with their replies.

I'll be watching for the new one.......
Lulu
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Hi,

I am a 20yr. old girl and  have recently been having symptoms that seem very characteristic of MS, but have not yet found out my diagnosis. The symptoms have been occurring periodically for 3 weeks and include tingling in my hands/arms, feet, and face. They spring up usually in the afternoon or evening and seem to worsen progressively over a few hours and then gradually diminish if not resolve completely over another few hours. Sometimes I go days feeling normal, but for the most part it has seemed like something has been tingling at any given time throughout the 3 weeks. The attacks that I have been experiencing usually last only hours (and therefor seem to not be relapses of MS), but sometimes I'll have tingling that remains in my hand or foot for days after all the other symptoms have become resolved. I got an MRI exactly one week after the first attack and the MRI report from the radiologist said everything was "normal," but I don't know what the strength of the machine was. I am currently waiting to see a neurologist and hear their interpretations.

My question is:
Is only a week after the very first symptoms too early for lesions to be large enough to show on an MRI?
Also, does the fact that my symptoms usually resolve in anywhere from 4 to 12 hours mean that I could have lesions that are too small to show on an MRI and do they seem like MS relapses?

I also wanted to say thank you. I have been obsessively researching the symptoms for and information about MS since my first attack and have been confused about many aspects of what I have read.
One of these confusions was whether or not lesions would only show WHILE symptoms were being experienced (because my MRI was done at a rare moment of complete normality for me).
Your clear and understandable description as well as your answers to many of the other questions asked have been such a relief to much of my frustration of reading other articles full of medical mumbo jumbo.
In what has been one of the scariest times of my life (being in limbo of not knowing my diagnosis), I really can't tell you how much it means to me that people like you are here to make it just a little easier to educate myself about what is happening to me.
Thank you so, so much.

-Alex
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1453990 tn?1329235026
Welcome to the forum.

There is no relation to the size of the lesions and the symptoms.  Little microscopic lesions can put someone in a wheelchair and big huge lesions can seem to have no effect.  In neuroscience, it is all about location.  

Symmetric symptoms, both feet, both hands, both arms are pretty rare in MS.  Given that you seem to have symptoms symmetrically in both the upper and lower extremities for relatively short periods of time, I'd think they would examine your neck for a problem (granted, the facial symptoms could not be explained by a cervical issue.)

MS lesions develop pretty slowly and resolve even slower.  So many People with MS (PwMS) have pain or  paresthesias that last in a single location for weeks or months.  Feeling better and symptom free, will not change lesion load much, if at all.  There are atypical presentations of MS, but at this point, this sounds like it would be something else. Many of us have worked with our doctors to "watch and wait."  Other tests and appointments with specialists go on and we get MRIs every 6 - 12 months watching for things to change.

Trust your body and keep looking for what is wrong, but you may need to cast a wider net and consider things beside MS.  B-12, Fibro, other Neurological and non-neurological causes.

Bob
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198419 tn?1360245956
Hi there,

Thanks for joining us. Your tingling may not be related to lesions at all, nor may they be attacks. There are countless causes for what you describe.

In the context of MS, many cases of tingling does not constitute an attack. Just mentioning this to put your mind at ease where lesions and relapses, concerned.  Since your MRI shows normal, the doctor should be checking other avenues for you. Even small lesions will show when your not symptomatic.

I'm glad you found our forum here educational. Thank you for trusting us enough to post and say so. Hope we can help you move forward with next steps. When do you go back to the doctor? And, has the doctor mentioned what he/she is doing on your behalf to find out.

I agree with you - this can be super scary. Especially when a symptom rises and gets worse before it gets better, only to return.

Definitely don't let this doctor give you the run around,
Hope to help,
-Shell
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what if a person with ms has developed several black holes in a matter of weeks and is in a coma, is it possible to regain any of that information because of the short period of time or is it just gone?
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1999646 tn?1327368425
I had a minor neurological event in 1991 (fatigue and left leg weakness) my GP told me he didnt think I had an auto-immune disorder and sent me on my way. In 2002 I had a Major Neurological event. The Neurologists all said probable MS, but I didnt have any new activity in 3 years, no diagnosis. I recently December 2011 went to a New Neurologist in a different state who performed an MRI and she said there was vascular changes that were new compared to 2006 MRI. She couldnt diagnose me either with MS. She said it was probably Acute Demyenating Ensythro Mylitis (SP?) caused from a virus. I cant except that opinion due to the fact it occurs primarily in prepubescent children. Can the vascular changes be the "higher blood supply to the area to fight the attack" you explained above in your article? I am not experiencing any NEW neurological changes. Can this mean I am possibly going to have an event soon? I am going to seek a different opinion, of course.
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2090063 tn?1332767842
I have similar symptoms.  There is another autoimmune condition called Myasthenia Gravis.  It flares up with stress and often affects muscles of the neck and eyes first, then peripheral muscles (arms and legs, toes and fingers). It can cause spasms and severe cramps.

No lesions or plaques show up on MRI.  It is trickier to diagnose, although there is a blood test which shows antibodies related to acetylcholine receptivity. This neurotransmitter becomes blocked, and is responsible for conductivity to muscles.  It feels like your muscles just can't hold a charge for very long, and you need to rest, then after an hour or so you can function a little better.

I have had these problems ever since cervical spine surgery eight months ago.  Apparently, severe physical or emotional trauma can begin the whole process.

Hanna
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Thank you so much for your very informative explanation about MRI, I found it so interesting & explained in a very easy to understand format, which was not too technical. I have MS, confirmed about 15 yrs ago after an MRI scan. I had vague symptoms for many years, starting with Trigeminal Neuralgia & always being fobbed off by the different specialists over the years, culminating in an operation on my TM joint, years more pain etc. & it was many years later, after seeing the same Neurologist that I was told I did in fact have MS. My MRI scan result was never actually properly explained to me, so thank you. Shebubs
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Hi,

I have been having strange symptoms in the past 3 months such as different sized pupils, itching all over, tingling in my face, fatigue, ppins and needles in my feet and hands and face, and sometimes in other places on my body, dizziness, panic attacks, fast heart rate, seeing floaters. These symptoms very in severity from day to day. Some days I don't have any symptooms or just a couple sharp pains in my feet.  I have had an MRI with contrast and it was normal. I have seen an eye nero doctor and he said I was normal. Pls give any advise I am woundering if I have ms but my mri was normal.
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can u take a look at my MRI? i got Lyme 3 yrs ago, undiagnosed for 2 now have arthritis my hands and legs tremble i get sharp pins and needles in my legs feels like its twitching and before bad weather it acts up and i get a pain and numbness feeling i have constant migrains and the nurse said my MRI looks good but if its at the beginning maybe its to small to see, i feel like i see a couple white patches, small, please e mail me ***@****
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Anyone have any idea how radiologists differentiate between a "black hole" lesion in an MRI and something else?  I just got a brain MRI last week and the radiologist noted that the lesion on my frontal lobe is unchanged since last MRI... and there are several "punctate foci of hyperintensity in the inferior right frontal lobe" - which, in his opinion, is a "perivascular space" issue.  

I have a black hole lesion on my c-spine, so I know they show up dark in T1 and bright in T2 MRIs, which is exactly how these "foci" are presenting. I even found them in my MRI, before getting the results, because they stood out so much. They are clustered, and directly adjacent to my ventricle, which as I understand it, is a common feature of MS lesions.  I'm not saying these are, in fact, MS lesions, but am curious as to how radiologists tell the difference - and if it really is a judgement call.
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572651 tn?1333939396
Hi Cancan, Quix did a lot to get this forum started, but she isn't around here these days because she is busy taking care of herself.  Your question is so good, I am going to copy it and start a new question - hypointensities (black holes) sound horrible and it might help to understand them a bit more.

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Thanks!  That's a great idea. =)

Quix did such an excellent job at explaining what so much of this means - and I hope that she is doing well!

I really wish there was a class we all could take that would walk us through all of the inner workings of this disease. The doctors just don't seem to have enough time to sit down and go through this kind of thing with us in a thorough manner.
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I am in desperate need of some advice. I am a 38yr old female who has been suffering on and off for years with weird symptoms. However just recently with severe neck pain pins needles sore horrible legs and feet. Dropping smashing and spilling everything. Mri of brain showed many more then 9 lesions in periventricular white matter, but only a small suspected syrinx on c spine. Radiologist put strong consideration of demyelinating plaques. However neuro laughed at me said it was stress and smoking, regardless of pain in crazy spots under my skull big toe jaw patches of numbness blurry left eye leg giving out etc. I dont know what to do.... im not scared but cant ignore the symptoms. She wrote me off. Ive never felt so alone and almost crazy.
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I have no income or insurance, but the MSAA paid for a cranial MRI as I have almost all of the symptoms of MS. If I could email you the scans, could you help interpret them? I'd appreciate it if you could. Email: ***@****
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5112396 tn?1378021583
Hi rt66gv. A couple of things here; Quixotic1, a great resource to the community, is no longer actively participating on MedHelp. She would not likely see your message.

Secondly, this is a patient-led forum. There are no doctors here, at least in the relevant area. Also, giving this kind of information/advise in the manner you mention (via email) would questionable in the ethics area. A neurologist needs to see you in person in order to assess how the MRI imaging fits into your physical presentations.

However, if your scans came with a radiologist's report, we do have some members here who have a knack of turning 'doctor-speak' into 'plain-English' if you're having trouble understanding the findings.

Here we can give pointers, a sounding board, support and personal experiences, but we can't diagnose.

Perhaps you could go back to the MSAA (I assume you mean the Multiple Sclerosis Association of America) and they can give you information about neurologists that accept pro bono work or alternative sources of helping fund some professional assessments. Perhaps others here can give feedback on that as well.

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9871228 tn?1406397607
I am unable to have any more MRIs due to a Pacemaker.  So how can my neurologist tell my MS isn't active slowly progressing when all he does is check my reflexes.  It's quite frustrating.  He has ordered CT scans, but apparently they don't show anything. Help....what should I do or say
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More than 10 years ago a neurologist told my sister she has MS based on the MRI of the brain she did back then. The doctor said she sees plaques in her brain that represents MS and she has been taking Avonex Pills all these years, though she has NO symptoms of having MS whatsoever. She does MRI of the brain, CT of spinal cord, eye exam, coordination exam, blood work and any other exam that you can think of every year and every time EVERYTHING comes out normal (the MRI still shows the Plaques but not a single plaque has been added since 2004). we are just wondering if she really doesn't have MS and the doctors have made a mistake in diagnosing the disease just based on the MRI results. We really need help of what we need to know to prove that she doesn't have MS.
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Well, how can you be sure she doesn't have MS? Have you considered that the reason she hasn't had flares or worsening symptoms may just be that the Avonex has worked amazingly well?

By the way, Avonex is not available in pill form, and no pill treatments for MS have been marketed for more than a couple of years. Please re-check with her regarding the treatment she's on.

ess
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Why did she have the first MRIs 10 years ago?
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1831849 tn?1383231992
I agree with ess. There were not MS meds available in pill form 10 years ago. If she had placques 10 years ago, and none since, I would put her in the Clinically Id=solated Syndrome category. It's absically a single "MS" like episode that never recurs.

Kyle
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Thank you for the clearly written posts they are wondering, I presented with optic neuritis, disc pallor numbness, positive Rhombergs, dizziness , RAPD LP clear the first Neuro said supratentorial multi focal white lesions maybe vascular or migraine, 3 more at same hospital want a Brain MRI and SpineMRI - I have a lot of tightness round my ribs and creeping , burning tingling in feet especially right side and weak hand . They think 50/50 ms lesions what is your opinion please ?
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5112396 tn?1378021583
Quix doesn't regularly contribute to this community anymore, though we all still benefit from her contribution. If you click on her name, you can read her past posts.

Your doctor may be waiting on another episode or MRI changes to take place in accordance with the McDonald criteria.
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18646657 tn?1466604616
I need your help, i have had ms symptoms for years, can hardly walk, finally got my mri, i can see lesions and black areas, dr says it looks "good" no ms he says....im so upset, i need to get treatment!
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987762 tn?1331031553
Hi and welcome,

Quix has not been active for some time, please consider posting a new question (green box at the top of the page), introducing your self and explaining your situation, so the community can offer you some constructive advice.

Cheers.......JJ
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Hi,
I have been having what looks like relapsing/remitting symptons that look like MS since 2002, My neurologist at the time did not do a spine MRI though I had MRI on my brain, this showed 2 areas of heightened activity!  I am unsure what that means. My GP always treated me as if I had MS and had written several times to the Neurologist saying that they need to diagnose me. I have never been diagnosed despite having positive tests on my neurological examinations such as positive Rombergs, upgoing planters and a very ataxic gait. I have since moved to a different area and had quite a bad relapse of my undiagnosed condition and referred to a neurologist. my question is that after almost a month of being unable to walk, urine retention and other symptoms I am starting to feel better, will the neurologist see any evidence of lesions if I am better when I get the appointment through.

Thank you kindly for your help.
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