Is this Multiple Sclerosis? MRI interpretation needed

[laural324]

My sister has been given a probable diagnosis of Multiple Sclerosis; however, the same neurologist also believed that her symptoms (blurred vision, numbness in hand and back, extreme eye/face pain) could be attributed to a stroke or brain tumor, so we would very much appreciate some additional feedback. I'm attaching the latest MRI results for more information.


MRI Brain with contrast

History of sudden onset of visual disturbance.

Sequences: multi-planar, multi-sequence images of the brain with contrast including MR angiography of the Circle of Willis.

Findings: No previous MR for comparison. No midline abnormalities except signal changes within the corpus callosum. A craniocervical junction is difficult to assess due to lack of T1 sagittal weighted images. Posterior fossa is not enlarged. The craniocervical junction is not well demonstrated. Aqueduct is patent. There is some prominence of the occipital horn of left lateral ventrical which may represent normal anatomical variation. There are several punctate and small areas of FLAIR hyperintensity in the deep periventricular and subcortical white matter. There are signal changes within the corpus callosum. Some signal abnormalities show perpendicular orientation to ventricular system. There are also signal changes within the brainstem affecting the ventral aspect of the medulla. There is a questionable signal abnormality within the upper cervical spinal cord however cervical cord is difficult to assess. There is a large FLAIR hyperintensity in the posterior limb of the left internal capsule. No signal changes on gradient echo sequences and diffusion-weighted images. There are a few punctate FLAIR hyperintensities in the left cerebellar hemisphere. Some foci of FLAIR hyperintensity show abnormal post-contrast enhancement with cloudy post-contrast enhancement seen in the large FLAIR hyperintensity in the left frontal subcortical white matter. There is abnormal post-contrast enhancement and FLAIR hyperintensity in the left temporal lobe, left internal capsule, subcortical parietal white matter and left cerebellar hemisphere. No significant mass effect. No midline shift. No obvious orbital pathology. No obvious abnormalities on MR angiography.

No evidence of acute infarction. There are multiple FLAIR hyperintensitites involving supra/infratentorial brain parenchyma and brainstem as described above. There is involvement of the corpus callosum. Some signal abnormalities show abnormal post-contrast enhancement. The overall picture most likely represents demyelination. MR of the C-spine should be performed for completion of the study.

[laural324]

Ah, I see what you meant now about the 'male' thing on my profile. Have changed it to female. :)

[laural324]

Hi tingletingle,

Thanks so much for your help! I am indeed Laura (the sister). :-) I will pass this information along to my sister and see if her 'second opinion' neurologist will be ordering the MRIs you suggest. Right now I'm doing all the reading/writing because she's lost her sight completely. Going on four weeks now. She was given a prescription for Carbamazepine so we're hoping that will help with the pain, and perhaps the vision.

Thanks again!

Cheers,

Laura

[tingletingle]

Oops, done it again. Apologies, you are Laura's brother!

It seems I have a bit of form for assuming all girls here. Just ask Kwarendorf!

[tingletingle]

Hello Laura,

What a loving sister you must be for getting involved at one of the most stressful, uncertain times of your dear sister's life. The symptoms that your sister is experiencing will no doubt be frightening to her.

I am no doctor, or radiologist so please take my counsel with a grain of salt. I'm just a humble person with MS and a newbie at that.

All I get from reading the report is 'most likely demyelination' which may or may not be MS related. But really the person would like another MRI of spine and better images of the existing MRI including  T1 sagittal weighted images and upper cervical spinal cord.

So, early days. There is obviously something happening on the MRI but just have to place your trust in the neurologist to get to the bottom of it.

I wish you and your family the patience, and strength see this difficult time through together. May this trial bring you all closer in love and faith.

Blessings
Alex