MRI Scan of Brain Report help.

[suzieqs]

Hi,

A little history first, I'm a 55 y.o female that prior to May 4, 2007 was walking 6 miles a day every day and caring for a 95 y.o male in his home as a home health provider, on May 4th of 2007 I was out on the playground with my granddaughter and running around and chasing her, and somehow stepped down wrong and fractured my left tibia, as this fracture healed I started having other problems, first my feet started feeling numb and began swelling around the ankles, then by the time I was off the crutches I began noticing difficulty holding on and grasping things (picking up a plate was becoming a challenge), also I started noticing nodules on my wrists similar to RA, my Dr. ordered tests for lupus, RA and gout (which all came back negative, but my WBC and platelet count were abnormally high) then in August of 2007, I had a seizure (tonic w/o clonic symptoms) of short duration (about 20 minutes), I was hospitalized overnight, scheduled for an EEG and CT of brain which did not give any indication as to why I had a seizure, I was not given a seizure diagnosis at that time, just seizure of unknown origin, no meds given at this time for this, then in June of 2008 (10 months later I had another seizure, but this one lasted 1.5 hours, collapsed a lung, plus other things I'm not really sure about as I currently don't have those records available to me, I then was placed on Dilantin, and hospitalized for 5 days, which are still a bit foggy, I don't remember much still, then about 6 weeks later I had another seizure, this wasn't as bad as number 2 but still bad and due to non-therapeutic dilantin level (0.3 mg/dl should be between 10-20 mg/dl, stayed in hospital again for 3 days this time and got my level back, with a dosage change, to make this part a bit shorter all in all I had 3 seizures 1 status epilepeticus, 1 tonic grand mal, and 1 partial, then I had an episode of dilantin toxicity and again seen and treated in ER.  Ok, now to move on to now, in April of 2009, I started having tremors in my hands, then came the tingling in my fingertips, difficulty swallowing at times, episodes of extreme fatigue, difficulty walking, shuffling when I walk, trouble speaking (slurring words, mispronouncing, know a definition of a word but not able to think of word, intermittent short term memory problems), last month, I asked my dr if I could get tested for MS, since some of the symptoms I have been experiencing could be related to that and it was about the only thing I hadn't been tested for, he agreed and ordered an MRI of the Brain with and without contrast, which was done and I have a copy and it reads as follows:

Saggital T1, axial T2 FLAIR, T! pre and post contrast, T2, diffusion scans, coronal T1 post contrast, T2, and coronal T2 and T2 FLAIR imagges through the hippocampus were obtained. 10 ml of Magenvist was utilized.

The cerebrospinal fluid structures are within normal limits.  The sella appear prominent and shows CSF signal in the T2 weighted images, empty sella syndrome.  The optic chiasm and the pituitary gland appear unremarkable.  No abnormal lesions are seen in the pituitary gland.

There is no acute bleed/abnormal extraaxial fluid collection.  There is a small round approximately 6 mm high signal adjacent to the body of the right lateral ventricle best appreciated in axial image number 15, coronal image number 14.  This is not appreciated in the T1 weighted images.  It does not enhance.  The finding is nonspecific.  It may be associated with small vessel ischemic process.  Other diagnostic considerations include demyelinating process, remotely low grade neoplasm, inflammatory process.  Short term follow up MRI scan in 3 months recommended.  There is no mass effect/midline shift.

The right and left hippocampus appears symmetric, without evidence of mass/aabnormal enhancement.  The right and left orbital contents are symmetric.  The right and left seventh and eighth nerve nerve complexes and cerebellopontine angles are symmetric, without evidence of mass/abnormal enhancement.  The corpus callosum and brain stem appear unremarkable.

IMPRESSION:

1. PROMINENT SELLA LIKELY REPRESENTS EMPTY SELLA SYNDROME.

2. 6MM ROUND HIGH SIGNAL ADJACENT TO THE BODY OF THE RIGHT LATERAL VENTRICLE DOES NOT ENHANCE.  IT MAY BE ASSOCIATED WITH SMALL ISCHEMIC PROCESS.  OTHER DIAGNOSTIC CONSIDERATIONS INCLUDE DEMYELINATING PROCESS, LOW GRADE NEOPLASM, OR INFLAMMATORY PROCESS OR INFECTIOUS PROCESS{FELT TO BE LESS LIKELY}.  SHORT TERM FOLLOW-UP MRI IN 3 MONTHS RECOMMENDED TO ESTABILISH STABILITY OF FINDINGS.

Now, what questions/requests should I ask my primary doctor about?  Should I request a referral to a neurologist now or wait until the second MRI has been done?  Also what does T1 weighted images mean? (Is that with contrast?) What does it does not enhance mean? (would that be the diffusion images?).  Any and all input from the community would be greatly appreciated.  

Oh also, just recently I have begun experiencing orthostatic blood pressure, and the only diagnosis' that I know about are Seizure disorder unknown etiology, seronegative Rheumatoid Arthritis, and Depression (although where that came from I'm not sure).  So any recommendations as to where I work in guiding my doctor(s) in aiding them in getting a more definitive diagnosis?

Thanks In Advance.

[suzieqs]

Everyone who's posted on this.

I called my Dr's office today and asked for a referral to a neurologist, mybe I took your suggestion when she asked if I had a preference and told her the msu neurology clinic, preferred.  

Also, checked to see if they had gotten all of my medical records from the Florida hospital(s) yet, and got the doctor's MA on that task today, including records from every ER  I've been in in the past 3 years when the attacks are at their worst and get all of the tests I've had done in the past, and get these records, since past tests, etc. can go a long way in helping with the dx.  I am a bit upset that they haven't done this yet.  But, at least now, with your prompting, I'm not going to sit idly by and let them just poo-poo my symptoms.

You've brought out the Bear in me, since I came here with this first post.  And she's gonna roar and slash her way through to fruition, I'm going to have everything, I need done, done. Now, not later.  

So I'm not in limbo land anymore.  

Love All of You
Suzie :)

[Mybe]

My doc is in Lansing.  Michigan State University Department of Neurology & Ophthalmology. I'm very impressed with them.
http://www.neurology.msu.edu

[suzieqs]

I'm bumping this back up so hopefully some others in the community are able to give me some ideas as to what, how, when, why, where, etc. I need to communicate with my GP to get him to agree with my having a consult w a neurologist.  Also anyone know of a MS Neurologist in the Lansing, MI area?  Suggestions, I'm on Medicare, do I actually have to have a referral or can I find my own neurologist w/o one?

[suzieqs]

Thanks so much for your response so quickly!  An additional question do you think I also should get a second copy of my MRI so I have one with the radiologist report included on the cd? Or do you think the one I have and the paper copy of the report is enough.

Also, I have been thinking about having my doctors, dictate their notes right onto my laptop,  (I have speech recognition software) so I have a copy of each and every procedure report, the hospital is willing to place a copy of each and every test, report, etc on my laptop for me, so hopefully the dr(s) will too I have been trying to come up with a way to contain all of my Medical Records  in one place, I've thought about getting a usb flash drive that I can carry on a chain, that carries all of my medical information, that could be used by my doctors, paramedics, etc. they'd just put the flash drive into a usb port on their laptop/computer, etc and all of my pertinant information, like recent lab tests, last dr visit, allergies, current meds, etc. are right there for them to see, especially if I'm in an active seizure or incapacitated at the time, etc.  What do you think good idea?  I think if everyone had at least their most recent lab tests, medical history, blood type, etc all on a small portable flash drive that they could carry with them at all times, it might help in reducing our overall health care costs.

[Quixotic1]

You should have been referred to a neuro long before this!  Yes, Yes, Yes!  Ask for a referral.

And, Welcome!

Quix

[suzieqs]

Thanks for your quick response to my post!  I already have a copy of my MRI on CD they gave it to me on the same day I had the test done, but I probably should get another one that includes the radiologist report with it.  My Report is in paper form right now.  At least I have a hospital that is willing to give me right then and there copies of all of my medical records, tests, etc. without any moaning or groaning.  I think they realize I'm very involved in knowing what is or isn't going on with me, I know something is definately wrong, but what is wrong I'm not positive yet and to me not knowing is worse than knowing.  

I'll call my Dr.'s office Monday and ask him to schedule a referral to a neurologist, asap. I've never had a problem asking for referrals anyways, if I felt it was necessary.

Thanks again.

Luckily my local hospital has speciality clinics right there that offers the entire gamut of specialists at various times, so hopefully I can have a referral appointment rather quickly.

[Deb61]

I would ask to get a referral to an MS specialist.  I wouldn't wait until your second MRI.  I'm surprised you weren't seeing one in light of your history of seizures because something is obviously going on in your brain.  

Lesions next to ventricles are common places of MS attacks.  See this medical article:

http://www.direct-ms.org/pdf/CCSVI/Adams%20perivenous%20lesions%20MS%2087.pdf

This article is a good one about the T1 versus T2 weighted images on the MRI as related to MS:

http://www.ms-gateway.com/understanding-ms/diagnosing-ms/mri-and-ms-81.htm

I cannot give you much more information than this, but others on this forum can and will chime in about your MRI results.  However, I'm pretty certain that they'll recommend that you see a neurologist now instead of later.  A neurologist will know exactly what testing needs to be done to find out what is going on with you.  

It's not uncommon for MS to present itself with a fall.  My sister, who also has MS, took a fall and was later diagnosed with MS.  There's other people that have had similar experiences, I believe Socrates, that began their neurological investigations that way.

There are also people on this forum that are experiencing seizures.  I've even had a grand mal seizure myself years ago.  

It also that not uncommon to have other autoimmune diseases with MS.  Lots of people with MS have other autoimmune problems.  I have a thyroid disorder which caused all sorts of other medical issues.  

Your GP sounds like a great doctor, but generally speaking, they've not had the training that neurologists have had.  I would absolutely get a referral to a neurologist.  Your GP should have given you one already, in my opinion.

When you go, get  a copy of the MRI on CD for your neurologist to look at.  He will want to look at the actual MRI images himself.  My neuro saw some things that the radiologist didn't see when he went over my MRI with me.  He pointed out lesions with me sitting beside him on the computer and talked about them.

Welcome to the MS forum, by the way.  I hope to see you around on the forum again.  Keep us posted!

Deb