MRI and MS Symptom questions

[cwpeace4]

I've been to two different neurologists.
The last one works in the MS clinic - but sees other patients.

I started having symptoms 1 1/2 years ago. Initally as sharp righ sided head pain and dizziness as well as weakness.  have been tested and treated for Migraines (which I do not have) and have had nearly every possible angle ruled out (no lupus, lyme etc..) .  My symptoms got worse.  Going to the second neuro she said it's probable that my head / face pain was Trigeminal Neuralgia and put me on Gabapentin.  This has helped my headpain reduce by 75% but my weakness (right side), hand tremor (right side) dizziness and fatigue continue.
She sent me to get a follow up MRI (my first one shows multiple scattered spots but nothing definitive of anything) and this last one was on a 3T machine.
The following is what the radiologist report came back as.  My current Neuro said that it's good MRI stayed consistent with nothing new and that it's likely I do not have MS. However is sending me to get three days IV treatment with Sumederol (sp?) to see if that helps my symptoms.
Below is what the report says.
Because an MRI comes back as unchanged, does that make the diagnosis of MS no longer a possibilty? or is it just a wait and see game.  She said she would answer my further questions on our appointment at end of Feb... I only was allowed to briefly talk to her on the phone when she called about my latest MRI results.
Also, if this isn't MS related.. what the HELL could it be?

--------- (MRI results below)-----

Clinical History: Blurred vision, neuralgia and neuritis.
Patient complains 14 month history of head pain and weakness.
Possible multiple sclerosis.

TECHNIQUE: Multisequence multiplanar MR imaging of the brain
was performed before and after administration of IV gadolinium
contrast, without adverse event reported.

FINDINGS:
Brain volume/extra axial spaces/basal cisterns: Prevertebral
volume is within normal limits, stable in comparison to prior
imaging.

Brain parenchyma: No diffusion restriction. Following the
intravenous administration of contrast, there is no abnormal
enhancement.

Lobulated T2 hyperintense and T1 hypointense focus is
identified within the left posterior parietal lobe (axial T2
series 9, image 17). The focus follows CSF signal on all
sequences and is most consistent with a parenchymal cyst. There
is no associated enhancement.

There is no diffusion restriction.

Punctate foci of T2 and FLAIR signal hyperintensity are
identified within the periventricular and subcortical white
matter of the frontal lobes and parietal lobes. Overall the
distribution of findings is greater than expected for the
patient's age. Side-by-side comparison with the study dated
2/15/2012 demonstrates no significant interval change in the
size, number or distribution of lesions. Findings are
nonspecific and differential considerations include
demyelination such as multiple sclerosis or chronic
microvascular ischemic change related to hypertension, diabetes
or migraine headaches.

Hemorrhage: There is no evidence of intraparenchymal or
extra-axial hemorrhage.

Ventricles: Ventricles, sulci and cisterns are normal for age
without evidence of mass effect or shift.

Herniation: None.

Calvarium: The bony calvarium is within normal limits.

Vascular system: Flow voids in the major intracranial vessels
are within normal limits.

Sinuses: Paranasal sinuses are clear. The globes and orbits are
within normal limits.

Orbits: Orbits are normal.

Visualized sella, mastoid air cells and skull base: Normal.

Visualized cervical spine: Normal.

PROTON MR SPECTROSCOPY was performed with 3D water suppressed
acquisition.Three dimensional long TE spectra were acquired
.from four contiguous slices including, 1) basal ganglia, 2)
infra callosal, 3) callosal and 4) supra callosal locations.
Quantitative processing of the spectra yields ratios of the
following metabolites:

Basal ganglia:
Choline/Creatine = 1.16 (normal range 0.52-2.19)
Choline/NAA = 0.76 (normal range 0.39-1.00)
NAA/Creatine = 1.53 (normal range 1.15-2.77)
Glu/Cr = 0.09 (normal range 0.10-0.42)

Infra callosal:
Choline/Creatine = 1.21 (normal range 0.81-1.87)
Choline/NAA = 0.6 (normal range 0.38-0.86)
NAA/Creatine = 2.02 (normal range 1.86-2.46)
Glu/Cr = 0.09 (normal range 0.20-0.36)

Callosal:
Choline/Creatine = 1.21 (normal range 1.04-1.66)
Choline/NAA = 0.56 (normal range 0.45-0.71)
NAA/Creatine = 2.15 (normal range 1.98-2.65)
Glu/Cr = 0.18 (normal range 0.24-0.37)

Supra callosal:
Choline/Creatine = 1.17 (normal range 0.96-1.63)
Choline/NAA = 0.54 (normal range 0.40.-0.63)
NAA/Creatine = 2.17 (normal range 2.10-2.92)
Glu/Cr = 0.22 (normal range 0.23-0.46)

Z-Average values for the metabolite ratios:
Choline/creatinine = 0.131
Choline/NAA = 0.163
NAA/creatinine = -0.16
Glu/Cr = 0.7630

The MR spectroscopy findings are grossly within normal limits.

IMPRESSION:
1. Punctate foci of T2 and FLAIR signal hyperintensity
primarily in the subcortical white matter distribution
involving the frontal lobes and parietal lobes, unchanged in
size, contour or characteristics in comparison to 2/15/2012.
Differential considerations include demyelination such as
multiple sclerosis, or advanced chronic microvascular ischemic
change usually related to hypertension or diabetes. Clinical
correlation is recommended.
2. No abnormal enhancement.
3. No diffusion restriction
4. Cystic cavity within the left posterior parietal lobe,
stable in comparison to prior imaging.

[Deb61]

It doesn't look like that the MRI report ruled out MS.  It says that your MRI is unchanged since the last one.  One of the diagnosis to consider is MS.  I've had MRIs that have stated that they were unchanged from the previous one.  She'll is correct in that MS is a clinical diagnosis.  The MRI is one piece of the puzzle, but it may support MS after your neurologist looks at all of the other pieces.  MS was one of the things the radiologist says that should be considered along with ischemic changes related to diabetes, migraine, high blood pressure, etc.

[sllowe]

Hi there,

I'm glad you have an appt. at the end of Feb. Every case can be so different. MS is a clinical dx, so the MRIs do not tell the whole tale. Meaning unchanged for one individual may mean one thing, and something different for another.

To truly understand MS or not MS, it's important to recognize that it varies. Hoping you have a thorough appt. coming up - one where all your questions will be answered. They are good questions btw :) Write it down, and bring it with you!
Thanks for joining us!
-Shell