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MRI reading help

Hi!
I posted a question a while back about my MRI showing hyperintenstites but the second with contrast said it was nothing. I had the MRI done due to blurred vision, aching limbs, fatigue and numbness and tingling in my right side. I have a copy of my results and wonder if anyone can tell me if it's cause to see a neurologist. The PA I see says no and to wait 6 months and do a repeat.

Here they are.

WITHOUT CONTRAST-

SEVERAL SCATTERED TINY T2/FLAIR HYPERINTENSITIES ARE NOTED IN THE CEREBAL WHITE MATTER. THESE ARE SUBCORTICAL AND ARE NONSPECIFIC. NO BRAINSTEM OR CEREBELLAR LESIONS ARE NOTED. THERE IS NO HYDROCEPHALUS OR ATROPHY OR RESTRICTED DIFFUSION.

WITH CONTRAST-

POSTCONTRAST IMAGES OF THE BRAIN DEMONSTRATE NO ABNORMAL ENHANCEMENT OF THE FOCI NOTED ON THE PRECONTRAST IMAGES. AGAIN NOTED ARE SCATTERED HYPERINTENSITIES IN THE FRONTAL LOBE WHITE MATTER AS WEEL AS THE PERIVENTRICULAR WHITE MATTER. THERE IS NO EVIDENCE OF DAWSON FINGER ON THE SAGITTAL FLAIR SEQUENCE.

I AM 29 YEARS OLD AND STILL EXPERIENCING THE SYMPTOMS

THANKYOU IN ADVANCE FOR ANY INPUT.
4 Responses
562511 tn?1285904160
Hi.  Welcome to the forum.  Sorry that you did not get a response last time you posted your question.  This forum gets busy and some questions get buried quickly. :-(

My answer would be "Yes" go see a neurologist.  The reason you had an MRI was because of your symptoms.  The MRI report states that you have very small "hyperintensities" aka lesions which are not screaming MS, but they are there. "Dawson" finger lesions are seen in MS (not seen on your MRI) and frequently in the periventricular area of the brain.

The contrast DOES NOT indicate there is no abnormality, rather it reads that there is no enhancement.  A lesion that "enhances" is a new lesion (60-days or less).  A lesion that does not enhance is an older one.  Basically, your MRI reads the same before and after contrast.  

If you do see a neurologist they may make you wait 6 months for another MRI - that seems to be the trend.  Personally I would not wait.  What is important is that the neurologist, PA or whomever talks with you at length about your history, i.e: How long have you had these symptoms?  Does it come and go?  Any other symptoms?  

A thorough neurological exam at this time is essential which will test: reflexes, gait, a look at the optic nerve, strength, coordination, etc.

Your PA should be ordering various tests to find other causes of your symptoms.  Take a look at the Health Pages to get an idea of what is typical testing for a person with symptoms such as yours.  These pages will also help you understand more fully about hyperintensities that enhance or not and the basics of MRI language.  

http://www.medhelp.org/health_pages/list?cid=36

Hope that helps.  Is your PA following up on your symptoms?  Testing thyroid, sed rate, those sort of things?

Keep us posted.  
Avatar universal
Thank you so much for your reply. He ordered a load of tests. I know they did thyroid, B12, lyme disease, but I'm not sure what else. I should add that the MRI of my cervical spine showed alot of damage including degenerative joint disease, dessication, spinal stenosis and hernias.. That may account for a few of my symptoms but definitely not all. I think I am going to try a new Dr, as I've been twice to ask for a neurology refferal and twice i've been told it's not warranted as apparently the MRI with contrast looks "normal". I guess I need to be a bit more assertive.
562511 tn?1285904160
They should give you a referral based upon the MRI findings of the cervical spine alone. Herniations and stenosis can be very painful and cause significant problems.  The spine is part of the central nervous system and your brain MRI has some hyperintensities. That should justify a referral to a neurologist.  (that's your argument to get your referral)  

Who ever is telling you that the "MRI with contrast looks normal" hasn't a clue what they are talking about.  More likely, you are in a managed care insurance plan who make it their policy to look the other way.  The images with contrast show the SAME ABNORMALITIES as the images without contrast.  The significance of these hyperintensities should be determined by a neurologist.  No other physician is qualified to make such a call except a neurologist.

Good luck.  Read the Health Pages.  They will serve you well.

Avatar universal
Thanks again Karen. I pretty just needed to know that I wasn't just being paranoid or over reacting. I will be making an appointment next week with someone else and try my best to put my foot down... I am reading through the health pages. Finally things are making sense. All the best and good luck to you.
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