Avatar universal

MRI report says "clinically significant", but neurology says it's normal.

History: 29yo woman. 15+ years of "random shooting pains" and daily headaches (mild to severe).  March of this year (7 months ago) I began to experience tingling and numbness bilaterally in hands and feet.  I've also been struggling with fatigue and a cloudy feeling This has progressed to include chronic pain deep in my hands and feet.  I've had copious amounts of blood work and spinal x-rays to rule out dozens of possible systemic and physical causes and was finally referred to neurology.  Neuro exam was normal. EMG was normal.

The neurology PA I was assigned to didn't think my symptoms were consistent with MS (and I agree) but offered to have a brain MRI done.

I just had the MRI last week (my first one), and got the report this morning (it comes automatically to the online patient portal after a few days).  They found 4 "tiny" foci of hyperintensity: two in right frontal subcortical white matter one in left frontal subcortical white matter, and one in left parietal subcortical white matter.  The report says "These are likely to be of clinical significance" and are "similar to hyperintense foci seen in patients with vasculopathy of migraines and demyelinating disease. Clinical correlation is suggested."

So I read the report and thought, "Okay, they found something...possibly migraine related or MS related."  

Meanwhile I missed a call from my neurology department (I don't think they realize I can see the report) saying the PA had received my MRI report and it was normal, showing no signs of MS.

So is it common for the MRI report to suggest clinical significance and neurology to say it's "completely normal"?  At the very least, I would have expected her to say, "well they found X, but here's why I don't think it's significant."  Or to address that the report found something that could be related to my chronic headaches.

I'm just feeling very frustrated, because I thought I might finally be getting some answers, but now it seems like maybe not.
3 Responses
987762 tn?1331027953
Hi and welcome,

From what you have mentioned about your brain MRI, wide spread symptoms which isn't very consistent with MS and having a long standing medical history of migraines, to me the significance of your MRI is that it's more likely reflecting your history of migraines because migraine is one of the most common medical explanations for non specific subcortical intensities.

"These are likely to be of clinical significance" and are "similar to hyperintense foci seen in patients with vasculopathy of migraines and demyelinating disease. Clinical correlation is suggested."  

In relation to MS "Clinical correlation is suggested" is more significant than the specific MRI information you've mentioned.......MS causes neurologically abnormal 'clinical' signs of lesion damage and your neurological assessment didn't find anything neurologically abnormal, plus your symptom inconsistency with MS, and the addition of your MRI results, MS really would be extremely low on your list of potential causes.  

I understand the frustration, your migraines are the more likely explanation for your MRI results, but if you think about it, even with your brain MRI, neurological assessment and EMG not find anything that 'could' neurologically explain what you've more recently been dealing with, it is diagnostically significant as it will limit what could be causing it.

I would advise you to consider asking your doctor......if it is not a neurological condition, what else could it be and what tests haven't i had yet to diagnose it?

Hope that helps........JJ
Avatar universal
Thanks for the explanation of "Clinical correlation suggested."  So your basically saying that if my clinical examination had shown any signs of MS, these MRI results could point in that direction, but since they didn't, it's really not much of an indicator of MS. That makes sense.

Still, I prefer the doctors to give me the more detailed answer, rather than just saying, "everything's fine."

You're right, it is good to have ruled out anything the MRI could have shown.  But  at this point I think they've tested me for everything they can think of, so now it's more a matter of learning to live with it. C'est la vie. ;-)

Thanks for your help!
667078 tn?1316000935
No test rules MS in or out. It takes a neurologist to look at the history, symptoms, other tests, and his experience to make a diagnosis. If they did MRIs on every single person they would find something. Radiologists do not diagnose they only suggest. Even if the neurologists see something consistent with MS they usually follow you for several more years to see if there are any changes. My first 4 MRIs showed MS and I was not diagnosed until after my 5 and a positive lumbar puncture.

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