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Meaning of MRI w/ Subtle Increased Signal
My symptoms started with swallowing issues (liquid in windpipe, small particles of food stuck in throat, occasional tired feeling of throat muscles below adam's apple) and very cold hands and feet. Within months I developed other symptoms: muscle twitching of thumb/index finger, lower leg, and eyelid; foot muscle spasms; and action tremors that worsen as the day progresses. Most of the time, these symptoms occur on the left side of my body - sometimes on the right. After my initial symptoms, I have become increasingly anxious as well.
I have seen ENT and Gastro and checked out normal. My neuro believes the symptoms are anxiety related. At my urging, we conducted an MRI which came back with the following results:
"Brian MRI without and with intravenous contrast using 20ml of Magnevist.
FINDINGS: Subtle linear increased signal on the FLAIR sequences is within the right frontal white matter and is visible on image 14 of series 13. A developmental venous anomaly is visible on the postcontrast sequences within the left parietal lobe subcortical white matter on image 15 series 17 and image 17 series 16. The brain otherwise has normal signal and gray white distinction. There may be small choroidal fissure cysts on the left on image 12 of series 7 that correlates to the increased signal on image 11 series 8 of the coronal FLAIR sequence. The ventricles have normal size and position. No intracranial mass or evidence of hemorrhage. No abnormal signal on the diffusion-weighted gradient echo sequences. No abnormal enhancement intracranially.
IMPRESSIONS:
1. Subtle linear abnormal signal in the right frontal white matter is too small to characterize. This is likely an incidental finding, but if there are partial complex seizures, then thin section 3D SPGR and 3D T2-weighted sequences in the coronal plane should be performed through the frontal lobes and reformatted in the sagittal and axial planes at this location. Rarely, balloon cell cortical dysplasia could have this finding.
2. Incidental left frontoparietal developmental venous anomaly."
What does this mean? Might the "subtle linear increased signal" and / or "venous anomaly" be MS and causing my symptoms?
I have seen ENT and Gastro and checked out normal. My neuro believes the symptoms are anxiety related. At my urging, we conducted an MRI which came back with the following results:
"Brian MRI without and with intravenous contrast using 20ml of Magnevist.
FINDINGS: Subtle linear increased signal on the FLAIR sequences is within the right frontal white matter and is visible on image 14 of series 13. A developmental venous anomaly is visible on the postcontrast sequences within the left parietal lobe subcortical white matter on image 15 series 17 and image 17 series 16. The brain otherwise has normal signal and gray white distinction. There may be small choroidal fissure cysts on the left on image 12 of series 7 that correlates to the increased signal on image 11 series 8 of the coronal FLAIR sequence. The ventricles have normal size and position. No intracranial mass or evidence of hemorrhage. No abnormal signal on the diffusion-weighted gradient echo sequences. No abnormal enhancement intracranially.
IMPRESSIONS:
1. Subtle linear abnormal signal in the right frontal white matter is too small to characterize. This is likely an incidental finding, but if there are partial complex seizures, then thin section 3D SPGR and 3D T2-weighted sequences in the coronal plane should be performed through the frontal lobes and reformatted in the sagittal and axial planes at this location. Rarely, balloon cell cortical dysplasia could have this finding.
2. Incidental left frontoparietal developmental venous anomaly."
What does this mean? Might the "subtle linear increased signal" and / or "venous anomaly" be MS and causing my symptoms?
Hi Concernedcasslaf - I've been around for a couple of years and have not seen eflanker post.
Submitted FYI :-)
Kyle
Submitted FYI :-)
Kyle
I know this is an old thread, but I am having similar symptoms and was wondering if you ever got a diagnosis?
Yes, I've been focused on diagnosing the swallowing issues but the their intermittent nature has made it difficult. ENT's scope showed nothing abnormal. I had an upper endoscopy done by a Gastro and am awaiting biopsy results - he didn't see anything abnormal via the scope. I took blood tests for MG, thyroid, and B12 and all came back negative. ALS was ruled out due to intermittent nature of symptoms.
I was thinking the same thing as Quix re: MG. There is a simple blood test for it; it tests for antibodies to acetylcholine receptors. The test is reasonably reliable as I understand it, to dx this disease or rule it out, in cases of MG involving the eyes. I think is test is less reliable when eyes aren't involved. Not sure if that includes cases of eyelid droopiness or just problems with eye movement. My memory on this is fading...I was tested for it > 2 years ago (neg).
I just reread your first post. Have you been evaluated for myasthenia gravis? This could cause the difficulty swallowing, fasciculations, droopy eyelid, feeling of fatigue in your throat, and the tremor.
This diagnosis is often missed and it might not be a bad idea to be checked for it. You might ask your neuro.
Q
This diagnosis is often missed and it might not be a bad idea to be checked for it. You might ask your neuro.
Q
I'm sorry this came so late. I meant to write a new response over the weekend. Hope you are still with us.
Reading your response does change my answer. When we talk about anxiety online, we never know how self-aware someone is or how they will take the discussion. Clearly you see that the anxiety is secondary to other things that had begun to happen.
I think you should have a thorough evaluation of your swallowing mechanism. I mentioned various of the tests that might be done above. Also, recently a member was evaluated for difficulties swallowing and had a very abnormal result. You can see her thread (her name is LATW) on the first page right now.
"Globus" is generally considered the sensation of a lump in the throat or of something stuck without there being a problem. If there really is an underlying problem, the same term could be used, but without the "hystericus" with it, I guess. (I HATE the term hystericus for anything!)
Action tremors are the tremors appearing when someone is performing an action. It doesn't have to be movement. I amy be just the holding of a position requiring sustained muscle contraction. To an extent, stress can cause a trembling, as would be seen in the state of adrenaline production and that could certainly look like an action tremor. the difference, I think, would be that in anxiety or heightened stress, the tendency to tremor would be seen all over, because the adrenaline is surging through the bloodstream and effecting the muscles all over. I do not think that anxiety would CAUSE a true action tremor per se, though it would accentuate one.
Another thing to look at if someone is diffusely tremorous is the thyroid.
Action tremors are the kind seen in MS. These disappear at rest or with sleep, whereas the tremor, say in Parkinson's, is a resting tremor and disappears with movement.
My advice is to get your swallowing problems evaluated in full.
Quix
Reading your response does change my answer. When we talk about anxiety online, we never know how self-aware someone is or how they will take the discussion. Clearly you see that the anxiety is secondary to other things that had begun to happen.
I think you should have a thorough evaluation of your swallowing mechanism. I mentioned various of the tests that might be done above. Also, recently a member was evaluated for difficulties swallowing and had a very abnormal result. You can see her thread (her name is LATW) on the first page right now.
"Globus" is generally considered the sensation of a lump in the throat or of something stuck without there being a problem. If there really is an underlying problem, the same term could be used, but without the "hystericus" with it, I guess. (I HATE the term hystericus for anything!)
Action tremors are the tremors appearing when someone is performing an action. It doesn't have to be movement. I amy be just the holding of a position requiring sustained muscle contraction. To an extent, stress can cause a trembling, as would be seen in the state of adrenaline production and that could certainly look like an action tremor. the difference, I think, would be that in anxiety or heightened stress, the tendency to tremor would be seen all over, because the adrenaline is surging through the bloodstream and effecting the muscles all over. I do not think that anxiety would CAUSE a true action tremor per se, though it would accentuate one.
Another thing to look at if someone is diffusely tremorous is the thyroid.
Action tremors are the kind seen in MS. These disappear at rest or with sleep, whereas the tremor, say in Parkinson's, is a resting tremor and disappears with movement.
My advice is to get your swallowing problems evaluated in full.
Quix
I just wrote you this brilliant answer, full of wisdom and insight, but and errant move of my little finger sent it soaring into the ehinterlands to land someday on some hapless soul's screen causing endless confusion. I'll try again later, but that kind of brilliance can only rarely be seen, so we'll just suffice with my ideas.
Phooey!
Quix
Phooey!
Quix
Quix
Thanks for your thoughtful response. I did some reading on BFS and don't disagree that my twitching + spasms + anxiety could = BFS (note: my twitching stays for days or weeks, goes away, and then reappears in another area staying for days/weeks). Regarding my swallowing issues, they started distinctly before my anxiety increased. Moreover, I know what globus feels like and the swallowing issues that initially presented do not appear to be of that nature. These initial issues had to do with swallowing liquids that would either go all the way or partially down my windpipe and cause coughing or clearing (ie, this would happen once every few days - prior to that, I would rarely "mis-swallow"). Plus, I wasn't anxious at the time and wasn't overthinking the swallowing process because these mis-swallows would always catch me by surprise. Thereafter, once I got anxious about things, I started noticing the globus effect when both the feeling of stuck food and ACTUAL stuck food occurred (ie, I have felt and seen the stuck particles after throat clearing). By the way, is globus just the feeling of stuck food or can it actually cause it as well?
Given the description of my pre-anxiety issues, what are your thoughts? And what about the action tremors - does anxiety commonly cause those as well?
Thanks,
eflanker
Thanks for your thoughtful response. I did some reading on BFS and don't disagree that my twitching + spasms + anxiety could = BFS (note: my twitching stays for days or weeks, goes away, and then reappears in another area staying for days/weeks). Regarding my swallowing issues, they started distinctly before my anxiety increased. Moreover, I know what globus feels like and the swallowing issues that initially presented do not appear to be of that nature. These initial issues had to do with swallowing liquids that would either go all the way or partially down my windpipe and cause coughing or clearing (ie, this would happen once every few days - prior to that, I would rarely "mis-swallow"). Plus, I wasn't anxious at the time and wasn't overthinking the swallowing process because these mis-swallows would always catch me by surprise. Thereafter, once I got anxious about things, I started noticing the globus effect when both the feeling of stuck food and ACTUAL stuck food occurred (ie, I have felt and seen the stuck particles after throat clearing). By the way, is globus just the feeling of stuck food or can it actually cause it as well?
Given the description of my pre-anxiety issues, what are your thoughts? And what about the action tremors - does anxiety commonly cause those as well?
Thanks,
eflanker
Hi, and welcome to the forum. Your main question is about the "subtle linear increased signal." Just trying to read the radiologist's mind here, but usually this description means that the lesion or spot they are trying to describe just doesn't have very clear characteristics. The margin isn't clear, it isn't very much different from the surrounding brain tissue. It looks like something is there, but it is unclear what.
This would be an unusual description of an MS lesion. They can be subtle, but rarely are they described at truly linear in the brain.
The "Incidental left frontoparietal developmental venous anomaly" means that, "Oh, and they just happened to see a variation of a normal vein in the left part of the brain between the frontal and parietal lobes. This develped differently as a fetus." It is inconsequential. Most of us have one or more of these somewhere in our bodies.
As for your symptoms, they also do not sound like MS. In many ways your doc is correct that these are all very frequent symptoms of anxiety and, especially anxiety about one's health. Swallowing difficulties and a feeling of something stuck in the throat are really common in anxiety. The medical term is "globus hystericus." But, I would not jump to that until after the swallowing had been evaluated for a physical problem. This can be done by a GI doc or by a Speech and Language Therapist (who usually works with a GI or ENT doc).
Speech and swallowing are two things that are semi-automatic. When you focus too much attention on them, they start to mess up and lose the smooth automatic flow. Anxiety vocused on them makes any problem worse. All people have swallowing problems from time to time and it is a very common complaint.
The cold hands and feet are other common anxiety problems. In anxiety the "adrenaline" hormones are circulating in excess and adrenaline cuts down the flow of blood to the skin and extremities and sends it to the muscles to prepare for "fight or flight."
Muslce twitching that moves around from one part of the body to another is not typical at all of MS. In MS they tend to stay localized for long periods of time, then they may aor may not move around. Many things can set of diffuse twitching - called fasciculations. A viral infection is the most common. Once the twitching starts it can become more diffuse and seem to go one forever - look up Benign Fasciculation Syndrome. Again, once the twitching is there the neurotransmitter effects of anxiety make them MUCH worse.
Now, I am usually very much against jumping to a conclusion that all neuro-type symptoms are due to anxiety. I think a basic work up should be done to check for stuff. Sounds like you have had a lot of this done. Also, if you have looked up muscle twitching you might have seen the link to ALS. This will make you even more anxious. I can't address much on that topic, but it doesn't sound like the classic presentation of ALS.
Sometimes it is best to just stop and treat the anxiety. Once the chemical part of anxiety is under control you can see what symptoms are left and how they act. Then you know whether you are dealing with real physical symptoms or ones caused by the chemical effects of anxiety. Note that at no time did I say the symptoms are in your head. They are real. The question is whether they are due to anxiety or a physical problem - which is very unlikely to be MS.
We understand how much all this can make one suffer and worry. And you, yourself, only know if you are prone to excessive worry about your health. Many people suffer from this and it can rob you of quality of life.
As a physician, I didn't see anything worrisome in the MRI results, but I am not a neuroradiologist.
I hope this helps. If your docs seem to genuine care about you, then I would listen to them.
Quix, MD
This would be an unusual description of an MS lesion. They can be subtle, but rarely are they described at truly linear in the brain.
The "Incidental left frontoparietal developmental venous anomaly" means that, "Oh, and they just happened to see a variation of a normal vein in the left part of the brain between the frontal and parietal lobes. This develped differently as a fetus." It is inconsequential. Most of us have one or more of these somewhere in our bodies.
As for your symptoms, they also do not sound like MS. In many ways your doc is correct that these are all very frequent symptoms of anxiety and, especially anxiety about one's health. Swallowing difficulties and a feeling of something stuck in the throat are really common in anxiety. The medical term is "globus hystericus." But, I would not jump to that until after the swallowing had been evaluated for a physical problem. This can be done by a GI doc or by a Speech and Language Therapist (who usually works with a GI or ENT doc).
Speech and swallowing are two things that are semi-automatic. When you focus too much attention on them, they start to mess up and lose the smooth automatic flow. Anxiety vocused on them makes any problem worse. All people have swallowing problems from time to time and it is a very common complaint.
The cold hands and feet are other common anxiety problems. In anxiety the "adrenaline" hormones are circulating in excess and adrenaline cuts down the flow of blood to the skin and extremities and sends it to the muscles to prepare for "fight or flight."
Muslce twitching that moves around from one part of the body to another is not typical at all of MS. In MS they tend to stay localized for long periods of time, then they may aor may not move around. Many things can set of diffuse twitching - called fasciculations. A viral infection is the most common. Once the twitching starts it can become more diffuse and seem to go one forever - look up Benign Fasciculation Syndrome. Again, once the twitching is there the neurotransmitter effects of anxiety make them MUCH worse.
Now, I am usually very much against jumping to a conclusion that all neuro-type symptoms are due to anxiety. I think a basic work up should be done to check for stuff. Sounds like you have had a lot of this done. Also, if you have looked up muscle twitching you might have seen the link to ALS. This will make you even more anxious. I can't address much on that topic, but it doesn't sound like the classic presentation of ALS.
Sometimes it is best to just stop and treat the anxiety. Once the chemical part of anxiety is under control you can see what symptoms are left and how they act. Then you know whether you are dealing with real physical symptoms or ones caused by the chemical effects of anxiety. Note that at no time did I say the symptoms are in your head. They are real. The question is whether they are due to anxiety or a physical problem - which is very unlikely to be MS.
We understand how much all this can make one suffer and worry. And you, yourself, only know if you are prone to excessive worry about your health. Many people suffer from this and it can rob you of quality of life.
As a physician, I didn't see anything worrisome in the MRI results, but I am not a neuroradiologist.
I hope this helps. If your docs seem to genuine care about you, then I would listen to them.
Quix, MD
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