My MRI Impression ?MS

[LisaSpainhour]

My MRI impression:
1. Partial Empty Sella
2. Nonspecific periventricular white matter changes. Findings consistent with hx of migraines. However, a demyelinating process or vascular etiologies cannot be excluded.

It states in the report also that they are multiple foci of signal abnormality in the periventricular white matter.

If you were reading this report what would you tell the patient?

Everything I look up leads to MS or Alzheimer's. Just want your opinion and I know you do not have my medical history so just by this report along. Thank you

[Julie_s_Mom]

Hello Lisa,
I don't usually participate in forums; however, I was researching some info for my daughter who is now 32 and has developed an odd rash.  She is a high paid exec in NYC and will see her dermatologist on Tuesday.  I reminded her to check her for Lupus (again).  Mother's will always be Mother's won't we?  My daughter experienced her first flare and was diagnosed with MS when she was 18.  It was the beginning of her 2nd semester at Notre Dame.  I will never forget the day I packed up quickly after school and drove to be with her.  I spent the week in her hospital room.  She had lost all use of her legs. When she was released and I drove her home to Chicago she learned to walk again. It was a very scary time.  Would she return to school?  She had exactly 20 days to be out of school without loosing the semester,but she made it.  Her Dr. in Chicago told her she probably would not have another flare for 6 years and he was exactly right.  The last 8 years have been long trials but she has had the determination to survive-going to her professional job with a limp upon occasion, having mono, having spinal meningitis, having major surjery at C3 on her spine with another upcoming.  Just be there for your daughter, or leave her alone as needed because she will most likely be in denial for a while.  My Julie approaches each hurdle as they come and fortunately she has great insurance.  I recommend for your daughter to get a job that offers long term care insurance ASAP.  Good Luck and may God Bless you, your daughter and your family.  Our family has certainly needed it.
Julie_s_ Mom    

[LisaSpainhour]

Yes Very Frustrated!   He said my VER test abnormal in both eyes and he would have to watched me closely.  I have been to 3 eye doctors (8 tests)they kept sending me to another to do tests and then another and no optic neurititis.  

What's up with you>?

[Momzilla]

How frustrating!  What kind of 'changes?'  Does it specify? Does your VER confirm past optic neuritis?  Have you had any other testing done?

Zilla*

[LisaSpainhour]

I had another MRI which showed not much change but deep white matter changes.  I had a VER test which turned out abnormal in both eyes but still the Dr said he could not dx me yet.

[LisaSpainhour]

Hi  Long time no hear from....How have you been??

The Neuro Dr since I said the spinal tap was normal and no optic neurititis that my chances of MS are only 10-20% and I ruled it out.  He asked what do you want to do and recommended a repeat MRI so I said yes and will do it in Nov.

As far as my daughter I am wondering if she is milking it some.  She is very lazy and has been for a long time but one time when I took her to the ER and they told me she just had gas.  She kept calling my work saying she could not breath and one of the Drs I worked for had me go get her and he had her do xray etc like hosp and found she had pneumonia and pelursy  so I felt bad thinking she was putting on.  It seems though she can travel but when she is at home always in bed.  Not sure how to handle her regarding the MS.  She does not help with anything or never really has but empty a dishwasher once and claims she has been doing it when we know she hasn't.  Her room is pitful.  Any help on how to handle her would be appreciated.  She will be 22 in Feb and does nothing nor has ever really around the house.  She will even watch me carry in groceries and not help.  She is always complaning about being sick and she does get bronchitis and stuff alot started in high school.  Thanks

[Quixotic1]

HI!!!   Sor sorry to hear about your daughter.  If she was missing a lot of work and not taking FMLA, then the firing was probably legal, but it varies widely between states.  For instance, worders in Nevada have incredibly few rights, and the ones given them federally are deeply undercut by the state laws and courts.  You would have to speak with legal aid.

I'm glad to hear of the repeat MRI coming up. Did the spasms in the arm prompt your neuro to do it?  Certainly high BP or migraines won't cause spasms.

About the dizzy.  Say, "The world seems to be whirling around me,"  That way they won't mistake "dizzy" for "lightheaded."

When is the MRI?  We'll be thinking about you.  quix

[LisaSpainhour]

I am going to have another brain scan to compare. I have been having spasms in my right upper arm and my whole left arm.  

My daughter is on the shots but still have spasms.  They injected her with steroids for awhile.  Her job fired her since she was out knowing her problem.  Does anyone know if they can do this?

Thanks

[LisaSpainhour]

Hi long time no talk to.  Yes I am going to see what happens with the Thyroid.  The Dr did call and said he still has not ruled out completely MS thinks maybe vascular but I told him I have r/o MS due to info online.  For instance 80-90% have had or have Optic Neuritis and I was defintely ruled out with that one.  They think maybe allergies in eye and age thing.  

I do have High Blood Pressure, High Cholesterol, ATypical Migraines, Sleep Apnea, Allergies, poss Asthma Mild COPD, LEE(edema), Arthritis in neck, back, feet (nodes on fingers also)  NOT RA by labs.  Many problems with back DDD, Slight scolosis and Lordosis, 3 bulging disc, Osteopenia on the line for Osteoporsis (mother severe) one nerve no reponse from eeg  sticking pin needles in your legs but not damaged.  I get back shots but last epidural put me out of work week due to spinal leak and the spinal tap I just had did not put me out of work but my head hurt when bending and coughing.

My main worry besides hurting is the feeling like I am going to pass out.  I have been trying to figure out how to describe to the Dr since I always say dizzy.  It is like your sitting in a car and you grab it because you feel like your moving but your not.  I have grabbed my husband in a restaurant thinking I was going to pass out or something but it is secs but it happens in frequency for awhile and then slows down but it did it at work twice today.  I still work and anyone looking at me would think I have no problems except my back when getting up from sitting or when I limp when my leg is acting up.

I just want a DX but would like it to be a right one :)

[LisaSpainhour]

I appreciate that but I am out of money for copays and time taking off from work.  I am going one time and then I will wait til next year and go from there.  Thank you so very much for your concern.

[Quixotic1]

Maybe back to square, but maybe not.  Low thyroid can cause weakness, pain and edema.  Let's see how you feel after the thyroid kicks in.  It may take several weeks after the thyroid is normalized to feel fully better.  BE glad, you really don't want MS.  I tried it and don't like it.  Two thumbs down!

The lesions cannot be ignored, but they sound like they are characteristic of MS, but more of a microvascular disorder like migrain or high BP which I gather you don't have.

Did the ophthalmologist think your loss of vision was from migraine???  Visual symptoms, vertigo or loss of balance, plus the lesions needs to be kept in mind until the cause is known.  In the meantime treat what they found, low thyroid and see what is left after.  Does that sound sensible?

Quix

[sllowe]

I'm new here to this forum, but your last words here grabbed me, so I feel compelled to say - Please Don't Give Up! It will be hard and tiring and you'll feel like you are repeating yourself (if you have to work your way through various Dr's). But, start by re-reading some of the suggestions here on this thread, as you have to be your own investigator and keep digging.  Something initiated your issues and if you feel uncomfortable with their dx it's for a reason. I wish you well. . .
sl

[LisaSpainhour]

If you are still out there.  I had a spinal tap and it was normal.  I have not had or have optic neuritis SO it looks like I do not have MS just my daughter does.  So I am back to square 1 ...They did put me on medicine for hypothyroidism.  We will see about all my other aches pains tighting in legs and swelling etc..I feel like giving up!

[LisaSpainhour]

My daughter started her shots Monday and so far no side effects.  She chose the daily one comopanze  

[LisaSpainhour]

I mentioned about the Empty Sella but they all say nothing to worry about.  although my labs came back and my thryoid was high 7.85 and has never been before.

[LisaSpainhour]

Thanks alot for the info.  I just got back from the Neuro Opthamalogist and he said he was just to check if any optic neuritis which he ruled out and said probably not MS.  My daughters optic neuritis showed up on the MRI i guess because the Dr said he saw that and 21 spots.  Don't understand why they can dx her so quickly and mine states white matter changes in perventicular but not sure but looks like MS.  So I guess I will do the spinal tap even though her Dr states they can be neg and u could still have it so I was questioning why do it but I do want to know why my MRI has changes which one in 2002 was normal.

[Quixotic1]

Hi, Lisa, yes.  I am a retired pediatrician and have recently been diagnosed with MS.  I hang out here because of all I went through to get a diagnosis and what I have learned in the process.  I am definitely not a neurologist, but have little bits and pieces of neurological knowledge, both from 23 years of medical practice and from researching MS.

The Disease Altering Meds have differing side effect profiles and different problems with the development of "neutralizing antibodies"  This last causes the med to lose ineffectiveness.  They all can cause deterioration in depression, but you also need to understand that MS itself has a higher incidence of severe depression than other neurological illnesses.  It is felt that the depression of MS is partly a direct effect of the disease and not just the effect of having a potentially disabling illness.

So, if your daughter has such a tendency, her family and friends need to keep a close eye on her mental status.

I started on Avonex which I inject weekly.  I've been on it for 6 weeks now.  Keep in mind that the disease-altering-meds have only been found to slow the rate of disability and decrease the number of relapses.  They will not cure or "turn-around" what damage has already occurred.

Here is a nice, informative private website giving an overview of MS.  It isn't 100% accurate, but close enough that I didn't find it misleading.  It is written for the non-medical professional,  Also you and you daughter should read the info on the MS Society page.

http://www.mult-sclerosis.org/

http://www.nationalmssociety.org/site/PageServer?pagename=hom_gen_homepage

I hope these help, Quix

[LisaSpainhour]

I thought I seen a post regarding you having MS and you are a Dr.  Is this correct?  

[LisaSpainhour]

Well my daughter is considering 2 medicine which are injections.  She had 21 spots.  She has past hx of depression/suidical tendency but it seems all side effects states mood swings/depression.  He glanced at one of the pics that compared to my daughter and said my mri looked consistent with MS but not realizing I was his next patient did not seem to look at it all just 2 pics out of alot.  I had Brain w Orbits.  Then when back in room with him after talking about my daughter he looked at my history form and said well since I do not know your hx and you have migraines(A typical vision problems) he will send me for a spinal tap.  He also suggest to keep appt with the Dr at Wake Forest the Neuro Opthamalogy Dr Martin since I have some upper vision loss on my tests.  Anyways, any info anyone can pass along for my daughter and I is appreciated.
Thank you

[LisaSpainhour]

Thanks I will asked the Dr.  I am going with my Daughter to her Neuro Dr and he is going to look at my MRI also and get me his opinion on 19th and my other appt at Wake Forest with the NeuroOpthalomogy Dr is the 25th.  I appreciate any info you can pass to me.  Thank you

[Quixotic1]

I just reread my previous answer and forgot a sentence.  A tumor or cyst of the pituitary gland will often give the appearance on MRI of an empty or partially empty sella.  That's the connection between

symptom=visual loss
location=where both optic nerves come together (optic chiasm) right at the sella
MRI=empty sella can be caused by a growth in the pituitary forcing the pituitary out of it's seat the sella

Quix

[Quixotic1]

Oh, yes, MS definitely can run in families.  It can also run in families that don't necessarily have MS, but other kinds of autoimmune disorders.

I have a lingering concern from your MRI.  The partial empty sella can be caused by several things.  One is increased intracranial pressure which certainly can be seen in MS.  Sometimes the MS plaques have so much edema around them that they exert a "mass effect."  You should ask you neuro about this.

However, my MAIN concern is that the sella is where the pituitary gland is supposed to be.  Tumors (usually benign) or cysts of the pituitary gland can press on the "optic chiasm."  This is the spot where the optic nerves from both eyes run together.  Pressure on this spot can cause loss of vision or disturbances of vision.  So I was much more concerned when you said the reason for your MRI was loss of vision.

Alternatively, those findings are also consistent with MS, but before everyone jumps to the conclusion that your MRI indicates MS, please ask them to ensure that you do not have a pituitary tumor.

If you need I'll try tofind articles for you.  I just looked at about 6, but they were highly scientific and abstracts only.  Quix

[LisaSpainhour]

I spoke to the Dr for my daughter and he said POSITIVE MS and that he had read scans for 37 yrs and know she has MS due to Optic Nerve damage and Neuritis previously per mri and lesions. FYI

[LisaSpainhour]

My daughter (21) just called me and states her tests x3 - MRI, EEG and something else were positive for MS.  She said the Dr called her on the phone today and stated the test all were pos for MS and wants to see her to discuss what to do.  She just had all her tests this week order by Neuro and ENT dr.  Mine was due to eye vision loss and balance problems so they wanted to send me to Wake Forest and have not heard anything about what they think.  I suppose Wake Forest will give me the results.  Does MS run in families.  My oldest daughter has some balance issues also and wonder if she should try to get tested also.

[LisaSpainhour]

I go to the NeuroOpthalamogy the 25th of June.