NOT YET DIAGNOSED ABNORMAL BRAIN MRI

[greenly62]

Hello.  I am new to this forum and appreciate any input.  I will try to keep the history/results brief.   Chronic daily headaches sent me to a neurologist 2 years ago (at age 50).  My headaches are always at the back/bottom of my head and behind my right eye (only, never the left), and include numbness around the eye.  Sometimes I have the numbness on the right side of my face but no headache.  I did have a brain MRI 2 years ago and was shocked when the report said MS should be ruled out.  This is what it said in the findings:

"There are several small foci of bright signal intensity on FLAIR sequencing in the deep white matter of both hemispheres, including the basal ganglia, and consistent with demyelinating disease and MS, vasculitis or premature ischemic gliosis"  

My neurologist then did other testing, include an LP, which was negative for the MS markers, as well as ruled out Lyme disease, etc. He believes that the spots that showed up on the MRI are due to the headaches and insomnia.  Recently, other symptoms seem to be getting worse, even though the headaches are much better, and I am only seeing my neurologist now every 6 months.  I have another follow up in a few more weeks.  My question is:

Should I push for another MRI of the brain and/or get a second opinion from another neurologist?  

I was relieved when he didn't diagnose me with MS, but recently am having more balance issues and spasticity in my legs especially.  Thank you for any input.  

[greenly62]

Kyle, thanks for the input.  Yes, I was having some other symptoms at my initial consult with the neuro, but I'm really good at having a reason for them, ignoring them and pushing forward.  

I had numbness/tingling/pain in my hands and one foot (which I attribute to degenerative discs in my spine), cognitive issues (which I attribute to menopause), loss of balance/vertigo (which I attribute to migraines), fatigue (which I attribute to thyroid)  … see the pattern?!?  

I wasn't aware he was asking these questions due to the possibility of MS and, quite frankly, knew nothing about it at the time. Lately I am having muscle spasms/weakness in my right leg so will definitely bring this up at my next appt.  Thank you very much!

[kwarendorf]

At the time of your first MRI you were not experiencing any classic MS symptoms. While some of us may experience headaches, they are rarely the primary symptom. Your MRI showed white matter lesions which can be caused by migraine. In addition to the listing of demyelination as a possible cause, the report mentions ischemia. Ischemia and headache are more stongly related than ischemia and MS.

That said, I would definately discuss the new symptoms with your neuro. If you are not happy with his response, or if he seems overly focussed on headache, I would seek a second opinion. As MS has the broadest rainbow of symptoms, then as ALex suggested I would see the MS doc.

Kyle

[greenly62]

Thanks for the input.  My neurologist is a headache specialist.  There is another one in my area who is an MS specialist so may seek out his opinion just to be sure, since I'm having more symptoms.  

[greenly62]

Thank you very much for the input.  I will definitely bring up the new symptoms.  Previously, we primarily discussed my headaches and I just say I'm doing better, which I am and leave it at that because I don't like all the meds he's had me try for them.  

[HVAC]

I would bring up the new symptoms and see what the neurologist says. He might send you for another MRI. If the neurologist is a headache specialist that is his specialty and where his thinking will go. If you want to rule out MS you may need a MS Specialist.

Alex

[jensequitur]

I would definitely seek another opinion on the MRI. I think it's the other way around – the headaches and insomnia are caused by the small foci, not the other way around.

As to whether you should get another MRI, it really depends on what the strength of the initial MRI was.

Since you've had an LP to check for oligoclonal bands, at this point I think it's unlikely that you have MS. But since your other symptoms are getting worse, if you feel like they aren't being treated, then you should go ahead and follow up. You are your own best patient advocate!