Test Results from MRI/Spinal Tap/VEP

[deborah0904]

These are my results:
       Pulse sequences employed included T1 weighted images, T1 dual echo axial images and T1 sagittal Images.  Al head MRI's include a flair sequence which comprises a fluid attenuation inversion recovery sequence.  These sequences are utilized to enhance visualization of intracranial lesions without utilizing iv contrast.
Findings: Mild encroachment by the cerebellar tonsils on the foramen magnum accompanied by capsulosynovial proliferative change of the atlanto-odontoid articulation.  No evidence of wedging of the cerebellar vermis, cervicomedullary kinking, syringohydromyella, cervico-occiptal assimilation, or hydrocephalus to suggest high grade Chiari Malformation.  Partial Empty sella noted with otherwise normal ventriculosulcal system.
Mild periventricular T2 and Flair Hypertensity noted. Small, punctate, subcortical white matter lesion involving the right temporal lobe for which incidental benign gliosis is favored.  In the proper clinical setting, a single demyelinating plaque can be seen in Multiple Sclerosis.  These lesions are also secondary to microvascular ischemic change, in patients w/hypertension, hypercholesterolemia, hyperlipidemia, and migraine syndrome.
No evidence of cochlear or vestibular hydrops, distention or inordinate visuialization of the endolymphatic, ductal or cochlear vestibular aqueduct system is noted.


     Spinal Tap showed my Myelin was 1.5 High.  The Reference Range is less than 1.5  ***Note: results of 1.5 - 4.0 should be considered equivocal.
     Albumin CSF was 10.50 - Low.  The Reference range is 13.90 - 24.60.
     IgG CSF was 1.7 which is normal
     IgG SR CSF was .1  
     IgG Index CSF 0.74
     Alb Serum was 3770
     CSF Total Protein is 23 MG/DL.  Negative for Oligoclonal Bands.
    
Would anyone care to comment on these findings?  Thanks.

Visual Evoked Potential:
     The visual evoked potential, as recording from the mid-occipital region are well resolved during electronic pattern reversal stimulation.  The latency of the first major positive component, P100 is 106 msec for the right eye and 113 for the left eye with the normal being equal to or less than 105.4 msec.
     Since the above P100 values are prolonged bilaterally, this study does suggest a demyelinating, process involving the visual pathways therefore clinical correlation is required.

[deborah0904]

Thank you Quixotic 1 for your comments.

I did go to a Neuro Opthamologist who said my eyes were great and no Optic Neuritis.

I also had a balance test and ENG at the Ear Nose Throat Specialist.  They tested for the vertigo using the water in the balloon and they also used the goggles to test the Nystagmus.  It will be a week before I hear from this test result.  I am anxious to hear from this.

I am in the process of trying to get a 2nd opinion from a new Neurologist.  I have a friend at a Health Insurance company who is trying to facilitate a quick appt. for this guy however, since I've been treated for the last 3 years by another Neuro, the new Dr. has to review my records to see if he will take me.  I'm just praying that he will.  In the last week my legs have gotten very weak and I'm having to use a cane.  The weakness in my arms are also worse.  My swallowing also seems to be worse.  Needless to say, I've become very depressed and exasperated.  I just want a Dr. to tell me what's wrong with me and what they can do to help me.  I don't consider myself to be a prideful person but I'm having a hard time being seen in public with a cane.  I'm overweight and have not been able to exercise for so long.  The first thing people think of me is that I'm having to use a cane because of my being overweight.  I'm to the point with my walking that I need a Handicap License and that's a whole new issue.  Oh well.

Oh! The  normal range for CSF IgG Index is 0.33 - 0.77.   Mine is 0.74 which is 3 points from the maximum.

Thanks again.

[Quixotic1]

First I wanted to say that your asked a couple weeks ago about "gaze nystagmus."  This is nystagmus ( slow-fast jerking of the eyes) when you gaze in a particular direction, like to the left or right.

Your MRI looks like they were focusing on a possible Chiari Malformation and didn't find any evidence that the cerebellum was being pulled downward through the hole in the bottom of the skull.

Then they saw a tiny (punctate means pinpoint) T2 hyper intense lesion in one of the temporal lobes.  The radiologist's best guess is that this is benign, but states that he couldn't rule out a single MS plaque, if your history and neuro exam are suggestive of MS.  (BTW - I presented with a single MS plaque in my brain.)

On your CSF, I would need to know the normal range for the CSF IgG Index.

Nothing else on the CSF stands out.  There is no medical problem with having a low protein.

The VEP results are interesting.  I don't know of any neuro who would consider a P100 Latency of 106 as abnormal.  The left eye is 113msec.  This is close to the usual cut-off of 115msec that is quoted as being diagnostic of optic neuritis.

Boy!  You have 3 or 4 things that are just "suggestive" of a problem, don't you?  A good neuro will keep all of these things in mind, but they are really very helpful in and of themselves toward making a diagnosis.

Did you ever get the referral for a VNG to evaluate your nystagmus?

Quix