Avatar universal

Please HELP interpret Brain MRI

Is this a sign of MS?



CLINICAL HISTORY:  Persistent headache for weeks, not responding to
pharmacological therapy, with new right temporal visual changes.  
Pressure behind the right eye.  

PRIOR STUDIES: No similar ones

TECHNIQUE: Standard sequences were obtained of the brain before and after
14 mL of MultiHance were given intravenously without incident. Coronal
fat saturated T2-weighted images and postcontrast T1-weighted images were
also obtained, from the globes to the optic tracts inclusive.  

FINDINGS: Cerebral ventricles and sulci look normal in size, shape and
position.   there is a minimal scattering of a few small FLAIR bright
white matter foci, lateral to the left frontal horn on image 11 of series
6, in subcortical white matter of the right frontal poles on image 13, in
the right corona radiata on image 14, in the cingulate gyral white matter
on image 15 and in the upper frontal lobes on images 16 through 18 There
is no mass effect.  There are no areas of restricted diffusion or
abnormal susceptibility.  There is no abnormal enhancement after
gadolinium.  Major intracranial flow voids look normal.  So do
extracranial soft tissues, including the orbital contents.    

IMPRESSION:  Normal aside from a spinal scattering of FLAIR bright white
matter foci in both hemispheres, for which differential includes minimal
small vessel ischemic disease, demyelination, Lyme disease, the effects
of hypertension or migraine and gliosis of any cause.  

Best Answer
572651 tn?1530999357
Hi RN and welcome.  That is a comprehensive report from the radiologist and it appears to include several possibilities, not just MS.  You have not shared any of your clinical history with us, and that makes a big difference. What types of symptoms were you having that had your doctor do these additional tests?

   A good neurologist will take your MRI images as well as your history, and start piecing it together.

There are so many things that can cause these types of spots (foci) on an MRI.  It is frustrating to have a report like this and have to wait to see the doctor for his/her interpretation.    The fact that you have nothing enhancing is good, it means that if you do have MS, you are most likely not in an active period.

Welcome again and I hope you will share more of your story.
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1936411 tn?1333831849
One woman's "kinda cool" is another woman's "kinda gross" ;)
Helpful - 0
Avatar universal
I've been light sensitive since 2007, but floaters are common for 99% of the population, they have nothing to do with MS, they are very tiny bacteria floating on your eye, so you are seeing them as if you are the magnifying glass.  kinda cool when you think about it
Helpful - 0
2094545 tn?1335117731
Check into occipital neuralgia, I think that my 1st neurologist incorrectly diagnosed me  optical neuritis when it was actually occipital neuralgia.  

Symptoms are headache like pain at the base and top of your head, eye pain and light sensitivity.   The headaches can light up your MRI too, as I am learning.

Good luck, we're in the same "looking, watching and waiting" period.  I will pray that you find out answers quickly.
Helpful - 0
987762 tn?1331027953
Hey doublevision, light sensetivity is actually connected to MS (ON or Uvetis), though out of the other visual issues, this is not as commonly known. So if anyone is maybe wondering what visual sx are sx of MS see below for the basics...


Visual Symptoms of Multiple Sclerosis

Visual disturbances are common for persons with Multiple Sclerosis. Visual acuity is measured as a fraction of normal vision. Vision that is 20/20 indicates “normal” vision. The following outlines eye disorders that can occur with MS:

Diplopia: Double vision or the awareness of two images of the same object. This occurs when there is a failure of the eyes to work in a coordinated fashion. The use of an eye patch is sometimes helpful in easing this symptom.

Floaters: Floaters can take many forms from little dots, circles, lines, to clouds or cobwebs. Sometimes people experience one large floater which can be distracting and make things difficult to read while others experience many floaters. Floaters are often times described as “lines”.

Nystagmus: Nystagmus is rapid and involuntary movements of the eyes in horizontal or vertical directions. This symptom can cause dizziness.

Optic Atrophy: Optic Atrophy is a degeneration of the optic nerve fibers which can lead to a loss of clarity, changes in the field of vision or both. Symptoms of optic atrophy are loss of sight but can vary from slight blurring of an image to serious site loss affecting one or both eyes.

Optic Neuritis (ON): Optic Neuritis is inflammation of the optic nerve and is many times the first recognizable symptom in diagnosing MS. The symptoms of ON is pain behind the eye, blurring of vision, color blindness, blind spots in the field of vision, difficulty in seeing low contrast and difficulty seeing in bright light.

Uveitis: Uveitis is inflammation of the area behind the eye (usually the blood vessels). Symptoms include light sensitivity, blurring of vision, floaters, pain and redness of the eye.


PS i have light sensetivity issues along with the Diplopia, Nystagmus etc.

Helpful - 0
382218 tn?1341181487
Re: the vision issues you describe eg having to wear sunglasses when out in the sun, glaring headlights bothersome, needing to keep the house dark, I haven't experienced any of that due to my MS.  I've had optic neuritis, diplopia and nystagmus (still have the latter two to a mild degree) and to my knowledge none of these problems you describe are related.  If I'm wrong about that I hope someone corrects me.  
Helpful - 0
739070 tn?1338603402
Hi RN,

Another RN with a similar medical background to yours re headaches except I  had new onset migraines (R eye) at 47. First MRI report very similar to yours and blamed migraines, HTN and /or vasuculitis from wrongly diagnosed Sjogren's.

Fast-forward, general neuro after 5 years and 7 neuros sends me to an older neuro at an academic hospital who learned to dx from clinical presentation and he  diagnosed me after negative lip biopsy for Sjogrens's.

With your history of clotting issues I would still include an autoimmune disease in addition to/or MS. Misery loves company and  a lot of patients with autoimmune diseases tend to have more than one.

I'm glad you found us and please keep us updated on  what your MRI results indicate.

Helpful - 0
Avatar universal
Darn, meant till not Tim , clumsy fingers!
Helpful - 0
Avatar universal
Hi RN,
You MRI report sounds very similar to mine.
I am still waiting to see a neurologist and I have to redo the MRI in 6 months to see if there will be any changes.
I also have similar symptoms.
I had the exact eye pain a year ago, but didn't think much of it, the dr. Thought it might be some sort of inflammation, but now I have the tingling pins and needles and slight muscle twitches, so I had an MRI, which came back inconclusive: tiny foci.
Good luck
Helpful - 0
Avatar universal
Well most of us in health care do have the advantage of knowing where to go research more information than the average person, so you have an advantage for which texts to obtain research from.  And true, it will wait Tim doc gets back, ms is a slow moving train.  It often takes years of ruling out mimic diseases to zero in on MS.  Then there are all the blood tests and other specialists.  We feel like we should be earning frequent flyer points at the doctors office.

Am sure someone has pointed out the excellent reference headings on the right side of the

Another RN
Helpful - 0
572651 tn?1530999357
Your first line made me smile - do you know how many of us would want to take a look at our results before the doctor had a chance to review them?  Probably all of us!  We suggest to everyone to get a copy of their MRI and radiology report for their records, and I hope you will go back and get those as well.

I am absolutely no medical expert, just a person living with MS and trying to make sense of all this.  That said, from what you write about the vision problems,  it doesn't quite 'feel' like MS to me.  We have several people here who either have their own vision issues or work in that field and I hope one of them will be able to help out.   Michelle or doublevision  are my go-to folks here when it comes to sight. I'll ask them to check this out and see if they can help.

You've already listed your own differentials for the numbness and fatigue, but those are also common MS problems.  I am in the process of recovering from my own bunionectomy (4 weeks out) and hope mine heals without long-term issues.  Unfortunately, my surgery was on my good foot, not the one that is always numb. LOL

Good luck with this next step and I hope someone else here can add to this discussion.

best, L
Helpful - 0
Avatar universal
Thank you Lulu for replying so quickly. I'm happy to have found this site.

I work in the healthcare field, and have access to my own records (which I know I should not be looking at). I was anxiously waiting to hear the results, but after not hearing for a few days, decided to look into it myself. I did not expect to see what I saw. I called my GP's office-she's away on vacation (explains why I haven't heard from her). I hope to hear from her early on next week. I showed the MRI report to the doctors I worked with and they recommended, getting in touch with my GP for a neuro eval.

I went to see me GP after ongoing, persistent headache / migraines that would last for as long as several days at a time-no relief with the usual OTC meds, and major pressure behind my eyes that started to scare me. She ordered the Brain MRI, since my symptoms did not sound like migraines with aura.

I have had headaches dating back to my early teen years, seems to always resolve with excedrin migraines, but then taking them often would lead to bruising on my arrns and legs.

I have sunlight sensitivity, and would literally burn in the sun. I have always thought it was from being allergic to sunscreen. I have stop using sunscreen, and now use cocoa butter when in the sun, but then would develop rashes in certain areas.
- Always has to wear sunglasses out in the sun.
-House stays dark, curtains can not be opened, as it irritates my eyes and   can trigger my migraines.
- Bright glaring head lights at night, bothers me as well.

I have numbness and tingling in my right foot / toes. I've always contributed it to my bunionectomy (5 yrs ago), and or tight shoes or high heels. It would last for as long as a week at a time.

Extreme fatigue, which I contributed to stress, insomnia, and not exercising. I was put on anti-depressants a few months ago to see if it would help me sleep, and diminished my fatigue.
-Celexa: made me even more fatigued. I could barely function.
-Prozac: sleeping better. increased appetite. still fatigue.

? clotting disorder. I can not be on OCP without leg cramps, chest pains = ER visits, elevated D-Dimer level and having to stop OCP. ANA work-up was negative, RF factors were elevated. Was then referred to Cardiology, was only to be told I can never take OCP. No other work-up was ever done.

I'm sorry this is long and drawn out. I would greatly appreciate, any and all inputs.


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