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Quix or Anyone; Enhancement Question
What is leptomeningeal enhancement and can you get this type of enhancement in the spine when you have MS?
I also found a great website that discusses the difference between lesions appearance that occurs in MS and other disease. The website is http://www.radiologyassistant.nl/en/4556dea65db62
There is a paragragh that talks about enhancement and how in the first four weeks of the inflammation there is enhancement with gadolinium due to loss of the blood brain barrier. According to the website....First there is homogeneous enhancement but this can change to ring enhancement. Would this be the same as letomeningeal enhancement?
Does enhancement have a lot to do with how long it's been since you had an attack? Say for example...my last attack was in the late Oct. of 2008. I was fully in the episode. Hypothetically, if I have MS and I was experiencing an attack and they performed an MRI at the time, my brain and spine would have lite up with homogeneous spots. But what really happened was, the MRI wasn't performed until Dec. 31 2008, after the attack was over. I still had left over symptoms, but I felt better than I did. Could this letomeningeal enhancement that they did find in the spine in 3 areas actually be this ring enhancement they are speaking of on this website or am I reading it wrong or not understanding the concept?
I also found a great website that discusses the difference between lesions appearance that occurs in MS and other disease. The website is http://www.radiologyassistant.nl/en/4556dea65db62
There is a paragragh that talks about enhancement and how in the first four weeks of the inflammation there is enhancement with gadolinium due to loss of the blood brain barrier. According to the website....First there is homogeneous enhancement but this can change to ring enhancement. Would this be the same as letomeningeal enhancement?
Does enhancement have a lot to do with how long it's been since you had an attack? Say for example...my last attack was in the late Oct. of 2008. I was fully in the episode. Hypothetically, if I have MS and I was experiencing an attack and they performed an MRI at the time, my brain and spine would have lite up with homogeneous spots. But what really happened was, the MRI wasn't performed until Dec. 31 2008, after the attack was over. I still had left over symptoms, but I felt better than I did. Could this letomeningeal enhancement that they did find in the spine in 3 areas actually be this ring enhancement they are speaking of on this website or am I reading it wrong or not understanding the concept?
Well this is a topic we have not had before. The leptomeninges are made up of two of the layers of membrane that surround the brain and spinal cord.
Leptomeningeal lesions or enhancement brings two thoughts to my mind, though I am sure there are many others. The first is a chronic CNS infection.
I have specifically seen reference to "leptomeningeal enhancement" in articles on Lyme Disease. Lyme Disease can certainly invade the central nervous system. It is a great mimic of MS. On the other hand lesions in the meninges (the linings of the brain and spinal cord) are not seen in MS.
Other infections of the CNS that can show this finding are the other things that can infect the nervous system linings like retro viruses, HTLV I & II, Tuberculosis, HIV, CNS fungal infections, also acute infections like bacterial meningitis.
The other disease which can show prominent leptomeningeal enhancement is neuroscarcoidosis. Sarcoidosis is another autoimmune disease that can also mimic MS when it occurs in the central nervous system.
Now this is not an exhaustive list, but it is a start.
In general, an enhancing lesion is said to be associated with new or increased symptoms, but it doesn't have to be. Also, lots of people have exacerbations and their MRIs don't show enhancement. The two do not have to be tied together in time. I have heard various estimates of how long enhancement lasts in a lesion and it appears to be in the neighborhood of 4 to 6 weeks, maybe a little longer.
But you are correct. If your MRI was not done until a full 8 weeks after your relapse ahd "bloomed," then you would not expect that there would be enhancing lesions. There possibly could be, but the odds would go way down. I think this is true.
I hope this helped.
Quix
Leptomeningeal lesions or enhancement brings two thoughts to my mind, though I am sure there are many others. The first is a chronic CNS infection.
I have specifically seen reference to "leptomeningeal enhancement" in articles on Lyme Disease. Lyme Disease can certainly invade the central nervous system. It is a great mimic of MS. On the other hand lesions in the meninges (the linings of the brain and spinal cord) are not seen in MS.
Other infections of the CNS that can show this finding are the other things that can infect the nervous system linings like retro viruses, HTLV I & II, Tuberculosis, HIV, CNS fungal infections, also acute infections like bacterial meningitis.
The other disease which can show prominent leptomeningeal enhancement is neuroscarcoidosis. Sarcoidosis is another autoimmune disease that can also mimic MS when it occurs in the central nervous system.
Now this is not an exhaustive list, but it is a start.
In general, an enhancing lesion is said to be associated with new or increased symptoms, but it doesn't have to be. Also, lots of people have exacerbations and their MRIs don't show enhancement. The two do not have to be tied together in time. I have heard various estimates of how long enhancement lasts in a lesion and it appears to be in the neighborhood of 4 to 6 weeks, maybe a little longer.
But you are correct. If your MRI was not done until a full 8 weeks after your relapse ahd "bloomed," then you would not expect that there would be enhancing lesions. There possibly could be, but the odds would go way down. I think this is true.
I hope this helped.
Quix
The MS specialist chopped it up the enhancement as normal vascular structures. I'm checking on all avenues just in case. The radiologist report says that it could be vascular structures secondary to dropped metastasis (cancer), lymphoma, or sarcoid.
I wish I had a doctor that was interested enough in what was going on with me to try to figure this all out and not just recheck in a year.
I wish I had a doctor that was interested enough in what was going on with me to try to figure this all out and not just recheck in a year.
Hi slightlybroken
I too wonder about this i had an mri just mths after i felt first mild sx then a few mths afterwards i had my first real attack as i call it could the mri missed my attack as done before the attack and if they do a mri now will they see scaring? or can you only identify lesions when in attack i dont think that true as thats what contrast for i would think.
i know that lesions are scars and that they are different at different stages but thats all i know i am sure quix or someone else will help.
what does your neuro say??
sam
I too wonder about this i had an mri just mths after i felt first mild sx then a few mths afterwards i had my first real attack as i call it could the mri missed my attack as done before the attack and if they do a mri now will they see scaring? or can you only identify lesions when in attack i dont think that true as thats what contrast for i would think.
i know that lesions are scars and that they are different at different stages but thats all i know i am sure quix or someone else will help.
what does your neuro say??
sam
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