What do my husband's brain MRI results mean?

[EdgarJudge]

My husband (age 42) had an MRI this week because he was experiencing a ringing and crackling sound in his one ear for weeks.  He is a heavy smoker who tends to get lots of sinus infections, and infections his mouth/teeth/gums. He has recently gotten one or two headaches that have stopped him in his tracks from the pain.  About three years ago, he was frightened when he stood up and had the sensation that he was collapsing sideways, but he was still upright. His father suffers from multiple sclerosis.

The results of the MRI say, "FLAIR sequence reveals multiple scattered high-intensity foci within the bilateral cerebral hemispheric white matter.  These are mostly evident within the subcortical white matter and centrum semiovale.  There are also periventricular white matter foci.  Additionally, there are signal changes within the central pons. In the white matter/pontine signal changes are nonspecific and of uncertain etiology. The sagittal T2 FLAIR sequences do not reveal any signal changes within the corpus callosum.  No foci within the middle cerebellar peduncles are evident."

His ENT shared these results with him online via a patient portal today (a Saturday).  We are going to make an appointment with a neurologist on Monday.  But right now, we are sick with worry.  Please help.  Any insight would be deeply appreciated.

[essdipity]

Hi. These MRI results are very consistent with MS, though that's far from the only factor to be considered. Your husband needs a very thorough neurological examination, and should see a specialist in MS, because this is a complex disease frequently misunderstood by general neurologists. Also, lots of other conditions need to be ruled out before any diagnosis can be made.

If he does have MS, it's far from the end of the world, and not necessarily at all like his father's illness. There are some very good treatments now. But just take it one step at a time. Ask us any questions as they arise.

Also also :-) sinus and mouth infections are not associated with MS, and smoking and ear ringing seldom are, though smoking is never a good thing. Maybe now he can quit?? Keep in touch, and ask him to post here too.

[suspiciouscombo]

Ess has nailed it above. And indeed yes.... You and your husband will receive support here from many dx and in limbo land. We understand where you are coming from and no doubt you've landed the correct path for support here and as you may find in a local chapter if needed.

Hugs to you both. Ox
SCombo

[suspiciouscombo]

Prematurely hit the send icon. Meant to mention that it is a bit quiet and slow over the weekends here, but know that others will chime in with support. Best to you both.

[aspen2]

Quix, a doctor who used to post here,  has covered this topic a number of times.  Here is one link.

http://www.medhelp.org/posts/Multiple-Sclerosis/White-matter-and-smoking/show/286958

Please note though, her response here takes into account the poster's significant eurological signs and symptoms.  Your neurologist will as well.  Nothing you have posted as far as symptoms (isolated feeling of falling; migraine onset) could be directly attributed to ms.

Has your husband had a neuro exam?  Your pcp could do a basic one.

What did the impressions or conclusions section of his report say?

Research shows smoking can cause white matter changes in subcortical and periventricular areas.  I'm not sure about the other areas you mentioned.   Without a positive neuro exam, the MRI results might be blamed on your husbands's extensive smoking history.  This may in fact be the cause.   The increase due to family history us actually quite small, although I can't remember the value.

It will definitely take a neurologist to sort out the MRI and your husband's history because the chances are much higher that the damage is ischemic due to smoking.

For those with ms, smoking is linked to increased symptoms and faster progression to secondary progressive.

https://mssociety.ca/research-news/article/researchers-link-continued-smoking-to-accelerated-ms-progression

http://www.medscape.org/viewarticle/851592

I've been exposed to chemicals  like those found in cigarette smoke via occupational exposure (on a large scale) and do expect (confirmed by my neurologist) that this was my environmental trigger for developing ms, even though there is not one known "cause" of ms.  As well as acute toxicity, chemical exposure can cause immune dysfunction.

Best wishes as you and your medical team sort through this.  You husband will likely have to have MRAs done, and a cardiac work up, as well as the more typical rule outs.

Keep us posted!

[aspen2]

Forgot to ask -- did your ENT give you an idea what the cause of the crackling in your husbands ear was?  I've had painful on and off  buzzing in my left ear for two decades on and off -- permanently since 2014.  Finally diagnosed as myoclonus of the stapedius muscle.  I had never heard of this before so just wondering if he has the same, or whether it's related to his sinus infections ...