Microvascular ischemic / vasculitic foci

[Emaanahm]

Dear med help,

Need your help to understand my health problem, i had clustor headache more than 10 to 15 years, now i am 36 year old, my both feet pulse are feeble and my right arm there is absent pulse likely the doctors  say its very hard to get the pulse of your right hand, i have bp with 130/90 and am pre diabetic, alway have dizziness, fatigue,numbness on my fingers, muscle ache , feverish feeling , headace, nausea , i  have seen a neurologist for my normal constant headaches they did MRI , they found out white matter disease  with lacunar infaract and now when recently they repeated my MRI for my constant one sport of my headace , it was found in MRI that Multiple foci of T2w/ Flair hyperintensity in subcortical while matter of bilateral frontal and parietal lobes, likey microvascular ischemic / vasculitic foci and my MRA does not show any abnormality as per my report only there is left posterior communicating artery is hypoplastic and also its reveal normal bilateral internal carotid arteries except for small focal area of luminal irregularity in petrous part of both sides, possibly artifactual due to bend in vessels and my all reports like ANA  profile , ESR and many other test related to brain is normal , but there is also some water fluid comes out from my nose on and off , i also have sinusitis noted in my MRI  in bilateral maxillary , sphenoid and ethmoid sinusitis noted and my neurogolist also showed me the mri saying see a large but not too large part of your brain tissue is dead and there are multiple white foci also , checked with rhemuthologist , Neurologist, physician and cardiologist , rest of all the doctors told me to visit a vascular surgeon as earliest coz it make bring stroke or paralytic attack any time , they told me do not sleep like a close chapter with this disease, coz it may be life threatening but cardiologist to me not to worry about any thing coz its not vasculitis its microvascular ischemic is small inches vessel problem not in my big artery connected to my heart so i don't have to worry about anything, its all normal he said but other doc saying it is vasculits, or takyasu disease or autoimmune disease , one doc say something and other say something , vascular surgeon i have not seen yet, and now i am on my tablets for 6 months plavics 75 mg , please guide me in right direction , wants to know is the disease i have is life threatening  or no, just wanted a second  opinion or a advice....

[Emaanahm]

Thanks for your guidance , very soon i will be going to a vascular surgeon ,cause i myself work in a hospital and have seen all the doctors last MRI which shows that i have "microvascular ischemic" white matter changes disease in my brain, as seeing my report they told me not to sleep with this disease cause its life threatening i may get stroke or paralytic attack any time  if i delayed treatment , your advice was somehow veryhelp and i appreciate it

[supermum_ms]

Hi there,

You maybe experiencing a little confusion or misunderstanding, there are no blood tests for MS, the blood tests you've had will be to look for other medical conditions but it would not of been specifically testing your blood for MS, because there isn't any.

You said...."my first MRI the radiologist have mentioned that it may be sign of delimenting white matter disease mostly MS,  was suspected , to rule out in detail the radiologist mentioned further evaluation required"....this would most likely be what you are paraphrasing from what you've read off your MRI report, but this is just what's commonly written in the general differentials for some one of your age group, and not as diagnostically significant as you are probably assuming.

Due to your age demyelinating conditions also need to be considered by your neurologist, but from everything you have written, your doctors are focused on vascular related medical conditions because it would 'most likely' explain the totality of your medical evidence, medical history, symptoms etc  

I understand how worried you are but you need keep in mind that your MRI report stated "Multiple foci of T2w/ Flair hyperintensity in subcortical while matter of bilateral frontal and parietal lobes, likey microvascular ischemic / vasculitic foci" and your medical history of Migraines, pre-diabetes and high range blood pressure are the common explanations for the "microvascular ischemic" white matter changes identified on your MRI.

Many medical conditions also cause some of the same or very similar 'symptoms' that are commonly associated with MS, the conditions you have a history of definitely do cause some very similar symptoms and if you search information on those medical conditions you will see this and it will most likely aid you in working out the direction you probably need to be taking.

Hope that helps clear up any misunderstandings you may be having...  

Cheers...........JJ

[Emaanahm]

Hi,

Mr Kwarendorf , i understand that, but from my first MRI the radiologist have mentioned that it may be sign of delimenting white matter disease mostly MS,  was suspected , to rule out in detail the radiologist mentioned further evaluation required , later they found that is not MS because my blood test all were negative , but the white matter disease i do have, what is causing it, or in future it may turn to Ms , i was just looking out the similar problems and systems if one have, because i have seen many doctors everyone says something or other , so i taught of searching the answer through internet with similar symptoms ...

[kwarendorf]

Hi E -

As JJ mentioned, what you describe does not sound like MS. All of your test results, and doctor opinions, suggest that your symtoms are caused by circulation issues.

We are n ot doctors, just folks with MS, or are in the MS diagnostic process. MS is a neurological disease. We do not know about blood flow problems.

Kyle

[Emaanahm]

yes, my neurologist has told me probably its vasculitis  microvascular ischemic that is the reason walnut size part of my brain is dead and there are multiple foci white matter as well , now a days i have giddiness, memory loss and also problem one word goes always wrong while communicating,and get confuse all the time but my eye sight is good ..done angiogram  there is high artery origin in my arm where the doctors hardly deduct my pulse in my right arm ...is it vasculitis disease or will i get ischemic attacks if left untreated or may be i am getting silent ischemic attacks in my brain which i am unaware of it

[Emaanahm]

i am now confuse with my medical state , what can go wrong with me and which part of my body is affected , i dont good pulse in my right arm and feeble pulse on  my both feets, neurologist recommended me to see a vascular surgeon for further investigation by doing biopsy of my blood vessels , i have seen a normal surgeon , he said its most properly autoimmune disease , and most important its effecting my brain ,what should i do further , can anyone help plz

[supermum_ms]

Hi and welcome,

Your question has landed in the MS community which you may not have intended, in regards to MS what you have mentioned isn't generally suggestive of a neurological condition like MS.

It's unusual for a neurologist or any specialists to be honest, to be stating alarmist commentary "see a large but not too large part of your brain tissue is dead and there are multiple white foci" and send you out the door without a medical explanation and plan of action. From my understanding your MRI results wouldn't be inconsistent with your diagnosis of migraines or hypertension, so i truly don't understand where that is coming from.

It's a bit extremist thinking to be assuming a few micro vascular lesions, is dead brain tissue and or evidence of a imminent life threatening medical condition and then just refer you on to see a cardiologist, did your neurologist by any chance mention ischemic transient attacks?

Your blood pressure is on the high side, possibly indicating related hypertensive condition, your also pre-diabetic and suffered with migraines for years, so heart and vascular conditions would definitely need to be investigated for potential causation.

You've now seen a cardiologist and your cardiologist is saying your heart is all normal, no vasculitis damaging your heart which is great to rule out.....I actually think your doctors will probably be considering the potential that this may all come back to your pre-diabetes state and the strong association there is with microvascular disease preceding clinical onset of type 2 diabetes, which has serious long term implications to your health.

Information on pre-diabetes and vascular disease:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366458/      

http://www.sciencedirect.com/science/article/pii/S1877593409000563

http://www.diabetes.co.uk/body/vascular-system.html

I hope that helps give you some focus and direction!

Good luck........JJ