MS Specialist notes prior to MRI

[kerrtelli]

I saw the MS Specialist this morning and he told me that the lesions were not in the "typical" place where he sees MS.  So i am posting the results from June 1st visit and the MRI's he ordered.

I am posting the doctors notes that he wrote prior to the MRI I had the first week of June.
Its long and I apologize.

On exam, she does have a clear drift of the left extremity, increased reflex, increased tone on the left, decreased rapid alternating movement and she walks with the left leg externally rotating.

IMPRESSION:  The patient's clinical exam is one of myelopathy and perhaps nondominant hemisphere syndrome.  Her other symptoms could represent multi centric lesions in the central nervous system.  The MRI scan verbal report seems consistent with demylenating disease.  The more recent MRI scan of the brain was done without contrast.

I recommend that we repeat that such with contrast as well as an MRI scan of the cervical spine with and without contrast.  If typical lesions can be droned also in the cervical spine, then I would think that the overall clinical diagnosis in her case would be overwhelmingly likely multiple sclerosis.  

The patient, her husband and I spoke at length about her clinical picture.  Tey wish to proceed in this fashion.  Once the dignosis is firm, then discussion for initiation of immunomodulating therapy will be considered.  I do not see a reason to treat her with intravenous Solu-Medrol at this time as it has been a period of time since this current exacerbation occurred.

MRI REPORT OF THE BRAIN

Findings:  There is no evidence of acute infarction, hemorrhage or mass effect.  There at least 21 focal T2 hyperintensities involving the white matter, predominantleysubcorticalin the arietal and frontal lobes.  There is minimal pericallosal T2 hyperintensities.  There is no abnormal enhancement following contrast administration.

IMPRESSION

Nonspecofic white matter T2 hyperintensities in an atypical pattern for multiple sclerosis.  No enhancement to suggest active demylinization.

SPINE MRI

C5-C6:  Small posterior disc bulge at C5-C6 without significant central or foraminal stenosis.

C6-C7:  Small posterior disc bulge at C6-C7 without significant central or forminal stenosis.

IMPRESSION:
1.  Cervical cord normal in signal and caliber.
2.  Minimal cervical spondylosis.

I am going for an LP on Thursday and a VER next week.

Sorry for the long post but I need some advice.
Should I just give up?

Thanks, Kerri

[kerrtelli]

Are T2 hyperintensities considered lesions?

[kerrtelli]

Thanks.  I saw your other answer on my LP post.  I know that I need these tests to solve the puzzle, I am just frustrated.  Snce June 1st I was pretty positive I had ms and then yesterday he dropped a bomb.  I was just thrown for a moment but I am definitely not going to give up.

You guys are the best.

[RedFlame]

Kerri,  Don't give up now, it sounds to me that you are in the home stretch.  He seems confident that you have MS, he just wants to have all the data available right now.  21 lesions is a goodly amount.  If you spinal tap is positive, he will be influenced even more.  New lesions only show up on enhancement for a couple weeks.  So, that wouldn't hinder your diagnosis.

Red

[kerrtelli]

Bump

[wiggles94]

hi Kerri - I am in limbo too - so I know how frustrating this can be.

Sounds like you have a good doc who is taking this very seriously and trying to get to the bottom of it.  I wouldn't give up - the LP may give more evidence as to what is going on - BUT  it may not as well.....but given your sx and lesions, i think an LP makes sense.

I was dx with probable MS , put on DMD and stayed on them for a year before I took the advice of another neuro (ms specialist) and went off the DMDs - he ??? the dx because the lesions are not in typical areas for MS - and I look good clinically -

Hang in there - and take a deep breath.  The good thing is that you are being cared for and if anything gets worse, sounds like your neuro would be right on top of it.

[Sidesteps]

No --- you have clear indication that there is damage and he believes you. I'd stick with him a bit longer based on this information.

Based on his chart notes, it seems he is saying, in a round about way, that he hasn't been able to meet the criteria. (I am curious others impression.) He needed lesions to be reflected in another area as well as enhancing lesions (or a clinical flare) to meet the disseminated in space and time criteria. To complicate the situation, it sounds as if you haven't had a flare in awhile and your lesions are also showing an atypical pattern.

It's frustrating but he does sound like he will treat you once he can figure out what he needs to treat you for. I think that is a good sign. Your doctor needs more data and that is why he is ordering more tests.