Possible MS, help with MRI results?

[MamaSquirrel05]

Hi there. Long story short, I am constantly exhausted, have been having vision problems more recently, difficulty coming up with the words I'm trying to say. I trip over myself and have numbness/twitching in my hands and sometimes my face. Went to the ER over the weekend because my husband thought I might be having a ministroke/TIA.CT scan was negative, ER doc strongly suggested MS as I'm "at the right age for it" (I'll be 28 next month). Family doc sent me for an MRI (he just thought it was a migraine?) These are my results:

DIAGNOSIS/IMPRESSION:  

Several white matter punctate foci of signal abnormality with the differential diagnosis favoring either demyelinating disease such as multiple sclerosis versus changes of chronic migraine headaches versus nonacute small vessel ischemic disease. No acute ischemic changes are present.

Can anyone please tell me what this could mean? Are they saying that it's either MS, chronic migraine headaches (which I've never had one nearly as bad as this past weekend) or nonacute small vessel ischemic disease (whatever that means)? Are there any other tests that they'll have to do to confirm MS?

Thanks in advance for any insight/commiserating.

[MamaSquirrel05]

Thank you all for the insight! In his office last week, the doc gave me 60 cc of Tramadol (sp?) and said that if it helps with the headache AND the numbness/tingling in my hands goes away, that means it's most likely migraine related. The headache went away (finally!) but I still feel weak, and my hands are tingly/numb. Today I've also been having strange muscle twitching at random, mostly in my right arm/bicep. I guess I'll have to wait until Wednesday to follow up with the doctor. I hope they don't have to do a spinal tap--I had two epidurals with my children and they were AWFUL. I still have back pain from it on occasion.

If you don't mind my asking, how long did it take for you to get a diagnosis and what tests did they have to complete? I don't want to assume or rush into anything, but if it does turn out to be MS, earlier treatment is a good thing, right?

Thank you!

[supermum_ms]

Hi and welcome,

The part of your MRI report that you've mentioned, isn't on it's own very 'suggestive' of any particular causation, for your age group though migraine and MS are definitely possible but your way too young (65>) for "small vessel ischemic disease" to be a consideration.

From my understanding "punctate foci" is generally less than 2mm, so it's basically saying tiny pin pricks, which are more commonly associated with migraines from memory, so if you do have a medical history of migraines, that's more likely going to be at the top of your list of potential causes.  

Q: "Are there any other tests that they'll have to do to confirm MS?"
A: I actually think MS is the less likely dx over migraine but generally when it comes to MS it's basically a collection of abnormal clinical findings, symptom type/pattern, medical history and test results eg MRI's (MS Mcdonald criteria), VEP, LP, blood tests etc and whilst MS isn't technically a dx of exclusion, there can't be any other medical explanation that your results fit either.

Try not to get too concerned about the possibility of MS, MS is definitely scary but try to think of it as being just 'one' possibility and stay open minded.....

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

[kwarendorf]

Welcome to our group :-)

First things first, like cjtmn, I am not a doctor. WIth one notable exception, none of us here are. We are a collection of folks that either have MS, or think they might. I'm in the former group.

Your symptoms are consistent with MS and the radiology report suggests that MS is a possible cause for the lesions seen on your MRI. This does not mean you have MS. Because MS attacks the central nervous system (CNS) the associated symptoms cover a very broad range. Vision problems are fairly common, as is fatigue.

At this point I would see a neurologist that specializes in treating MS. There is no smokiing gun test for MS. The diagnosis is made based on an accumulation of evidence. In addition to the MRI, blood tests are needed to rule out MS mimics like Lyme disease. Often a lumbar puncture (spinal tap) is conducted to look for evidence of inflammation in the CNS. Eveoked potential tests and nerve conduction studies can be included as well. But the most important part of the diagnosis is the clinical exam.

An MS specialist is experienced in detecting MS related signs/behaviors. General neurologists are not experienced enough in MS to perform an MS related clinical exam.

The process can be long and often frustrating. But you have the first step almost done (you should have MRI's of you brain, c-spine and t-spine. All done with and withou contrast). We can answer a lot of questions so ask away :-)

Kyle

[cjtmn]

Hi MamaSquirrel,

First, I am not a doctor of any kind! I am really new to this forum and have been reviewing a lot of MRIs & blood tests lately myself.

I am very surprised that the ER doc would say "probably MS" just based on symptoms. The Dx process for MS looks pretty involved, so while perhaps your symptoms & age qualify for further investigation, I wouldn't put too much weight on those off-the-cuff remarks alone. You are going down the right path to obtain more information.

As for the MRI notes, I *think* that the wording simply implies that the findings could be consistent with any of the illnesses mentioned (demyelinating disease, of which MS is one, migraines, or vascular problems). It did not suggest that you definitely have one of those problems, just that the findings would support any of those potential issues with further clinical observations.

Others on this forum are way more knowledgeable than I am, but I suspect you are headed down the road of more testing to either rule out or start to confirm a Dx.

Best of luck to you. I hope you are feeling better very soon and get some answers.