Symptoms + MRI Question

[nobsrl]

Hi all, I'm hoping you could help me by answering some questions I have about my continuing medical problems. I have been dealing with numbness/tingling issues for about a year now (started for the first time last June (2016).) The numbness is usually in my lower legs, left arm, and head. It gets worse and turns into this sort of shooting/tingling feeling when I bend my neck. These symptoms come in "bursts" that usually last for about 1-2 weeks. When these "bursts" happen I also usually have a lot of nausea, fatigue, back/rib pain, double vision, eye twitching (like eye lid twitching), and weakness in my legs. I'll usually go anywhere from a few weeks to a little over a month between "bursts." When this first got bad last summer, I saw a neurologist. I had seen him before for migraine headaches, and he thought these symptoms were just new symptoms of my migraines. I have been having migraines for about 5 years now and the symptoms of those have never changed (I have had about 4 migraines since leaving high school- I'm a junior in college currently, we determined my senior year that fluorescent lights triggered my migraines and that's all my high school had.) I had an MRI when I was younger just because I started having migraines at a young age, but my neuro ran another MRI when I came to him with these new symptoms in August 2016, but contacted me saying "everything looked good." This is what the report said:

The ventricles are normal in size and position without midline shift
unchanged from the prior brain MRI study. Best seen on the FLAIR images
there is again seen to be a rounded focus of increased FLAIR signal
intensity in the inferior left cerebellum measuring 7 mm in size which
is unchanged. Additionally on the current FLAIR images there is a small
rounded focus of increased FLAIR signal intensity in the superior aspect
of the right basal ganglia measuring 3 mm in size which was not present
previously. No other areas of focal signal abnormality within the brain
parenchyma are seen. No restricted diffusion to suggest acute infarction
is seen. No susceptibility artifact on the gradient echo images are seen
within the brain parenchyma. On the contrast images no abnormal
enhancement is seen within the brain parenchyma. The etiology for these
areas of FLAIR signal abnormality is unclear. Differential
considerations include age indeterminate ischemia, inflammation,
demyelination, and gliosis. The absence of interval change of the left
cerebellar focus since the 2014 scan would radiographically speak
against neoplasm as a possible etiology. Continued follow-up is advised
as clinically warranted.

There is a retention cyst in the right maxillary sinus which is
decreased in size from the old scan.

Impression: There is a 7 mm rounded focus of increased FLAIR signal
intensity in the left cerebellum which is unchanged from 07/11/2014. A 3
mm focus of FLAIR signal abnormality is present in the superior aspect
of the right basal ganglia which was not present on the old scan. No
abnormal enhancement is seen within the brain parenchyma. The etiology
for the above-described areas of signal abnormality is unclear with
differential considerations as discussed above. Follow-up is advised as
clinically warranted.

I'm just wondering if everything really is fine? The increased FLAIR signals worry me, especially with my symptoms. I had a nutrient deficiency test run this week to make sure all of that was within normal and everything-Vitamin B12, Folate, Ferritin, Iron+TIBC, and Zinc- were within normal limits. I was a tiny bit low in Vitamin D, but I live in the midwest and winter just ended so my doc said not to worry. I have been going through a very bad "burst" of numbness and tingling the past week or so. My GP put me on Methylprednisolone to calm it down, as that has worked 2 times in the past (one other time I was given Methylprednisolone and another time Solumedrol.) My doc was willing to give me the steroids because I had an elevated Sedimentation rate (31mm/Hr) that couldn't be explained by anything else.

Do you have any explanations for this? Are the things on MRI normal/within normal limits? My symptoms are starting to impact my everyday life, and the fact that they get better with steroid treatment worries me because I've read that steroids are one of the first treatments for MS flares. Please let me know any info you have! Thanks!

[supermum_ms]

Hi and welcome,

Oral steroids are generally prescribed for many different types of medical conditions but it's a very 'high dose of IV steroids' that are prescribed when an MS relapse is severe and typically causing disabling vision or mobility issues, otherwise general oral steroids wouldn't do much if anything at all.....

Keep in mind with RRMS, relapses can last for as little as 24/48 hours to even years sometimes but unlike other medical conditions with a relapsing remitting symptom pattern, an MS relapse is generally when previously remitted symptoms have returned, and or established symptoms worsen, and or a new symptom happens, but if it's sooner than 30 days since the last relapse and for less than 24/48 hours it's not likely an MS relapse.  

The erythrocyte sedimentation rate is a nonspecific marker of inflammation, and this would really only be indicating your immune system is dealing with inflammation and or an infection, and on it's own a high sed rate could be something eg allergy, viral infection, autoimmune conditions like Lupus, arthritis etc etc etc  

I actually would suggest you consider getting a second neurological opinion, from what i understand with migraines is that symptoms can mimic neurological conditions like MS and micro vascular (1-3mm) brain lesions are associated but a 7 mm lesion in the left cerebellum and a symptom pattern that often lasts 2-3 times longer than migraines typically last, would potentially be enough to open the door for there to be an alternate cause, so it might be worth considering if only for peace of mind....

Hope that helps......JJ