Large periventricular lesion and two smaller lesions on brain MRI - MS?

[jessica9280]

started having symptoms of numbness and tingling first in my right foot and then in my right hand, and now I'm having it exclusively in my left hand and fingers. It's been going on for about almost two months now. I have also been experiencing fatigue, muscle spasms and cramping, along with worsening anxiety over the last few months. I saw the neurologist who sent me for a brain MRI without contrast, and they found one large periventricular lesion and two smaller lesions. He also sent me for blood work to see if the issues were caused by my thyroid or vitamin B deficiency, but the blood work was normal. Now he is sending me for a lumbar puncture next week, then a possible cervical MRI. I know the diagnosis for MS has to show lesions dessiminated through space and time, but does this sound like MS? I have pics of my MRI but didn't see how to post them in the forum.

[supermum_ms]

Hi and welcome to our little MS community,

It is more common for MS to first present with tingling, numbness, pins and needles, burning etc type symptoms on only one side of the body (unilateral) so yes MS would be on the list of possible causes BUT it would actually be highly unusual for MS to switch over to the other side during an attack....that type of symptom pattern wouldn't usually be very suggestive because it's not what typically happens with MS brain and or spinal cord lesions, so it's possible that the causation may not be a neurological condition like MS.

Periventricular lesions are not exclusive to MS but they are 1 out of the 4 specific MS Mcdonald criteria locations, to meet the MS Mcdonald criteria there needs to be lesions in at least 2 out of the 4 locations, spinal cord lesions would be another criteria location and would often be enough to meet the DIS and DIT aspects but please keep in mind that there could be something happening with your spine but it could be a structural spinal issue and not  lesion related..

You mention there is 1 large lesion, do you know it's size, shape, or if any of the lesions lit up with contrast?  

At this stage there isn't enough objective evidence that would put MS at the top of your causation list, if you can try to be open minded about the causation, and please consider being proactive about your worsening anxiety. Anxiety can make any uncertain medical situation a lot harder to deal with, it's in your best interest to not let your anxiety get really bad before seeking mental health support, so please consider prioritising your anxiety to help you get through the diagnostic process.

Hope that helps......JJ

[Aramas206]

While this isn't an answer to your question, I want to give encouragement for the upcoming LP. There are many horror stories out there, so I was sooo scared and anxious about it. It didn't hurt for me at all, in fact, the numbing stuff tickeled. I did get a spinal headache 3 days later (not a fun way to spend Thanksgiving), but I also didn't follow instructions and did not wait three days before taking ibuprofen (Holy cow, new retainers after getting braces off hurt Sooooo Bad.) Spinal headaches hurt super bad too but laying flat at least makes them go away!
Good luck, hope you get answers!

[aspen2]

Agree with JJ.  8 mm is not actually considered large, and is still likely to be deemed non-specific.  My largest lesion of 12 was that size.   It takes a neurologist and years of training to piece together the particulars, of which the MRI is only one.

Make sure you have vitamin D and magnesium levels checked.  I have to supplement both -- the vitamin D is for MS, but the magnesium is just to correct a deficiency and symptoms unrelated to ms which include spasms, cramping, tingling, twitches and fasciculations.

And, of course, anxiety can cause tingling, etc.  And low magnesium can cause anxiety.  It gets complicated.

I hope your further tests go well; keep us posted!

[supermum_ms]

Reading your own MRI's at home and getting anything correct is very very hard to do, even radiologists who read the films and then write the reports will sometimes get it wrong and they've had years of specialised educational training in comprehending the different MRI techniques, MRI physics, neurology, 1T vs 1.5T vs 3T, open vs closed etc etc behind them.

I would recommend you don't try to understand the scans and consider reading your MRI report instead, keep in mind the report itself can be very complicated to understand depending on the level of radiology speak they've used. Your MRI report will provide more accurate specifics, eg the larger lesion you see 'may be' a system anomaly and not a lesion if it's not in the consecutive slices.....Unidentified bright objects or UBO's look like larger lesions but they are just ecko's, um think of a camera flash showing up in your picture when nothing really bright was there in real life.

I'm not saying it isn't a lesion, just trying to explain some of the reasons why interpreting your own MRI is unlikely to be as informative or as meaningful as your actual MRI report would be....btw 1-3mm is usually ischemic micro vascular related and anything bigger than 3-4mm is often looked into more closely.

Hope that helps......JJ

PS other members have uploaded their MRI images with their other fun pictures, located on their profile page but please if you choose to do that, remember to remove any identifying information around the edges of the images.        

[jessica9280]

Thank you all for your help and reassurance. The one large lesion is ovoid shape and looks to be about 8mm in size. It is on the left side of the MRI at the bottom of the ventricle. The other two are smaller, and one shows on the top right portion of the MRI along the edge, and the other shows on the lower left side close to the edge. Sorry my technical knowledge is not great to explain exactly where they are! I do have images of the MRI but couldn't find how to post them on here. I haven't had an MRI with contrast yet but I'm assuming my doctor is waiting until after the lumbar puncture.