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1336491 tn?1340619541

brain lesions not near ventricles ?????

Hi All

If brain scan shows hyperintensity or however the neuro words it - if he says theres multi hyperintensity but its not near the ventricles could they still be a sign coinciding with ms ..

he did say mine could be smoking related

jan xxx
12 Responses
147426 tn?1317265632
Okay, it sounds like you have multiple areas of hyperintensity.  But, the neurologist is stymied because they are not periventricular????  Oh, Sheesh!  Lesions in MS occur in many places other than the periventricular (around the ventricles) area.  But, neuros that know less about the disease are really stuck on the periventricular location.

Now since he is invoking the lazy and unenlightened "smoking gun", lol, I assume that the lesions in your MRI are subcortical.  The subcortical area is the region of white matter just under the layer of gray matter on the exterior of the brain.  This area gets confusing because the subcortical area is the classic area for "small vessel ischemic disease".  This is lesions from damage to small arteries caused by things that damage such little vesses.  These include high blood pressure, migraine disease, diabetes, vasculitis (like from Lupus) and, yes, smoking.

However, MS regularly causes lesions in the subcortical area, but especially in the area that actually spans the border between the white matter and the cortex.  Now, if all the lesions are subcortical, too many neuros will think only of small vessel disease.  This is being too narrow-minded.  MS can present with just subcortical lesions.

Okay, on for smoking.  Deep breath.  Yes, smoking is a risk factor for small lesions, like those seen with advancing age and high blood pressure.  However, it is more of a statistical risk and not such a literal one.  Many smokers have no lesions.  But, when you look at a huge number of healthy people with NO neuro diseases, and do all the controls, you find that yes, to a small extent smoking increases your risk for white matter lesions.  The problem is ever looking at an MRI of someone with neurological symptoms and jumping to the conclusion that all the lesions are from smoking.  Impossible to tell except that smoking is not that huge a factor and lesions from smoking generally do not cause nuero symptoms.

So you can't look at an MRI of someone with neuro symptoms and dismiss all the lesions because the smoke.  If the lesions from smoking caused symptomatic lesions then all/most smokers would have neurological symptoms and THEY DON'T.  So, the neuro has to look at any lesions IN THE CONTEXT of someone who has neuro symptoms.

And then, there is the knowledge that smokers have a higher risk of MS.  So it certainly doesn't make sense to dismiss the consideration of MS because someone smokes, does it?

Easy answer.  Only having lesions in places other than near the ventricles can certainly still be MS.

Smoking is way overcalled as a cause of T2 hyperintense lesions.

quix
751951 tn?1406632863
Hi, Jan.  Wish I had a clear-cut answer for you.

I had been a smoker not too many years before I underwent my first MRI of the brain.  That was ordered around a dozen years before I had any symptoms other than a classic migraine.  Nobody mentioned smoking as a possible cause of my few small lesions (oops: "punctate-to-small T2 hyperintensities," which also happen to show on the FLAIR sequences, IIRC) until I questioned whether something other than migraine might be causing the flood of new symptoms I experienced beginning about two years ago.  None of those symptoms were anything like my previous experience, so it was (and still is) hard to make the connection between something that was textbook migraine and something that much better fits other explanations.

Pardon my skepticism, doc, but it feels as though, if it ain't clear-cut, you guys will call it migraine, and if you don't know what caused it, blame weight, smoking, or age.
Avatar universal
Hi Quixotic1,

Your reply to Jan has really helped me to understand things in my situation a little better.  I see my neuro in about a week and obviously as a smoker I am sure the question will arise.  But I am hoping he is experienced enough to look at my symptoms and consider all options before jumping for the smoking.  I have a fear that everything is going to be put down to smoking+stress. I know full well I am quite a stressy person and I know some of my issues can also be put down to anxiety, but not all. I really need him to look beyond my stressy past but I don't know how to approach this because it is possible he may look at my notes and already have it pinned in his mind.
956292 tn?1334054869
Hi

I hope you are well!!!! your post also was a great help too...I'm subcortical with lesions amongst other places....

I'm in limbo

Jibs
1312898 tn?1314568133
Hi Jan,   I don't know why radiologists and neurologists are so reluctant do diagnose.  Like Quix has said in some of her writings---they do the MRI to find something, and then find something only to explain it away.  

It's so frustrating!  Hang in there


Red
147426 tn?1317265632
One way to counter the "due to smoking" issue is to ask a couple questions:

1)  But, all smokers don't have lesions, do they?  If not, then how can you know that mine are ONLY due to smoking?

2)  And all smokers don't have neurological symptoms, so then why don't we have to consider that my lesions are very possibly due to something else that DOES cause symptoms?

Red, just a note.  MS is a clinical diagnosis (based mainly on the signs and symptoms of the patient.  The MRI should be used as a helpful tool.  MS is not a radiological diagnosis, so the radiologist would have no business diagnosing it.  The most they should do is mention if something is suggestive or consistent with a demyelinating process such as MS.

Quix
1336491 tn?1340619541
hey quix   great questions

i will sure ask him them cause i know the smokin will come up.. cause i know he found stuff on my spine but he only mentioned the brain hyperintensity once, and im going to ask him about that.  Do people ever have more than one brain scan xxx

jan xx
147426 tn?1317265632
Also, smoking does NOT cause spinal cord lesions.  It would be sillier than silly to accept the spinal cord lesions as strong evidence, but to dismiss the brain lesions.  However, sillier things have happened.

Both before the diagnosis and after most people end up getting quite a few MRIs I had at least 6.

Q
1336491 tn?1340619541
Hi quix thanx again

Even of the brain ?? mri i mean xx not just the spine..

Ive come along way re; mri,s i first had to have valium and was in a right state sort of used to em now.  but i still hate em  i am really claustrophobic .

jan xxxx
883901 tn?1294000772
Hi,
I think it must be something that the Neuro's in the UK say, as I am having the same problem,

Here is what my Neuro sent in a letter to my GP:

This women's MRI scan of the brain & spine was performed on 10 June but has only just been reported. The MRI scan showed areas of high signal intensity in the white matter of both cerebral hemispheres, unchanged since previous MRI of the head in October 2008. Although the nature of these lesions is uncertain, from their position and lack of evolution, I think it more likely that they are ischaemic than inflammatory, she has a obvious risk factor for small vessel cerebrovascular disease in smoking and obviously any other risk factors such a hypertension, diabetes ect. I think it is unlikely that she has Multiple Scleosis.

The MRI scan of the spine shows some degenerative changes of at C5/6  and C6/7 and a disc bulge at C5/6. The disc bulge is impringing on the cord, but not actually compressing it and there is no evidence of signal change within the cord itself. I think this lesion could expalin the presence of Lhhermitte's Phenomenon when she flexes her neck and it doesn't look as if surgery would be indicated. She will be reviewed on 13th September.

I am annoyed in a way as I was suppose to have contrast but this was not followed through.

I have now given up smoking for 4wks, because of this, have had my blood pressure, & blood tests taken all are perfect, so that rules that out. I am sick like PastorDan said, they will blame anything on something else if they are not sure.

My Neuro said my symptoms were typical of MS but my Neuro examination did not fully back it up. My doctor says my symptoms represent MS, has adviced I tell my Neuro everything when I nx go in Sept. I am worried that I will be tossed aside & then start the whole thing again.

I hope we both get our answers soon, but with the way the NHS are it's a slow process.
Let me know how it goes for you...

xxxxxxx
1336491 tn?1340619541
Hi there

good grief yes it sounds the same, but like our dr quix said i think these are reports wrote by radiologists as opposed to a neurologist.  I was also thought to have disc compression but my mris are saying not..

i too want answers and am very grateful to quix and team on here for educating me in all of this confusing medical jargon..

its been 5 weeks now since my lumber puncture - have u had one ??? ask i would.  they are nothing to worry about it was a walk in the park xxxx

my sx are exactly same as they were 9 months ago but worse i have also had the 3 x day IV treatment in hospital, its not worked..

keep me informed lots love jan xxxxx
Avatar universal
Okay help, I have multiple neurological symptoms, tremors, fatigue, affected eyesight and a resonating feeling throughout my body but worst in my legs. If February I had a rare encephalopathy syndrome so did headache then partial seizure then full seizure, repeat...consequence was a coma so deep that only my pupils registered painful stimuli. My eyesight is permanently damaged but sometimes it will get worse. I apparently had two lesions on an MRI in July, now I have four all related to the ventricles but other than the fact that nine months after I took I'll i feel like really crappy still.
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