brain mri question

[Missy1018]

i recently had an mri in june and now a follow up last week.  can someone tell me what they feel about these findings.  

Again seen are numerous T2-hyperintense foci in the cerebral white matter.  There is also a prominent lesion, about 6-7 mm size, in the left basal ganglia area in or adjacent to the posterior limb of th einternal capsule.  Of note, there are no periventricular lesions, and in the corpus callosum, only a single small lesion is noted along the far left lateral aspect of the anterior part of the corpus callosal body.  Also, there are no visible lesions in the brainstem or cerebellum.  Typical features of multiple sclerosis are lacking.  Prominent perivascular spaces are noted in the left cerebral peduncle of the midbrain.  

Any ideas what I should think?  Thanks

There is no pathologic enhancement in any area.  There are no areas of restricted diffusion on DWI.  The ventricles are normal.  The major vascular flow voids are unremarkable.  The orbits and paranasal sinuses are unremarkable.  

[Quixotic1]

Well, there are a lot of great minds in the medical community in Boston.  Here's hoping that you land with one of them.

Quix

[Missy1018]

I've been trying to find answers for so long now.  
I've always had weak liimbs, headaches, migraines.  In 2007 I had my appendix out and after that I had problems with word recall.  The surgeon said it was a sign of stroke during surgery.  I had a CT scan which showed something in the Robins Virchow space and right basal ganglia.  From there I've had numerous MRI's.  With each one I have more and more lesions.  The neurologist told me to day that my lesions are a little further away from the center where they normally appear.  I had a small plaque on the left parietal region in July which was not there last week.  And the new lesion in the right basal ganglia and corpus callosom.  
I have had the VEP test which was negative and a spinal tap which I cannot recall right now what those results where but I know they were not definitive.  

The neurologist that I see asked me if I would consider going to Boston for a second opinion as my case is not black and white.  So I called today to make an appt.  and I go January 13, 2012.  

As far as bloodwork goes, I have lupus anticoagulant, my liver enzymes always run high as well as my cholesterol, lipids, triglycerides and CRP levels.  
Thanks for sending me this email.
Missy

[Quixotic1]

Hi, Missy,

If I remember, you are still looking for a diagnosis.  

The important findings in your report are:

numerous T2 hyperintense lesions, mostly small, with no location mentioned except that they are not periventricular.

--  A lesion in the corpus callosum

--  The cerebellum and brainstem are free of lesions

--  Enlarged Virchow-Robin spaces in the interior of the brain.

--  A large lesion neasr the basal ganglia

--  No sign of stoke or area deprived of blood flow

--  The follow up fails to report any difference in the number or location of these numerous white matter lesions.

So what does all of this tell us.  Well, your findings are FAR from normal.  That must be held in the doc's mind no matter what else is said.  Unfortunately, the findings are not "classic" for MS.  Do they exclude MS?  ABSOLUTELY NOT!  They mean the doc is going to have to look outside the comfortable box and think hard.

Your lesion in the corpus callosum is ABNORMAL.  There should be no lesions there and few things outside MS routinely cause lesions there.

The lesion near the basal ganglia is also very abnormal.  Do you have any movement disorders like spasms, or tremors?

Would you remind me what kinds of symptoms you have had and what pattern they appeared in?  Or point me toward a post that describes this?  If you would write a journal post describing any attacks and previous testing it is always helpful.   Also include any abnormalities on your neuro exam.  And lab tests to rule out mimics.  What is your neuro saying about all this?

With the right combination of attacks,  exam findings and symptoms, this MRI is more than sufficient to make a diagnosis of MS.

Quix