prominent right lenticulostriate perivascular spaces

[marian13]

Hello everyone,

I have posted on this board before about my Brain Mri scan which i had done last September, some of you may remember my post about my symptoms and reults of tests which I had done back then.

Well to start i am not improving  in fact i think i am getting worse., especially my left eye, a muscle weakness and intermittent diplopia said by an orthoptist whom i was referred to by an ophthalmic surgeon. He has written to my Neurologist about this muscle problem.Still all the same symptoms but worsening of some and no diagnosis  of anything other then cervical stenosis. I had an Mri of brain with Contrast and Mri of cervical spine. The cervical spine has shown moderate cervical stenosis at level c5- c-6  and mild  at c6-c7. My neurologist referred me to spinal surgeon.

The surgeon has said ACDF which stands for anterior cervical decompression and fusion is a reasonable option for me, but that he cannot guarantee that my symptoms will be completely resolved and there is a possibility that my symptoms could worsen and deteriorate. He basically said that the big question with me is my symptoms and the only way to find out if it will work is to do it. It's 50/50.

My brain Mri with Contrast radiologist report says.
No prior brain imaging or clinical information available. I do not know what the clinical question is prompting this scan. When i read this i was upset because i just presumed that the radiologist would have been given information from my Neurologist, but not so.

I have given the clinic a copy of my previous 2014 Mri report, and they have requested a copy of the CD from the hospital where i had it done. The radiologist will then do an addendum. So any day now that should be done.

Result: Normal ventricular system.
No visible intracranial mass or haemorrhage. No pituitary mass.
No restricted diffusion.
Prominent right lenticulostriate perivascular spaces.
Small number of focal 2-3 mm diameter white matter abnormalities noted in the right frontal lobe, best seen on inversion recovery imaging, which could represent previous vascular or post-traumatic lesions.

I am waiting to hear from my Neurologist once he looks at my Mri,  I just wanted to ask if any of you know if this is a normal  Mri with Contrast result. The prominence was not mentioned in my previous Mri. My previous Mri mentioned numerous high signal foci in both cerebral hemispheres, this Mri says small number of focal white matter noted. Does this mean enhancement? All confusing and technical.

I would appreciate anyone's thoughts.

Best Wishes

[marian13]

Hi JJ,

You have no need to be sorry to me, more so i have to apologise to you.

I have blown all this out of proportion, i am analysing something that may never happen. It's crazy. The reality is i don't have a diagnosis for my symptoms and i may never, me worrying about it won't help me it will only hinder me.

You gave great advice and i must for my own good stop analysing my Neurologists thoughts and trust his good judgment. I really like my Neurologist and he is really trying to find a cause to my symptoms. He is doing all that he can for me, and i can't ask anymore of him.

It's time to take stock and if i get a diagnosis of anything then and only then need i deal with it. No more working myself into a tizzy, for something i have no control over. I must control my thinking and stop  over analysing.

Thank you jj for making me see things more clearly.

Best Wishes
Lorraine : )

[supermum_ms]

I'm sorry, I think I may not of been very clear in what i was saying about 'anxiety', i was not at all stating or suggesting your anxiety was responsible for any of your symptoms!

I was suggesting you 'consider' if your current level of anxiety, is 'possibly' leading you to over think things and make you worry even more.

I probably couldn't tell you anything about anxiety that you don't already know but my purpose was only to provide you with an alternate, less worrying perspective and respectfully provide you with some food for thought.....

Hugs........JJ

[marian13]

Hi JJ.

I really genuinely appreciate your thoughts, and i can understand your points. But because I'm an anxious person that doesn't mean that my interpretation of my Neurologists words are incorrect. People read things differently and everyone is entitled to their opinions.

MS is a chronic illness, i have a central nervous system problem that can't be explained, but because my Neurologist highlighted a possibility of developing MS, and not any other Neurological disorder, that in my opinion is telling me that he has a suspicion in my particular case for MS.

Now other people will interpret this differently, but when your the one that has symptoms that can't be explained and a medical professional  tells you ,you are at a risk of developing a chronic illness, that to me is serious.

If there is no way of him knowing if i or anyone else is at risk of developing MS, why say it at all.  The surgery he has no confidence in because of the complexities of my symptoms, and because my symptoms could stay the same or deteriorate following surgery.

I think an MS specialist would be the best person to review  my symptoms and MRI imaging. They would be the best person to advise me should i be leaning towards MS or not, they would have a very good knowledge of the mimics of MS and they would probably be the best person to clarify things better to me, they may even be able to reach a diagnosis as to the cause of my symptoms.

I have great respect for my Neurologist and i genuinely believe he is doing all that is possible to help me, but an MS specialist may be able to shed more light on my symptoms and their cause.

Anxious i am more than most, my GP whom I have been a patient for 10 years and knows my past history and me pretty well doesn't believe my symptoms are anxiety related, quite the opposite, she believes i have significant neurological symptoms , their cause 7 months on no answer. This is a worry for me, because i know anxiety pretty well it's part of who I am, this is different, this is a disease of some sort.

These are the medical facts of my case.

Muscle weakness in left eye causing intermittent diplopia.
Positive rombergs, positive Hoffman's sign, hyperflexia in both upper and lower limbs.

All pointing to a neurological problem, but have yet to find an answer to these abnormalities.

Thanks for your help and thoughts i appreciate it.

[supermum_ms]

Please take a step back for a moment and breath..........i seriously believe you are over analysing everything and because you are anxious and worried, you're starting to make huge leaps and jumping to conclusions that are just feeding your worries even more.........  

It's really not in your best interest, to start assuming the wording he used, has any alternative hidden meaning! IF, as you said "he knows i am anxious and frustrated" then it is more reasonable to believe his language choices, were more likely chosen to calm down your anxiety and be reassuring, and not in anyway in preparation for what could come.    

I would interpret your neuro's opinion as being focused on your structural spinal damage and up coming corrective surgery. It would be unprofessional if he had even tried to reassure you, that all your issues would be resolved by the surgery.

Any good doctor should consult with any other professionals involved in a spinal surgery case, before they should with confidence. discuss with their patient what level of recovery that can expect after this type surgery.  

In relation to his opinion regarding MS.....

"I asked him is he following the McDonald criteria?   He said  yes along with other criteria. The criteria is very stringent. I asked him how confident are you that i don't have MS he said i cannot guarantee that you won't develop MS. I asked him about possible MS he said there is no possible MS, it's MS or  no MS. "

"He also said if he were to bet on it that he would bet i would not develop MS."

What i get out of all you've mentioned......your neuro was telling you his professional opinion, and based on your diagnostic evidence and his MS experience, he doesn't believe you have MS or would actually develop MS in your future!  

He genuinely can't give you or anyone guarantees, if he did he'd be playing God....

Alternate and similar wording that has commonly been mentioned here by  neurologists are eg:
"i'm not convinced you have MS",
"I'm 99% sure you don't have MS"
"You don't have MS"
"the diagnostic evidence is not suggestive of MS"
"you don't meet the diagnostic criteria for MS" etc etc    

When all is said and done, if you can still make any assumptions of 'low risk' is meaningful or bad, I strongly believe it would be in your best interest to seriously consider.....if your anxiety and worry, ''could be' be the reason why you are looking and finding more meaning in the language used, than you possibly otherwise would, if you were not as anxious as you are currently?
      
Breath!

Hugs...........JJ


  

[marian13]

Hello, and than thank you for your reply.

The neurologist said i have a low risk of developing MS. There is no way of telling who is at risk of developing MS, so i don't know why he would say i have a risk of developing MS. It confused me.

He said i have a central nervous system problem, but cannot say what it is that's causing my symptoms. Everyone knows we all have a risk to develop something, but when a professor of neurological disorders tells you have a risk of developing a chronic illness, i take that serious. Of all the neurological disorders there are and there are many, my Neurologist  was able to give his expert opinion that i have a low risk of developing  MS.

I recently had a breast issue, which prompted many tests, and my consultant didn't say to me you have a low risk of developing breast cancer, knowing you have risks is of course part of life, but when a consultant starts talking risks, that puts a different spin on it and it does worry people.

I am looking for no guarantees because there aren't any. I have symptoms that can't be explained but i have a low risk of developing MS. I do not meet the diagnostic criteria for MS, but because my Neurologist said i have a risk of developing MS, and didn't mention any other explanation for my symptoms, that to me is a possibility of developing MS, hence possible MS.

I like my Neurologist too, and he knows i am anxious and frustrated, and i don't think he said what he said lightly. He may be preparing me for what could come.

Best Wishes

[kwarendorf]

"he said there is no possible MS, it's MS or  no MS."

I like him! You seem to be asking him for gaurantees. No one can guarantee anythng when it comnes to MS. Everyone on the planet has very low risk of getting MS. It is not genetic, it is not based on environmental factors. It just happens. It can just happen to anyone. SO I suppose everyon is at some risk of getting MS :-)

Kyle

[marian13]

Thank you for your reply.

I met with my Neurologist today and he is not confident about surgery resolving my symptoms. He is calling a. Multi disciplinary meeting about my case. He said it is warranted for my case. It will be himself the surgeon and radiologist. He will let me know the outcome of that meeting.

I did not meet the diagnostic criteria for MS  last December and i don't meet it today. But  i have a low risk of developing MS. He also said if he were to bet on it that he would bet i would not develop MS. But he cannot tell me what is causing my symptoms either.

I asked him is he following the McDonald criteria?   He said  yes along with other criteria. The criteria is very stringent. I asked him how confident are you that i don't have MS he said i cannot guarantee that you won't develop MS. I asked him about possible MS he said there is no possible MS, it's MS or  no MS.

So I'm none the wiser as to the cause of my symptoms.  He will do another Brain Mri in 12 months. But for now it's no diagnosis of anything. I am going to seek an MS specialist for their opinion about my symptoms and MRI imaging. Don't know what else to do.


Best Wishes

[marian13]

Dear jj,

I got a call early this morning to see my Neurologist. He wanted to discuss my upcoming spinal surgery. My good  was with me for the consultation.

My neurologist  said that surgery will not resolve all my symptoms, and that in my particular case he would like to have a multi disciplinary meeting with himself, the surgeon and radiologist regarding surgery. He feels this would be the right thing to do in my case, and a decision will be made whether surgery will go ahead or not.

Regarding MS, he said i do not meet the diagnostic criteria but i have a low risk of developing MS, and if he were to put a bet on it, he would bet i would not develop it. He said  a close eye will be kept on me. He said i do have a couple of white spots but not in the areas for MS. They are non specific.

I asked him at the end of my consultation,  Dr. How confident are you that i don't have MS?  He replied I cannot guarantee MS will not happen but it's a low risk, I asked him about possible MS? He there is no possible MS, it's MS or No MS.

He said because of my symptoms that MRI'S of  My brain should be done to keep an eye on thing's, 12 months time will be the next one. I have had enough for now he said smiling.

I am going to wait for their decision. I think it would be a good idea for me to see an MS specialist because i would like an MS to review my symptoms and MRI images.

Thank you for your reply and i will let you guy's know how things go.

[supermum_ms]

Hi Lorraine,

I had to go back through your history because although i did remember your id, i couldn't recall any of the specifics.

After looking at what you posted for your spinal MRI, i'm actually thinking that you have a more likely structural spinal explanation for your issues, than you do a brain related explanation. Based on your combined results, I genuinely don't see anything to indicate that there could also be something like MS going on....  

"I have  just had MRI of Cervical Spine and the results are as follows.

Normal vertebral body height. Straightening of the normal lordosis.
No intrinsic cervical cord abnormality or white matter disease.
Multilevel lower cervical disc degeneration.

C3-4: Mild central disc protrusion slightly indenting the cord just right of the midline.
C4-5: Mild broad-based central and right paracentral disc bulge slightly indenting the cord.
C5-6: Large left paracentral disc protrusion causing cord compression and narrowing of the left lateral recess and foramen.
C6-7: Focal right paracentral disc protrusion compressing the cord and narrowing the right exit foramen and lateral recess.

Summary: Multilevel degenerative disease, with neurological compression most pronounced on the left at C5-6 and on the right at C6-7. "

In regards to your question heading "prominent right lenticulostriate perivascular spaces " this is commonly called Virchow-Robin spaces and as far as i understand, 'dilated' VR spaces are connected to MS along with a half dozen other conditions but i'm not sure if there are any clinical implications when they are 'prominent' meaning enlarged, being the opposite, sorry.

I am going to advice you to 'consider' taking a step back, possibly taking a break from trying to interpret every nuance of these reports, which could be creating unnecessary frustrations and confusion along the way. It may help if you get a second surgical opinion, I honestly don't think there is anything significantly abnormal mentioned on your brain MRI.

Keep in mind that the neurologist report will be based on the totality of all your test results and it may be more informative and less stressful if you get your mind off this, until after you've heard back from your neuro.

CHeers.............JJ  

[immisceo]

It's a pity it was done without the benefit of the radiologist knowing what was specifically being queried. The findings don't mention demyelination, which is typically in the wording of results that point to something like MS. Instead, you have a few small lesions (though your previous MRI stated 'numerous') that could be related to a vascular/blood flow-type issue or a past injury like a concussion or migraine, etc. The prominence of perivascular spaces isn't something you usually see mentioned in the MRIs of individuals with demyelinating diseases, but this is just from my layman's memory.

Nothing in the wording you've typed indicates if anything showed up after contrast was introduced. Usually the wording in regard to this is pretty clear. "No evidence of enhancement" or " x number of lesions in ______ region enhanced"

The MRI doesn't appear to indicate something like MS, but perhaps the addendum will shed a bit more light.