MRI results

Question

Can someone tell me what this means, please?

Numerous frontal lobe punctate, subcortical and deep white matter lesions. There is a moderate-sized left subinsular white
matter lesion measuring up to 9 mm in long axis. There is left greater than right frontal and occipital lobe periventricular white
matter T2 prolongation. There is mild corpus callosum undersurface irregularity. No abnormal white matter lesion enhancement
is identified to suggest active demyelination. No restricted diffusion within the lesions. No mass or midline shift. Mucous
retention cyst versus polyp in the left maxillary sinus. Mild right maxillary sinus mucosal thickening. Remaining paranasal
sinuses are clear. Mastoid air cells are clear. The orbits and calvarium are unremarkable.
IMPRESSION
1. Stigmata of multiple sclerosis without evidence of active demyelination.

DrSharma · Accepted Answer

Hi there. Your MRI report suggest that there are markers of Multiple sclerosis in your brain though no signs of active demyelination are present. these finding need to be correlated clinically for signs and evidence of multiple sclerosis. These multiple neurological symptoms including seizing hands and tremors could be due to a chronic demyelinating condition called multiple sclerosis where the disease phase is characterized by active phase and remissions. It has multiple symptoms and signs and is a diagnosis of exclusion. The symptoms of multiple sclerosis are loss of balance, muscle spasms, numbness in any area, problems with walking and coordination, tremors in one or more arms and legs. Bowel and bladder symptoms include frequency of micturition, urine leakage, eye symptoms like double vision uncontrollable rapid eye movements, facial pain, painful muscle spasms, tingling, burning in arms or legs, depression, dizziness, hearing loss, fatigue etc. You have many of these symptoms. The treatment is essentially limited to symptomatic therapy so the course of action would not change much whether MS has been diagnosed or not. Apart from clinical neurological examination, MRI shows MS as paler areas of demyelination, two different episodes of demyelination separated by one month in at least two different brain locations. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons, transmit nerve signals slower than non-demyelinated ones and can be detected with EP tests. These are visual evoked potentials, brain stem auditory evoked response, and somatosensory evoked potential. Slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI in addition, a spinal tap. Therefore, it would be prudent to consult your neurologist with these concerns. Take care.

dudewarrior · Answer

Can you tell me what this MRI examination of the head means, please? MRI examination of the head was performed on sagittal and traverse planes. Images were obtained prior to and following Gadolinium enhancement. MRI examination shows asymmetrical enlargement of the right lateral ventricle. Extensive periventricular white matter demyelination is noted on the right side. There is relative sparring of the occipital lobe white matter and medial aspect of the anterior lobe white matter. No evidence of positive mass effect is seen. Also, post-Gadolinium study shows no evidence of abnormal enhancement. Findings seen on this examination may be related to chronic ischemic change of the right parietal white matter with central atrophy. Finding may be related to chronic ischemic change of the right middle cerebral artery distribution. The presence of significant right carotid artery stenosis may be present. Correlation with duplex carotid ultrsound examination may be helpful. The remainder of the cerebral parenchyma is entirely unremarkable. Area of the brain stem and cervicomedullary junction are within normal limits. Mucosal thickenings are seen at the left maxillary sinus with air fluid level highly suggestive of sinusitis. MSK;w Impression: Asymmetric enlargement of the right lateral ventricle is noted with extensive periventricular white matter demyelination. This may be related to multiple old periventricular white matter infarct or chronic ischemic changes. No evidence of mass lesion or neoplastic process is noted. Also, no evidence of Gadolinium enhancement is seen. Further investigation with duplex carotid ultrasound examination is recommended to rule out the presence of significant right internal carotid artery stenosis. Evidence of sinusitis is seen in the region of the left maxillary sinus. Small retention cyst is also noted at the left maxillary sinus.

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