Single Demyelination Focus

[Lisa2U]

My doctor told me that my MRI (brain without contrast) was normal. This test was done in January 2011, but I never obtained a copy of the results until last week.

When I obtained a copy of the radiologists report, the impressions were listed as followed..

IMPRESSIONS
1. Single demyelination focus within the right, frontal subcortical white matter, non specific.
2. Differential considerations are within normal ranges, miscrovascular ishemic demyelination and demyelination disease.

These symptoms didn't start all at once. It started off, in 2005, with a simple pins & needles sensation in my left foot and from this, the symptoms progressed. As of the beginning of this year 2011, I have now completely lost the sensation in both my feet (toes and heels) and both feet go numb during the course of the day and night. I have a tremor and distinct weakness in both my legs, although my right side is much worse than the left. My right arm and hand is also affected with a loss of sensation in my fingertips (pinky and middle fingertips), weakness in my right arm and a tremor in my hand and arm that comes and goes. Some days the tremor is quite bad and I am unable to hold certain objects (spoons, forks, pens). Other days it's just like a jello sensation in my legs and arm.
My coordination and overall balance is messed up making me stumble frequently when I walk.
Every morning, I wake up and either both of my feet, parts of my legs or both of my hands/arms being completely numb and I have to lay there for several minutes until the feeling comes back so I can get out of bed.
I'm in the process of finding another neurologist, but I was wondering if these MRI impressions are indeed normal.

What the heck is "Single demyelination focus within the right, frontal subcortical white matter, non specific"

Can you explain what this is in simple terms?

thanks
Lisa

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are multiple causes for lesions seen on MRI. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented.

Other causes of plaques in the brain can be migraine. People with migraine often have plaques on their MRI that are of unclear cause or significance.

Other causes of plaques on MRI can usually be distinguished based on history and symptoms, such as symptoms of neurologic deficit (for example arm weakness or difficulty walking etc). These can also be distinguished based on the MRI appearance. These include, but are not limited to, multiple sclerosis, other demyelinating disease, and inflammatory processes such as vasculitis.

A single focus of abnormality on MRI could be several causes. It depends on the exact location and the appearance it has on the various MRI sequences. It is difficult to provide you much information other than what is provided. Given that you do have symptoms, I would highly recommend you discuss your MRI findings with the ordering physician. You would benefit from a referral to a neurologist for a thorough neurological examination. If MS is a possibility, it may take time to diagnose and may require additional testing such as a spinal tap.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Lisa2U]

I meant to add that this MRI I had done back in January (my very first one) was ordered during my 1st visit with a neurologist that my primary care doctor had sent me to because she suspected MS as a possible diagnoses.
On the second visit is when she told me the brain MRI was normal and so she had me do an EMG/Nerve conduction study on all 4 limbs and a lower lumbar spine MRI.
On the 3rd visit, I got the results for both the MRI (lumbar spine) and EMG/NCS
The lower lumbar spine revealed mild multi-level degenerative disease?? but she told me that this was normal as well (I'm only 39 years old, female)
She told me that my EMG/NCS results were also normal...and that was that.

She told me to follow up in 6 months and didn't seem to care about treating the actual symptoms I was having.

My primary care doctor suggested to me that a 2nd opinion was warranted because of my symptoms and that's what we are currently in the process of doing.
Like I said, it wasn't until this past Friday when I picked up copies of the brain MRI results from Janaury, that I read the radiologists impressions, and I can't help but wonder if these are indeed normal results taking into consdieration my current symptoms.

I'm hoping that my new neurologist will at least treat these problems I'm having, even if he is unable to come up with a diagnoses.
If I can just get steady on my feet again, I would be good with that :)