bluesky63 wrote: Willowford, if you would be so kind, I am very interested in some specific issues regarding lesions and MRI.
* Some doctors diagnose people with MS even if their MRI is completely clear. Therefore that must mean that some people can have flare-ups and disability and progression that is not reflected on their MRI. How is this consistent with the definition of MS?
* Some doctors believe that unless you have a corresponding lesion on your MRI that directly reflects clinical symptoms you are presenting, then you are not having MS activity, and therefore your symptoms cannnot be from MS. And yet in support groups, patient after patient will share their stories of how annoying this is. Is this a case of an incorrect assumption from the doctors, or just a few uninformed doctors, or something else entirely?
* Some doctors believe that the MRI does not correlate to the clinical picture and they use it as a general snapshot every few years but they don't try to exactly match presenting symptoms to specific MRI lesions. Are these doctors doing it right? Why the different approaches? Is there a consensus behind the scenes?
* Some people never have enhancing lesions. Never. If one of the hallmarks of active disease is a breach of the BBB, shouldn't there be enhancement sometime? Many MS doctors do not seem troubled by this, and yet this seems to go against the concept of the definition, just the same way that a clear MRI would.
Shall I go on? Is it the end of the semester yet?
itaska21 wrote:These are all very informative posts. The complex relationship between symptoms and lesions. I personally would've just been so THANKFUL to know I had another lesion to factor into this ongoing disease! The doctor NEVER even contacted me for an appointment when the actual radiology report was received by her. All she did was give me her own interpretation of the mri right after having it done. Oh, and she did look at the 2009 mri too while I was there. By the way, she made some sarcastic remark to the poor student who was shadowing her that day about patients doing online research, and how counter-productive it was.... I won't even say what I think about that!
sous wrote:hi, what is CNS?
Has anyone managed to get over a cognitive relapse? I have just found out I have a big lesion that has formed in the right lobe in the emotion/executive tasks area and my brain has been mush for 8 weeks now. It has let up about 20% but I am still basically useless and worried it is going to progress to dementia or something. Anyone been through this? and got their personality/brain back?
Itasksa have you noticed any cognitive issues with your lesions?
jimmylegs wrote:lr, when my brain was mush and i had an active lesion, it led to a long road of discovery. it started with the zinc, linked up to uric acid levels. i also noticed that i suddenly was a bunch less stupid once i corrected the zinc deficiency.
this week it came full circle. i know that low zinc means your body can't do the urea cycle right. it means that you don't process toxic ammonia properly. i found out this week that a patient with a level of zinc only one point lower than mine resulted in ammonia levels up in the 700s, when the normal range is 15-45. units in related recent posts by me.
related to your specific question, i just found this article on hyperammonemia and brain edema (read: slow blood flow) and brain lesions. yes it is a rat study but still interesting. and this:
Hyperammonemia, brain edema and blood-brain barrier alterations in prehepatic portal hypertensive rats and paracetamol intoxication.
http://onlinelibrary.wiley.com/doi/10.1 ... 6/abstract
Induced hyperammonemia alters neuropsychology, brain MR spectroscopy and magnetization transfer in cirrhosis
have you been keeping up with your zinc and do you know your level?
I have PM'd you Willow.
Thanks again for the replies
Added: My liver has always struggled but strangly I am better MS wise when the enzymes are really high. My liver went back to normal just before this relapse (I stopped a load of supps at my dr's request to see if we could get the liver back to normal). So don't know if it dumped everything into my blood in one go (I also was drinking lots ginger/lemon tea and detoxing) Could this cause a lesion though???
willowford wrote:I just PMed you back; I made a comment about CT there but didn't realize you were concerned about it.
Its done all the time (I've seen it save lives in other contexts). There are risks though, especially if you're having lots of CTs in a short period of time. One CT has RARELY causes a problem, usually in people with renal failure. They'll do blood work first to make sure your kidneys are fine and this will further reduce the risk of complications. But if you're worried, for peace of mind, ask the doctor for the risks of the complications when you go in.
LR1234 wrote:I was wondering whether it was a stroke or something due to my clotted veins but the dr's assure me its not. I am having a CT scan (at my request) to see how the blood is flowing. Slightly worried about the CT radiation level for brain/neck and chest (to include azygous)
My Dr says MRV in this situation would not be sufficient.
Dr. Sclafani has discussed the radiation levels experienced for different types of scanning, e.g., venogram, CT, standard x-ray. From the numbers he's given for a chest CT, 8 mSy, and I've calculated that this would be the equivalent of 272 standard chest x-rays. There is a risk associated with CT scans. The questions that need to be addressed are if the risk is worth the benefit and if there is an alternative that can provide the same level of information with less risk.
willowford wrote:Great link - provides info on all the imaging modalities. I've heard docs explain that one x-ray has ABOUT the same exposure as flying across the country once, which is a good analogy. (could mean that one CT is approximately equivalent to 277 times! Hence the concern for flight attendants and pilots who could do this in a year).
CT is definitely up there in terms of risk, which is why its not routinely used unless they're looking for very serious conditions where the benefits outweigh the risks.
According to the post " A head CT scan is 2 mSy, a chest CT 8mSy. Annual allowable occupation dose limit is 50 mSy."
So definitely having 25 CTs in a year put one at a very high risk.
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