Need help with husband's MRI findings

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Need help with husband's MRI findings

Postby preethav » Tue Oct 04, 2011 5:47 pm

I am a new member; I am anxious about my husband. My husband has crohn's disease. About 2 months ago, my husband complained of a little vertigo, and a feeling like his ears were plugged up. The vertigo passed within a day (it was more positional), but the left ear didn't clear up. He has constant ringing, and a plugged up feeling. He saw his PCP, and he thought perhaps sinus issues, so they tried decongestants, and nasal steroids. When that didn't work, he went to an ENT - he checked out my husband's ear, and said his middle and outer ear were fine; the problem was with his inner ear (he showed moderate hearing loss in high frequencies on audiometry tests).

So, we took an MRI. Good news - no acoustic neuroma, or lesions (or non-enhancing lesions) in any part of the brain related to hearing (1.5 T MRI with contrast - pons, auditory nerves, etc. all clear). The radiologist however mentioned "several foci of increased signal in the periventricular white matter, most prominent adjacent to the left ventricular trigone". The summary said - bilateral ischemic gliosis secondary to small vessel disease.

He has no other symptoms - no weakness, no ataxia, no vision problems, etc. The ENT told us these spots are just "age spots - like freckles on the brain, and they are nothing to worry about". However, on reading some, it appears these spots are more prevalent in people with hypertension, diabetes, migraines, high cholesterol etc. My husband has none of those conditions.

Does the radiologist findings warrant a visit to the neurologist? Does it sounds suspicious of early MS? BTW, my husband is 46 years old.

Thanks so much for any advice you can provide a very anxious wife.

PV
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Re: Need help with husband's MRI findings

Postby cheerleader » Tue Oct 04, 2011 8:22 pm

preethav wrote:I am a new member; I am anxious about my husband. My husband has crohn's disease. About 2 months ago, my husband complained of a little vertigo, and a feeling like his ears were plugged up. The vertigo passed within a day (it was more positional), but the left ear didn't clear up. He has constant ringing, and a plugged up feeling. He saw his PCP, and he thought perhaps sinus issues, so they tried decongestants, and nasal steroids. When that didn't work, he went to an ENT - he checked out my husband's ear, and said his middle and outer ear were fine; the problem was with his inner ear (he showed moderate hearing loss in high frequencies on audiometry tests).

So, we took an MRI. Good news - no acoustic neuroma, or lesions (or non-enhancing lesions) in any part of the brain related to hearing (1.5 T MRI with contrast - pons, auditory nerves, etc. all clear). The radiologist however mentioned "several foci of increased signal in the periventricular white matter, most prominent adjacent to the left ventricular trigone". The summary said - bilateral ischemic gliosis secondary to small vessel disease.

He has no other symptoms - no weakness, no ataxia, no vision problems, etc. The ENT told us these spots are just "age spots - like freckles on the brain, and they are nothing to worry about". However, on reading some, it appears these spots are more prevalent in people with hypertension, diabetes, migraines, high cholesterol etc. My husband has none of those conditions.

Does the radiologist findings warrant a visit to the neurologist? Does it sounds suspicious of early MS? BTW, my husband is 46 years old.

Thanks so much for any advice you can provide a very anxious wife.

PV


welcome, PV-
As a wife, and an anxious one, I understand your concern. It doesn't sound like MS...your ENT is right, lesions do appear on MRIs as we age. Did your doctor tell you that Crohn's can be related to neurological symptoms? It can cause cerebral vasculitis (like what the doctor saw on the MRI) It could be about a malabsorption of vit. B, or a coagulation disorder. Sometimes vitamin supplementation or anticoagulation therapy are used, and there is some healing....here's some research.
http://www.ncbi.nlm.nih.gov/pubmed/10795098

Another avenue---Has Menierre's been mentioned? That's what the auditory symptoms might be. Has he been scanned for jugular vein thrombosis? This could be more about the vasculature and coagulation factors. Thus the mention of "ischemic" gliosis and small vessel disease. That's more about blood flow and oxygenation to the brain.
Print out this paper, ask if your husband can have his carotid arteries and jugular veins checked from thrombosis, and get his coagulation numbers done.
http://www.thefreelibrary.com/Hyperhomo ... 0111111836

I'm sure he's on a good diet if he has crohn's....
Hang in there, try not to stress out, and let us know how you do.
from one wife to another...
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Re: Need help with husband's MRI findings

Postby preethav » Tue Oct 04, 2011 8:55 pm

Cheer:
Thank you so much for your reply. And thank you for the information. I am thinking that an MRA should tell me something about his jugular vein. Also, he had a complet CBC that was normal just a few weeks ago - would that have checked for platelets and therefore coagulation? Maybe not, I'll try to read up on it.

Meniere's wasn't suggested because of lack of nausea, vertigo,etc. We saw the ENT today, and he looked over the MRI and was satisfied that nothing in the MRI could explain my husband's hearing loss. He said most likely it was a viral thing, and that the fine hairs on the cochlea were affected. He said there is a 40% chance that he'll regain hearing in that war on his own. He suggested a steroid provision (injecting steroid into the middle and inner ear) to hasten the recovery. My husband is mulling it over.

In the meantime, I called and made an appt for him with a neurologist. He was routinely checked out by a cardiologist just a couple months ago, including a stress test and he did just fine. My husband's crohns is currently in remission, and his blood numbers are all normal. Also, he is on Remicade which can cause MS like symptoms. So, hard to tell what the heck is going on with him.

I doubt I'll get any answers from the neurologist except wait and see if any symptoms develop, but at least she'll have a baseline for him.

Thank you so much for your insight!! Very much appreciated. I'll keep you posted on what I find out

PV
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Re: Need help with husband's MRI findings

Postby NHE » Wed Oct 05, 2011 3:27 am

preethav wrote:Thank you so much for your reply. And thank you for the information. I am thinking that an MRA should tell me something about his jugular vein.


If you're going to use magnetic resonance (MR) scanning, then the test would be an MRV as it better isolates the veins. However, a doppler ultrasound, if done by an experienced technician, might be a better approach as the cost would be considerably lower. The definitive test would likely be an intravascular ultrasound though it's use is less widespread. A good screening test would be the doppler ultrasound to start with if you should choose this line of testing.

NHE
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Re: Need help with husband's MRI findings

Postby preethav » Wed Oct 05, 2011 8:49 am

Some of these things sound really scary. I am hoping it is nothing to worry about, which is what all the doctors have told me so far (2 ENTs, the general physician). I guess I'll wait to see what the neurologist has to say as well.

My husband's crohns disease is currently in remission thanks to Remicade. So, I doubt he's having crohns vasculitis - it is rare, plus it is even rarer without active digestive disease I think. Also, the only symptoms of any kind of vasculitis he has is a runny nose (has had that for years now), and hearing loss - no skin conditions etc. I think crohns people hypercoagulste when they have bleeding, which he doesn't right now. But this one is a simple blood test - I think I can get his PCP to run it.

The neurologist has MRI results of his brain from a couple of years ago, taken for different reasons - I think comparison of the two should tell us if we need to do more investigation. Now to wait one more week! The waiting and the anxiety is really getting to me, I need to figure out how to chill. My husband is fine, in fact he's gone to work, and I'm the one sitting here unable to get bad thoughts out of my head.

I don't think he has MS given his lack of symptoms and mon enhancing lesions. Now we just need to figure out if the several foci of high signal are anything to worry about.

Thank you so much for our support. I will post next week with what I find out after the neuro visit.

PV
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Re: Need help with husband's MRI findings

Postby preethav » Wed Oct 12, 2011 2:41 pm

Saw the neurologist today. She compared the MRI from 2009 and the MRI results we took in, and said she didn't really see any differences. She wasn't happy with the resolution of the MRI that was taken, but she said that from what she could see, she saw no indications that anything was different.

But she recommended doing an ABR to see where my husband's hearing loss is coming from, even though the MRI was clear. Is this really necessary? I so want to just put this down to what the ENT said - a viral infection causing hearing loss, and move on. I read that an MRI is superior to an ABR in finding lesions and tumors, so I am confused about why she is recommending an ABR.

She said even if the ABR was abnormal, there would be no change in course of treatment (ie. do nothing for now). My husband is scheduled for a 6 month follow up and repeat MRI just to be safe. I am tempted to just say we'll do another MRI in 6 months, and see how he's doing then, and not worry about the ABR right now.

Advice appreciated.

Thanks,
PV
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