Lesions with no physical symptoms?

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Lesions with no physical symptoms?

Postby Cholderby » Sun Apr 07, 2013 5:08 am

First I had a brain MRI during an exacerbation. In addition to an active lesion, there were three old lesions in my frontal cortex. The neurologist explained that these didn't cause symptoms because they are in the thinking part of my brain*.

Now I have my neck and spine MRI results back and there is "A moderate-sized demyelinating plaque is seen at C4" and "an additional`equivocal plaque at T6-T7". I still have three weeks before my next neurologist appt. and I'm kind of impatient. So...I guess I understand how I can have brain lesions with no symptoms, but I don't get how I can have spinal cord lesions with no symptoms.

C4 control the biceps and deltoids, is that where you would expect to find symptoms?

*Do I really have no symptoms from these or is this why I can't remember where I put my car keys? Or perhaps there is so much brain matter there at present that cognitive symptoms won't begin until I've lost more frontal cortex ground. Thoughts?

My last question is what's an "equivocal plaque"?

In summary....I'm totally confused. :mrgreen:
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Re: Lesions with no physical symptoms?

Postby jimmylegs » Sun Apr 07, 2013 6:51 am

with cervical lesions, i think you would expect the symptoms to affect the relevant body parts yes. it's hard to say with brain lesions.

when i had some very specific cognitive symptoms, mri had found an active lesion in my brain. i asked the neuro if trouble in that region of the brain could have anything to do with my difficulty processing visual information, and he said yes.

since that time, i identified my zinc deficiency and the problem resolved never to return. yay! haven't had another mri since though. better get on that to see what's going on in there. (right, anonymoose??? ;D )

sorry i tried searching but am not getting any joy re 'equivocal plaque'
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Re: Lesions with no physical symptoms?

Postby MarkLavelle » Sun Apr 07, 2013 9:17 am

Cholderby wrote:C4 control the biceps and deltoids, is that where you would expect to find symptoms?
It's not that simple. Damage at C4 can affect any part of the body connected at or below C4 (because all those nerves go through it). For example, my largest lesion is at C2 and I have paresthesia over my whole skin, not just my head.
*Do I really have no symptoms from these or is this why I can't remember where I put my car keys? Or perhaps there is so much brain matter there at present that cognitive symptoms won't begin until I've lost more frontal cortex ground. Thoughts?
I have the impression that cognitive problems don't usually show up until you've got a decent percentage of brain matter demyelinated...

RRMS dx 3/3/11; Copaxone since 12/1/11
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Re: Lesions with no physical symptoms?

Postby mmpetunia » Sun Apr 07, 2013 9:27 am

I have multiple spinal lesions, yet the jury is still out on whether they are causing any symptoms. I have 4-5 cervical lesions and another at the conus t12-l1. I have arm parathesias but no noticeable symptoms from the thoracic lesion. Not sure if the cervical lesions have anything to do with the arm pain... It is suspiciously peripheral in nature, but tests are inconclusive.
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Re: Lesions with no physical symptoms?

Postby CaliReader » Sun Apr 07, 2013 6:27 pm

I have three cervical lesions and one thoracic lesion. I have worse motor coordination in my hands than I used to. I have trouble with zippers, and can't use chopsticks any more.

Re memory, I think that I read some research about atrophy of the hypothalamus, a brain structure associated with memory, being common in MS. I know that my short term memory is much worse over the last five years.

There is supposed to be a lot of redundancy with brain function. I hope your lesions stay 'silent' and you don't get new symptoms.
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Re: Lesions with no physical symptoms?

Postby HappyPoet » Sun Apr 07, 2013 11:43 pm

An equivocal lesion (as opposed to unequivocal) is one that might not really be there. This is sometimes written if the lesion can't be seen on all MRI modalities used, e.g., T1, T2, Flair. What the radiologist sees might just be an artifact, so they sometimes will write, "correlate with symptoms." If there are no correlating symptoms, then the equivocal spot seen will usually not be counted as a lesion. The counting of lesions can be important when a doctor is trying to decide if an MS diagnosis should be made and when a doctor is evaluating whether or not a DMD is working well.

Hope this helps.
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Re: Lesions with no physical symptoms?

Postby Cholderby » Mon Apr 08, 2013 12:14 pm

HappyPoet wrote:Hope this helps.


It sure does! MS has quite the learning curve. :?
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Re: Lesions with no physical symptoms?

Postby centenarian100 » Mon Apr 15, 2013 3:38 pm

In MS, asymptomatic lesions are very common and often outnumber the number of clinical attacks by several fold.

For instance, check out this study of clinically isolated syndrome (people with one demyelinating attack)

http://brain.oxfordjournals.org/content ... 8.full.pdf

scroll down to page 4 and take a look at table 2.

Out of 107 patients with 20 year follow up, 30 (28%) had >/= 10 MRI brain T2 lesions at baseline (after the first attack).

Obviously, these patients had many prior asymptomatic lesions.

asymptomatic spinal cord lesions are also possible [and common] as described by calireader, and mmapetunia

I agree with happypoet about the equivocal lesion

Mark is right about the C4 lesion. The "C4 lesion" refers to the spinal level (next to the C4 vertebral body)-in other words, where the lesion is anatomically. The C4 dermatome and myotome are areas of skin and muscles respectively which are innervated by the C4 nerve root which exits the spinal cord at the C4 level (actually at approximately between the C3/C4 vertebral levels). The symptoms [if any] arising from a spinal cord lesion depend on which fibers are injured and may be far below the level of the lesion.

As you can see from the cross sectional diagram of the spinal cord, the anatomy of tracts is complicated and injury to different areas can cause different symptoms

Image
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Re: Lesions with no physical symptoms?

Postby MarkLavelle » Mon Apr 15, 2013 4:39 pm

Image
Nice map! Does anyone know where to find a larger, clearer version?

RRMS dx 3/3/11; Copaxone since 12/1/11
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Re: Lesions with no physical symptoms?

Postby HappyPoet » Mon Apr 15, 2013 6:03 pm

Image

Terrific map, 100. Using PhotoBucket's edit function, I couldn't make the image larger because sharpness of text becomes lost. Maybe someone else can do the job better than I. Alternatively, perhaps 100 can post the source link?

Edit: I believe the letters above the upper right section stand for:
S - sacrum
L - lumbar
T - thoracic
C - cervical
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