New here, just found out...20 lesions

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New here, just found out...20 lesions

Postby photographerKel » Mon Jun 22, 2009 2:24 pm

Hope im doing this right, but i need answers and im really hoping someone can help. for the last 2 weeks ive been having "spells"....arm getting numb and tingly, feeling of dreaminess, trouble walking and slurred speech, this things happen in "spurts"....hospital said STROKE, but MRI showed lesions. My doc was unwilling to answer many questions, but said "probably ms and we will refer you to a neuro"...problem is, when i read the MRI report, it kinda sounds like "hey, this chic has 20 lesions, but none are active"...which makes me think, hmmmm....if none are active, why am i having so many sypmtoms and why now? I was hoping if i posted some of this lingo from the Mri on here, someone could help me understand it, so here it is, and im sorry for all the "junk", just nervous, i have 5 girls, and im a photographer and hard to wait to have the neuro explain all this lingo...

"Greater than 20 supratentorial rounded areas of high signal intensity measuring 5-7 mm are seen predominantly scattered throughout the subcortical white matter of the frontal and parietal lobes bilaterally. Three of these are in a periventricular location. None of the white matter lesions are juxtacortical in locatin. None of these lesions demonstrate mass effect or enhancement. No posterior fossa lesions are identified. The ventricles and sulci are normal in size and position without midline shift or mass effect. None of the white matter lesions demonstrate decreased signal intensity on the spin echo T1 weighted images precontrast."
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Postby patientx » Mon Jun 22, 2009 3:30 pm

It's tough to really understand what some of this stuff in the MRI reports means. That's why being a radiologist is a specialty, and this is where a neurologist can be helpful.

I'd have to go back and look up some of the terminology. But I think I can help answer some of your questions. Active vs. inactive lesions doesn't correlate to having symptoms. What they call a "lesion" is a spot that shows up brighter after the MRI image is produce (hyperintensity). These can be caused by many things; in MS it's the destruction of the myelin or scar tissue trying to repair the myelin. If the damage is actively happening, these spots will show brighter when a contrast agent (gadolinium) is injected, and the MRI is repeated. This just indicates that damage is happening at the time of the MRI. If the lesions don't enhance, this just means that damage was done sometime in the past. But, MS is a weird disease, and symptoms can show up any time (not to say that's what you have).

With, MS lesions show up in some typical locations. Based on the MRI and your symptoms, the neuro should be able to make a pretty good determination, or at least what further tests to do.

Hope this helps.
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Postby photographerKel » Mon Jun 22, 2009 3:43 pm

So, your saying it IS possible, for the damage to have been done, months ago, and just now be having symptoms? Ive had "spells" everyday for over a week. Arm pain that quickly turns into a numb/tingly heavy feeling, literally feels like i have a blood pressure cuff on. Also, only on right side, after this episode, i feel dreamy, i slur words, cognitive functions are strange, lol. this all subsides, except the heavy feeling in arm, and the fatigue afterwards. Im stuttering, i try to say a word and it wont come out. i try to stand up, and i fall, constant neck and right shoulder pain...my doc is saying "in my opinion from your symptoms and the mri, it is ms, but the neuro will confirm it"...i just cant see this being ms, just now getting symptoms, but lesions are not enhanced? none of this makes sense at all. Today I walked my granddaughter (okay i finally said that word, im only 41, and "granddaughter has been hard for me to say hehehe) out in the lake, she is only 2, i picked her up and my arm went completely numb and i lost my balance and fell, this is rediculous.
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Postby photographerKel » Mon Jun 22, 2009 3:45 pm

forgot to add, right arm, after the tingling and heaviness starts, wont rest at my side, its kind of raised at an angle...doc pushes it down, but it pops right back up, kind of comical.
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Postby LoveActually » Tue Jun 23, 2009 7:28 am

I'm new to this as well but it is my understanding that even if a lesion is inactive, you can still suffer symptoms from the damage it has already done. I may be completely off with that statement and if so, I'm sure one of the knowledgable folks here will set it straight.
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Postby cheerleader » Tue Jun 23, 2009 7:49 am

Hi Kel...
Sounds like a crazy time for you...hang in there!

My husband had a lumbar puncture to confirm his MS diagnosis....his 20 lesions were also in the area common for MS, the corpus callosum, and many were enhancing at his first flare...your lesions are in different areas...the fact that none were enhancing could point to a different diagnosis. The radiologists report for my husband said his lesions indicated demyelinating disease (MS)-


Thus it is important to remember that a person who is noted to have white matter lesions on a brain MRI does not necessarily have MS. White matter lesions can be seen in numerous other conditions and they are more commonly seen as we grow older. The thinking behind this is that they represent microvascular ischemic changes in the brain (the smaller caliber blood vessels in the brain showing signs of ischemia or decreased blood flow). Hence these white matter abnormalities on MRI are more commonly seen in patients who have microvascular and macrovascular risk factors such as a history of hypertension, diabetes and high cholesterol (dyslipidemia/ bad lipid profile).

White matter signal changes on MRI may also be seen in patients who have infectious and other inflammatory conditions. They have been reported in the MRI of patients with a history of migraine headaches (migraine too is a vascular disorder and that may explain the connection).

So I want to end by saying that the presence of these white matter signal changes on brain MRI has to be correlated to the history, clinical examination and other ancillary investigations. Your doctor shall help you in going about this in a methodical manner. I repeat these white matter lesions do not suggest MS in each and every case they are found.

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There will be more tests ahead. Try to stay calm, take it a day at a time. There may be another explanation.
cheer
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
http://ccsviinms.blogspot.com
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Postby patientx » Tue Jun 23, 2009 5:11 pm

Kel,

Yes, with MS it is possible for damage to have been done to the white matter and have symptoms show up later. I'm not sure of the exact timing, whether it's month or weeks. With MS, though, lesions will typically only show enhancement for about 6 weeks. After 4 MRIs, none of mine showed contrast enhancement.

But this isn't too say that you have MS. I don't mean to sound critical of your doctor, but he's getting ahead of the game. White matter signal intensities (I really don't like the term lesion) can have many causes and can be many things. As Cheer pointed out, they are frequently seen with vascular conditions in the brain. Or you could have some infection going on. It's just not as simple as looking at the MRI.

Your symptoms are pretty confounding, and must be really scary. When you see the neurologist he will (or at least should) run many other tests, starting with a neurological physical exam. He should do blood tests to check for other things like infections. Then, maybe possibly a lumbar puncture.

Hang in there.
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