spots

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spots

Postby reneelucia » Tue Jun 23, 2009 10:08 am

The neurologists can see spots on the brain and spinal chord after an mri. Can they predict what part of the body will be affected depending on the location of the spots? Why or why not?
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Postby lyndacarol » Tue Jun 23, 2009 4:48 pm

You asked a good question:
Can they predict what part of the body will be affected depending on the location of the spots?


The accepted science seems to say there is a correlation between lesions in the brain, their location and symptoms that we experience. But because there are people with MS symptoms and disease diagnosis who have NO lesions, I am not sure there is any connection between lesions and symptoms at all.

Fortunately, at this website we are allowed to hold unconventional ideas without repercussions.
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Postby Lyon » Tue Jun 23, 2009 6:17 pm

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Last edited by Lyon on Wed Jun 22, 2011 2:35 pm, edited 2 times in total.
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Postby robbie » Tue Jun 23, 2009 7:02 pm

Say with optic neuritis I think the area of the brain for that is at the back above the brain stem, so for you to get ON there must be some inflammation in that area but there may not be a lesion.

Holy shit that’s the smartest thing I’ve ever written. :lol:
Had ms for over 19 years now.
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Postby Lyon » Tue Jun 23, 2009 7:22 pm

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Postby reneelucia » Tue Jun 23, 2009 8:50 pm

I have lesions but the neurologists never match the lesions with the symptoms. I just developed a new lesion but the doc says its small. I asked if that was the reason for the new symptoms...answer maybe.
Sounds like the mris are just used to make the initial diagnosis but after that, it is the clinical course this disease that is important. Is that right? How often do people get brain/spine mris? I had a series last year when first diagnosed, then this year. In my case my symptoms have worsened severely but the mri says I only have on small new lesion. Why the difference between worsening symptoms but a relatively good mri? What are the neurologists concerned about, mri's or symptoms?
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looks like I found an answer on line

Postby reneelucia » Tue Jun 23, 2009 9:02 pm

Lesions vs. Symptoms


IS THERE A LESION FOR EVERY SYMPTOM?

It seems that one of the most difficult questions on the forum is "What relationship there is between lesions actually seen on the MRI's and the symptoms that one has?" Can you reliably see a lesion for every symptom? Is there a symptom or can you find an abnormality on the physical exam for every lesion that is seen? The answer is an unqualified, "NO." Too many doctors, neurologists and people try to draw conclusions about this. It may be one of the greatest pitfalls in using MRIs to diagnose Multiple Sclerosis.

THE BRAIN

First, lets talk about the BRAIN. Remember that about 90% or so of our brains are "unused." That means that we don't know what those areas do when they are healthy or might do if they are damaged. ALL of the scientific articles are clear that the majority of MS lesions in the brain are not "eloquent", that is, they don't "speak up" with actions or sensations in the body. The same is true that those areas don't show symptoms if they are damaged. No good MS Specialist is going to try to map all the lesions with the symptoms that are showing up in the patient. It is almost impossible and it is a waste of time. It is well documented that some people with many, severe symptoms may have very few visible lesions. And some people who are diagnosed when they have just one symptom may have a whole brain full of lesions on their first MRI which had never before "spoken up."

Many lesions in MS are still invisible. All good MS doc's will tell you that they believe that many brain lesions are still invisible to the MRI. The National MS Society site states that 5% of people with MS have "normal" MRIs. If they are invisible, then of course they can't be used to diagnose MS. But, also a negative MRI does not completely rule out MS in a person with a history and physical findings that suggest the disease. My own MS Neurologist say something very interesting when I developed severe facial pain. In MS this would be caused by a lesion in a specific place. He looked at my newest MRI and said,"Well, I don't see a lesion that's causing your face pain. That's good! You don't want a big lesion in your brainstem!" By saying this he was indicating two things. The first is that he knew I had a lesion, but it was invisible. The second was that he believed me when I said I had pain, even though there was no proof on the MRI.

Now, some lesions can be big enough and in known active areas so that we can recognize that those lesions are causing a specific symptom. But this is the exception, not the rule.

MS "tends" to cause lesions within a characteristic pattern in the brain. But this just means that, when you look at a large number of people with MS and plot all of their lesions, the majority of lesions will fall into this pattern. This pattern is generally symmetrical side to side, but not a perfect mirror-image. Any one person or any person with just a few lesions may have them occur in any white matter location. . Even people with a "characteristic pattern of lesions" will have some that don't fall into the perfect "zones." Please reread those last two sentences.

The more the lesions follow the common pattern, the easier the job of the neurologist, and the easier the diagnosis. It's those people with suggestive symptoms and suggestive abnormalities on physical exam but WHO HAVE NO LESIONS, VERY FEW LESIONS, OR LESIONS IN LESS USUAL PLACES that will have a tougher time with the diagnosis (if they have MS). Too many people are told that their lesions "aren't in the right place so they don't have MS." Or they are told that they don't have enough lesions, so they do not have MS." In reality they shouldn't have been told they don't possibly have MS. They should be told that the MRI is inconclusive. In this case the neurologist, if he suspected MS before the MRI, should continue to suspect it after the MRI and do more extensive testing. Also, plans should be made to repeat the neuro exam and the MRI at intervals like every 6 months or at some interval or if the patient develops more symptoms.


The point to take home: Most lesions seen in the MRI of the brain do not correlate well with the problems the patient has. A good doctor will not try to tell you different. And you shouldn't spin your wheels trying to look up mapping of the brain - unless that is something you would do anyway for giggles.


THE BRAINSTEM AND SPINE

The nerves in the brainstem and spine are all "eloquent" to some extent. They drive the functions and the movement of the body and they relay information like sensations from the body back to the brain. A small area of damaged myelin in the spine is "more likely" to cause a direct symptom or problem. Spinal lesions are a little less common than brain lesions, but more directly connected (in an obvious way) to our disease. But, also many spinal lesions are still invisible. One of the reasons for them being invisible is that they are harder to get good clear MRI images on. This appears to be one of the strengths of the newer generation of MRI machines. They have a higher magnet strength and because of this they have a higher resolution. They can see smaller lesions. The strongest MRI machines currently in clinical use today use a 3 Tesla magnet. Tesla is the "unit of measurement" of magnets, like "amps" is the unit of measurement of an amplifier. Older MRI machines, which are by far the most common in use, may use a magnet that is 1.5Tesla or weaker. Much stronger magnet MRI machines are being developed, but currently are used only in research.

Lesions in the brainstem and spine are stronger evidence for the presence of MS than are lesions in the brain. This is because there are many disorders that cause brain lesions, but many fewer that cause lesions in the spinal cord or the brainstem. And even though there tends to be a better correlation between symptoms or abnormal physical findings and lesions here, it is still often hard to draw connections between all of them.



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Re: spots

Postby NHE » Tue Jun 23, 2009 10:27 pm

Optic neuritis is inflammation of the optic nerve which also affects the retina. http://www.mult-sclerosis.org/opticneuritis.html

When I was diagnosed, the doctor could see the inflammation just by looking into my eye, no MRI was needed.

Here's a nice page which links possible symptoms with the various cranial nerves. http://www.mult-sclerosis.org/cranialnerves.html

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Re: looks like I found an answer on line

Postby Thomas » Wed Jun 24, 2009 7:02 am

Lesions vs. Symptoms
Remember that about 90% or so of our brains are "unused."


This is wrong. From "Neuroscience for kids":

"We use only 10% of our brains" is false; it's a myth. We use all of our brain.

http://faculty.washington.edu/chudler/tenper.html
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Postby daniel » Wed Jun 24, 2009 11:13 am

My first few MRIs were done mostly of my head and upper spine. There were about a dozen lesions in my head and none on my spine.

Since most of my symptoms had to do with numbness/tightness below the wait, my new neuro ordered another MRI of my whole spine which did show lesions there.
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Postby robbie » Wed Jun 24, 2009 12:04 pm

Is clonus caused by inflammation or a lesion in a certain area?
Last edited by robbie on Wed Jun 24, 2009 12:38 pm, edited 1 time in total.
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Postby Lyon » Wed Jun 24, 2009 12:14 pm

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Postby robbie » Wed Jun 24, 2009 12:37 pm

That’s what I meant (clonus) so they don’t know about location of lesions causing certain symptoms either. I always thought that’s what makes all our symptoms so different depending on where the lesions settled in.
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Postby Lyon » Wed Jun 24, 2009 1:02 pm

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Request of reneelucia

Postby lyndacarol » Wed Jun 24, 2009 5:20 pm

Renée-- Your quotation entitled
Lesions vs. Symptoms


IS THERE A LESION FOR EVERY SYMPTOM?
summed up EXACTLY the idea I was trying to express. Would you edit that post to include the source of that quote or put it in a separate post in this thread? I would like to know where you found it.
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