Posting for my wife, MRI report 'May be MS'

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Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Fri Mar 02, 2018 7:19 am

So, long story short, my wife went in to get an MRI on her shoulder because she couldn't raise her arm (very well anyway) out in front of her. She went for an MRI.

Some of the notes on the shoulder:
*possible small tear or strain/inflammation of the teres minor (one of the rotator cuff muscles)

But, they also did a cervical MRI (neck) and noticed the following:
*some abnormality of the signal in the spinal cord (demyelinating areas), "may be MS" it said

They were also pointing out an area where the spinal cord fluid channel on one side of the spinal cord seemed a little pinched, or narrower than the rest. The doc said usually they'd see a bulging disc with it, but her disc was fine. Could that disc have recently healed but is still swollen/inflamed, pushing on the cord and causing the signal abnormalities?

Not really sure what to think since the teres minor (if she had a small tear) could explain not being able to raise her arm (she can't pass the "elbow to the side, someone pushing your arm in towards your belly" test either, a standard rotator cuff test. And, she really doesn't have any symptoms of MS at all. She is energetic, fit (does crossfit), no depression, etc. She does deal with migraines and seems to have hypnagogic jerks every night when she falls asleep, but other than that, really no standard MS symptoms.

She is being referred to a neurologist and will be getting more imaging done (brain, etc.)

Any thoughts? I have a couple pictures of her MRI but not sure if I'm allowed to post those here? Is there anything else that it could be besides MS?

Thank you so much!
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Re: Posting for my wife, MRI report 'May be MS'

Postby jimmylegs » Fri Mar 02, 2018 8:42 am

short answer yes it could be something else, and they'll need to run more tests before any further certainty is achieved.

the oldest nutritional differential dx is vit b12 status. the 'normal' range is poorly defined so 'normal' levels are worth looking at askance. high normal is better, but no need to take it to extremes. having your own copy of all such test results allows you to be the judge re whether any given test result is satisfactory or not.

there are a few other ways to ensure that the SO's nutritional status matches healthy controls and not the nutriitonal profile of a standard ms patient. vit d3 level is the only other mainstream one at this time.

if migraines are in the mix it could be worth looking more broadly at degree of adherence to all public health recommendations in case there are any gaps worth addressing. that aspect is not part of the mainstream ms dx process.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Fri Mar 02, 2018 8:53 am

jimmylegs wrote:short answer yes it could be something else, and they'll need to run more tests before any further certainty is achieved.

the oldest nutritional differential dx is vit b12 status. the 'normal' range is poorly defined so 'normal' levels are worth looking at askance. high normal is better, but no need to take it to extremes. having your own copy of all such test results allows you to be the judge re whether any given test result is satisfactory or not.

there are a few other ways to ensure that the SO's nutritional status matches healthy controls and not the nutriitonal profile of a standard ms patient. vit d3 level is the only other mainstream one at this time.

if migraines are in the mix it could be worth looking more broadly at degree of adherence to all public health recommendations in case there are any gaps worth addressing. that aspect is not part of the mainstream ms dx process.



Thanks for the reply. What other things could cause abnormal spinal cord signal and a narrow (at a single point) spinal fluid channel?
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Re: Posting for my wife, MRI report 'May be MS'

Postby jimmylegs » Fri Mar 02, 2018 9:30 am

re abnormal spinal cord signal, ie demyelination, b12 would be the go to alternate explanation as posted above.

no comment re narrow spinal fluid channel and ms; i don't see language from your docs making that specific connection so far.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Fri Mar 02, 2018 9:43 am

jimmylegs wrote:re abnormal spinal cord signal, ie demyelination, b12 would be the go to alternate explanation as posted above.

no comment re narrow spinal fluid channel and ms; i don't see language from your docs making that specific connection so far.



Would it help if I posted a couple shots of the MRI? Am I allowed to, legally, etc.?
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Re: Posting for my wife, MRI report 'May be MS'

Postby jimmylegs » Fri Mar 02, 2018 9:53 am

not sure re helping, not being an mri tech. others may chime in.

no restrictions re posting - it can be a bit of a pain though. you need to post it somewhere of your choosing online, make sure the image dimensions are reasonable, then link to the image(s) url in a post here.
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Fri Mar 02, 2018 11:53 am

jimmylegs wrote:not sure re helping, not being an mri tech. others may chime in.

no restrictions re posting - it can be a bit of a pain though. you need to post it somewhere of your choosing online, make sure the image dimensions are reasonable, then link to the image(s) url in a post here.


https://photos.app.goo.gl/12xgcfgQxTWQGCQB3

https://photos.app.goo.gl/gg60ugS1jKHv7C5x1

Here they are. The one with the mouse pointer is just trying to point out where the spinal fluid channel is "pinched", or narrower.
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Re: Posting for my wife, MRI report 'May be MS'

Postby Scott1 » Fri Mar 02, 2018 1:06 pm

Hi,

Even a neurologist will seek a professional technicians report on an MRI scan so I don't think our interpretations are something you should trust. When I have an MRI the machine produces many images and we really only get to see them at one level. They can zoom in, measure the size of the change, determine if the tissue is necrotic or whether cavitation is evident. Usually the neurologist looks at a range of symptoms plus the MRI interpretation to make the call that it is MS. It is stepping way over the mark if a technician looking at a picture makes that call. The best they should do is say something like "consistent with primary demyelination".

The shoulder isn't likely to be MS related based on what you've said. If they say they can fix it by shaving a a tiny bit off the bone then try hydrodilation first as it sounds like a standard frozen shoulder. An injection of water into the joint to expand the gap and a bit of gentle massage and manipulation a week later works wonders.

Regards,
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Re: Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Fri Mar 02, 2018 1:16 pm

Scott1 wrote:Hi,

Even a neurologist will seek a professional technicians report on an MRI scan so I don't think our interpretations are something you should trust. When I have an MRI the machine produces many images and we really only get to see them at one level. They can zoom in, measure the size of the change, determine if the tissue is necrotic or whether cavitation is evident. Usually the neurologist looks at a range of symptoms plus the MRI interpretation to make the call that it is MS. It is stepping way over the mark if a technician looking at a picture makes that call. The best they should do is say something like "consistent with primary demyelination".

The shoulder isn't likely to be MS related based on what you've said. If they say they can fix it by shaving a a tiny bit off the bone then try hydrodilation first as it sounds like a standard frozen shoulder. An injection of water into the joint to expand the gap and a bit of gentle massage and manipulation a week later works wonders.

Regards,


Thanks. The shoulder MRI did say "increased activity in the teres minor (muscle of rotator cuff), possibly indicating a small tear or inflammation"...nothing about the joint/bone. Overall, it didn't say there WAS anything wrong, but obviously something is since she can't raise her arm out in front of her, or pass the test where someone pushes her arm to her belly (she can't resist the force). All other movements of the shoulder are pretty normal.

I'm not sure who exactly wrote on the report "may be MS" but it certainly wasn't a neurologist. Like I said, if it wasn't for the shoulder issue, we wouldn't even be talking about possible MS because she has no symptoms (besides the shoulder, but I don't think it's related). I think if she has MS, we discovered it by accident via her shoulder issue.
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Re: Posting for my wife, MRI report 'May be MS'

Postby jimmylegs » Fri Mar 02, 2018 3:20 pm

research doesnt seem to be making the connection either
https://scholar.google.ca/scholar?hl=en ... wing&btnG=

saw one connection out in the main interweb about a person who thought his spinal canal narrowing could follow on from his ms. far from conclusive. good old correlation vs causation.

more re demyelination (b12 is still the first go to if working to exclude ms however)

Iron and copper in progressive demyelination--New lessons from Skogholt's disease.
https://www.ncbi.nlm.nih.gov/pubmed/25563774

CNS demyelination associated with copper deficiency and hyperzincemia.
https://www.ncbi.nlm.nih.gov/pubmed/12427906

Copper Deficiency Myeloneuropathy Resembling B12 Deficiency: Partial Resolution of MR Imaging Findings with Copper Supplementation
http://www.ajnr.org/content/27/10/2112
odd sx? no dx? check w/ dietitian
DRI=MINIMUM eg bit.ly/1vgQclQ
99% don't meet these. meds/lifestyle can affect levels
status can be low in ms & other cond'ns
'but my results are normal'. typical panels don't test all
deficits occur in 'normal' range
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Re: Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Fri Mar 02, 2018 3:32 pm

jimmylegs wrote:research doesnt seem to be making the connection either
https://scholar.google.ca/scholar?hl=en ... wing&btnG=

saw one connection out in the main interweb about a person who thought his spinal canal narrowing could follow on from his ms. far from conclusive. good old correlation vs causation.

more re demyelination (b12 is still the first go to if working to exclude ms however)

Iron and copper in progressive demyelination--New lessons from Skogholt's disease.
https://www.ncbi.nlm.nih.gov/pubmed/25563774

CNS demyelination associated with copper deficiency and hyperzincemia.
https://www.ncbi.nlm.nih.gov/pubmed/12427906

Copper Deficiency Myeloneuropathy Resembling B12 Deficiency: Partial Resolution of MR Imaging Findings with Copper Supplementation
http://www.ajnr.org/content/27/10/2112


Thanks very much!
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Re: Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Fri Mar 02, 2018 5:33 pm

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Re: Posting for my wife, MRI report 'May be MS'

Postby NHE » Fri Mar 02, 2018 11:27 pm

Jimmylegs is correct. A B12 deficiency is the primary suspect in cervical spinal cord demyelination. The condition is called subacute combined degeneration. I recommend that your wife get her B12 levels checked as soon as possible. A full B12 analysis includes homocysteine, red blood cell (RBC) folate and methylmalonic acid (MMA) in addition to B12. Homocysteine and MMA are two biomarkers which indicate how well the body is processing B12. Homocysteine is a cardiotoxic amino acid that builds up when either B12, folate or B6 is low. It can cause everything from high blood pressure and irregular heartbeat to an increased risk for heart attack and stroke. Elevated levels of MMA are thought to be more specific to B12 deficiency, but can still produce false negatives, i.e., low MMA in the presence of low B12, especially if a person has recently been on antibiotics. Low folate can elicit a B12 deficiency over time as methylfolate is used to recycle spent B12 back to the active methylated form. I suggest getting RBC folate tested rather than serum folate since it provides a better picture of long term folate status and is less sensitive to fluctuations from dietary folate intake. Lastly, the lower end of most laboratory ranges for B12 are much too low and actually represent a deficiency. Some go as low as 180 pg/mL. However, I was deficient at 247 pg/mL. A good range to be in for B12 is 500-1000 pg/mL.

For further information on B12, you may be interested in reading the following topic.
natural-approach-f27/topic24857.html
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Re: Posting for my wife, MRI report 'May be MS'

Postby NHE » Sat Mar 03, 2018 12:12 am

nwolfe88 wrote:https://photos.app.goo.gl/12xgcfgQxTWQGCQB3

https://photos.app.goo.gl/gg60ugS1jKHv7C5x1

Here they are. The one with the mouse pointer is just trying to point out where the spinal fluid channel is "pinched", or narrower.

I'm not sure why the contrast seems blown out in the lower half of the images. It makes it difficult to see what's going on in the second linked image.

Compare your images to images of subacute combined degeneration (SCD) on the Radiopaedia site especially Case 2 Sagittal T2 and Case 4 STIR.

https://radiopaedia.org/articles/subacute-combined-degeneration-of-the-cord-1

SCD tends to produce broad regions (depending on severity) of hyperintense signal indicating demyelination. Compare to the MS image on the page which tends to show more punctate lesions.
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Re: Posting for my wife, MRI report 'May be MS'

Postby nwolfe88 » Sat Mar 03, 2018 4:23 pm

NHE wrote:
nwolfe88 wrote:https://photos.app.goo.gl/12xgcfgQxTWQGCQB3

https://photos.app.goo.gl/gg60ugS1jKHv7C5x1

Here they are. The one with the mouse pointer is just trying to point out where the spinal fluid channel is "pinched", or narrower.

I'm not sure why the contrast seems blown out in the lower half of the images. It makes it difficult to see what's going on in the second linked image.

Compare your images to images of subacute combined degeneration (SCD) on the Radiopaedia site especially Case 2 Sagittal T2 and Case 4 STIR.

https://radiopaedia.org/articles/subacute-combined-degeneration-of-the-cord-1

SCD tends to produce broad regions (depending on severity) of hyperintense signal indicating demyelination. Compare to the MS image on the page which tends to show more punctate lesions.


Thanks a lot. They are phone pics of the MRI on my computer so the exposure is probably messed up.

Her daily multi has 1,667% of daily dose of b12...could she still be deficient?

So this wouldn't be related to her not being able to raise her arm? She can barely hold a bottle of water at face level with her elbow at her side. The MRI didn't show any tear (definitively) so this confuses me. She said it has been hurting for a month or two and then one day, after working out, that night she said everything just tightened up and it's been that way since.
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