MRI results - can you help?

[ebrownkirkland]

Hi. I have a question about my MRI results that I'm hoping someone can help me to make sense of. My neurologist had me go in to "assess for demyelinating disease" (the MRI report said "Evaluate for multiple sclerosis"). Here are the findings of the MRI:

COMPARISON: Outside MRI on 10/11/16
FINDINGS: MRI examination of the brain was performed both prior to and after administration of intravenous contrast material. Intravenous Gadavist
9 cc was utilized.

Scattered white matter lesions are present. One of these is new or has increased in size compared to the prior study. It is immediately adjacent to the right lateral ventricular atrium. It measures a maximal 8-9 mm in size. There is no diffusion restriction, but the lesion mildly enhances on post-contrast imaging.

Other lesions are stable. Occasional subcortical right frontal lobe lesions are noted, each measuring about 2 mm in size. There is a 3 mm lesion in the lateral right frontal lobe. There are similar small lesions in the lateral left frontal lobe. No large tumefactive or worrisome confluent lesion is present.

There are no abnormal fluid collections. There are no masses. There is no mass effect or midline shift. The ventricles are normal in size, shape, and configuration. Diffusion-weighted imaging is unremarkable. There is no evidence of acute infarction. The intracranial flow voids are grossly normal. The gray-white matter junctions are unremarkable. Clival and calvarial marrow signal is normal.

IMPRESSION:
1. There is an 8-9 mm lesion in the right periatrial white matter, new or increased in size from the prior study. It enhances on post contrast imaging.
2. Other lesions are stable

Just hoping someone can tell me what all this means. I have been monitored by a neurologist off and on since 2011, but in 2011 when I was sent for a lumbar puncture, it came back normal, so I went for a long period of time ignoring other symptoms until October of 2016 when the thumb on my left hand went completely numb. Since then I've had other odd symptoms, including numbness/tingling in one side of my face (that's how all of this began back in 2011), and, more recently, numbness and tingling in my shins and all down the outside of my left leg to my ankle. I thought it was my lumbar spine that was causing all the issues but my neurologist only sent me for an MRI of my brain and c-spine (c-spine MRI was pretty much normal except for some bulging discs) because he is thinking it is MS. I do have low B12 but am being treated for that and am now in the normal range. The neurologist said low B12 would not cause the issues I am experiencing. I am a 39-year-old female.

Thanks in advance for your help. Sorry for the long message.

[NHE]

Hi. I have a question about my MRI results that I'm hoping someone can help me to make sense of. My neurologist had me go in to "assess for demyelinating disease" (the MRI report said "Evaluate for multiple sclerosis"). Here are the findings of the MRI:

----------------------------------------------

IMPRESSION:
1. There is an 8-9 mm lesion in the right periatrial white matter, new or increased in size from the prior study. It enhances on post contrast imaging.
2. Other lesions are stable

Just hoping someone can tell me what all this means.

You have a new lesion that wasn't seen on your last MRI. It enhances with gadolinium contrast meaning that it's a site of active inflammation. Note that gadolinium can cross the blood brain barrier at sites of active inflammation since the immune cells have made the blood brain barrier leaky at that location.

I have been monitored by a neurologist off and on since 2011, but in 2011 when I was sent for a lumbar puncture, it came back normal, so I went for a long period of time ignoring other symptoms until October of 2016 when the thumb on my left hand went completely numb. Since then I've had other odd symptoms, including numbness/tingling in one side of my face (that's how all of this began back in 2011), and, more recently, numbness and tingling in my shins and all down the outside of my left leg to my ankle. I thought it was my lumbar spine that was causing all the issues but my neurologist only sent me for an MRI of my brain and c-spine (c-spine MRI was pretty much normal except for some bulging discs) because he is thinking it is MS. I do have low B12 but am being treated for that and am now in the normal range. The neurologist said low B12 would not cause the issues I am experiencing. I am a 39-year-old female.

Thanks in advance for your help. Sorry for the long message.

B12 deficiency can cause white matter lesions, even periventricular lesions which are thought to be classic for MS.

Plasma vitamin B12 status and cerebral white-matter lesions.
http://www.thisisms.com/forum/natural-a ... ml#p226718

See also ...

Total homocysteine is associated with white matter hyperintensity volume: the Northern Manhattan Study.
http://www.thisisms.com/forum/natural-a ... ml#p226998

Raising B12 levels after a period of deficiency severe enough to cause neurological damage does not immediately repair the damage, though it should slow and/or possibly inhibit new areas of neurological damage from occurring. Neurological damage takes time to heal. More often than not, B12 deficiency induced neurological damage does not heal completely unless the deficiency is caught at an early stage.

Potential outcome factors in subacute combined degeneration: review of observational studies.
https://www.ncbi.nlm.nih.gov/pubmed/16970556

[ebrownkirkland]

Thanks, NHE. I have read that B12 deficiency can cause white matter lesions (though I didn't know it could cause periventricular lesions which are thought to be classic for MS). But can the lesions that low B12 can cause show up as enhancing with contrast?

[ebrownkirkland]

I was finally able to find what my first MRI report that I had back in November 2010 said. The MRI found "two nonspecific punctate foci of elevated T2 and FLAIR signal...within the subcortical white matter of the parietal regions bilaterally." The radiologist further indicated, "Nonspecific punctate foci of elevated T2 and FLAIR signal within the subcortical white matter of the parietal regions, one site on the left and a second on the right which may represent changes secondary to demyelination, vasculitis, chronic small vessel ischemic changes or another nonspecific underlying inflammatory or infections process."