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Two questions.. last year's brain MRI
Posted: Sun Oct 15, 2017 4:26 pm
by LisaH
This is a screenshot from the brain MRI that I had in November of 2016. Can anyone tell me based on the numbers on the side if it was a 1.5 or 3t MRI? I can't make sense of the numbers myself. Also... based on images that I've seen of MS lesions... the white area noted in this shot looks like it might possibly be one. Could someone who might have a clue please give me an opinion on this? I'd really appreciate it very much. I'm not confident that it would have been noticed by the person who read my MRI. They were focusing only on the pituitary mass that had been found on my CT scan.
Re: Two questions.. last year's brain MRI
Posted: Sun Oct 15, 2017 8:38 pm
by LisaH
Well... after digging further into the options on my MRI software, I found the answer to one of my questions. The magnetic field strength is 1.5. From what I've read, a 3T and up is best for showing MS lesions. So, it's possible that something was missed on last year's MRI. In July, my MRI was focused only on the pituitary region. My appointment with the movement disorder specialist is this Thursday and I'll be discussing this with her. I want a quality brain MRI and a spine MRI. If I do have MS, I'd like to know. If I don't have it, the MRIs will show that and we can look into other possibilities. My symptoms continue to get worse. My neurologist increased my gabapentin dosage because it wasn't helping with my occipital/trigeminal neuralgia as much. This happens frequently with gabapentin and similar meds so I wasn't surprised. My most troubling symptom now is stiffness and spasms (sometimes painful) in my legs. I feel like I'm walking through thick liquid or pushing against something when I walk. It feels like I'm walking up a steep incline when I'm on a flat surface. This is so strange for me because I've always walked fast and now my legs don't feel like my legs anymore. What makes it even more frustrating is my bladder control issues. It seems to get worse when my legs are especially stiff and spastic. I have a frequent urge to pee and my stiff legs make it harder to get to the bathroom in time. I'm also dropping things more and having tingling and numbness a lot (mostly my feet). I was in the middle of making coffee the other day and suddenly had no idea what to do next. I just stood there for about 10 seconds completely confused. I'm having a very rough night and there's nobody here to ramble to. 
Re: Two questions.. last year's brain MRI
Posted: Sun Oct 15, 2017 9:04 pm
by NHE
Well, the region highlighted by the white square looks like it could be a lesion. What does the radiologist's report have to say about it? Keep in mind though that lesions can have many different causes and that not all of them are due to MS.
Re: Two questions.. last year's brain MRI
Posted: Sun Oct 15, 2017 10:16 pm
by LisaH
The MRI report only described the size of the pituitary/sella cyst and how it compressed my optic chiasm, etc. and then noted my chiari malformtion. I'm not sure the radiologist was really focused on other parts of my brain because the MRI was ordered because the CT scan I had showed the cyst. Also, if it is a lesion, it would be easy to miss. The screenshot I posted was from a flair sequence. The software allows you to change to T1, T2, etc. and the white spot appeared when I changed to T2. Does it seem to be in a place where MS lesions might normally be? I know that's a very important indicator (of MS or something else) when lesions are found.
Re: Two questions.. last year's brain MRI
Posted: Tue Oct 17, 2017 6:08 am
by LisaH
Here's another screenshot (back of the head view) from last year's MRI. Any idea what the three white areas in my neck might be? 
Re: Two questions.. last year's brain MRI
Posted: Tue Oct 17, 2017 7:05 am
by ElliotB
Wouldn't your neurologist and/or radiologist be the best choice for accurate answers to your questions, after all they have years of specialized training...
Re: Two questions.. last year's brain MRI
Posted: Tue Oct 17, 2017 7:11 am
by LisaH
Of course, ElliotB... and I plan to discuss this at my appointment. I was just hoping someone here might offer some insight in the meantime.
Re: Two questions.. last year's brain MRI
Posted: Tue Oct 17, 2017 7:39 am
by ElliotB
As a MRI can often be difficult to interpret, even sometimes by those well trained to do so, being patient until your appointment may be in your best interest. When is your appointment with your doctor?
Re: Two questions.. last year's brain MRI
Posted: Tue Oct 17, 2017 7:44 am
by LisaH
I see another neurologist (movement disorder specialist) on the 19th. I know you're right about being patient but that's easier said than done. Hopefully this doctor will be able to offer answers instead of more questions.
Re: Two questions.. last year's brain MRI
Posted: Tue Oct 17, 2017 8:00 am
by ElliotB
Good luck! Hope you get the answers you are looking for!!!! Please let us know what you find out...
Re: Two questions.. last year's brain MRI
Posted: Tue Oct 17, 2017 2:43 pm
by LisaH
Thank you, ElliotB! 
Re: Two questions.. last year's brain MRI
Posted: Thu Oct 19, 2017 5:42 pm
by LisaH
Well... I'm very discouraged by my visit with the movement disorder specialist today. After many questions about my symptoms, she performed an extensive neurological exam. After each set of tests, she went to her computer to type notes. At one point, she had to leave the room for about 2 minutes to retrieve something and I was able to read bits and pieces of what she'd typed. She noted that I have frank weakness in both my upper and lower extremities and very exaggerated reflexes. There was something about my foot stomp being slow, whatever that means. It was apparently in reference to one test where she had me stomp each foot on the floor while sitting. I'm not sure, but I think she noted that my tandem walk was normal. During that test, I had difficulty getting started and then lost my balance repeatedly because of the stiffness and spasms in my legs. That's considered normal?! I didn't have time to read any other notes. After the exam, she told me that she doesn't really think I have MS because I don't have spasticity and that my exaggerated reflexes might be normal for me. My regular neurologist never did an extensive exam so there was no "baseline" she told me. She also said that the strength in my arms was "variable" and explained that I exhibited more strength on one pull than the previous one, etc. which didn't make sense to me at all. She then told me that she thinks I have a functional movement disorder because of my neurological exam... but "just in case I'm wrong" she said... she wants an MRI with and without contrast of my brain, cervical spine and thoracic spine. It will be on a 3.0T MRI instead of the 1.5T used last year. She went on to say that if I do have MS, it's important to find out to begin treatment. She also said that my symptoms point more toward a possible cervical spine issue but we'll be checking both cervical and thoracic to be thorough and also in case of a syrinx. I was quite shocked at the functional movement disorder suggestion because that seems like a "we don't know" diagnosis to me. If they can't say for sure that it's MS, ALS, or Parkinson's, it must be a functional movement disorder, apparently. She said it's the third most diagnosed movement disorder there and it's just as real and debilitating as other movement disorders. And one more thing... she mentioned several times that stress in my life is most likely the cause for the functional movement disorder or developed because of a "past trauma". Does anyone think this seems strange? Comments, please! 
Re: Two questions.. last year's brain MRI
Posted: Fri Oct 20, 2017 7:24 am
by Snoopy
Hi Lisa,
She said it's the third most diagnosed movement disorder there and it's just as real and debilitating as other movement disorders. And one more thing... she mentioned several times that stress in my life is most likely the cause for the functional movement disorder or developed because of a "past trauma". Does anyone think this seems strange? Comments, please!
Functional Movement Disorder is also known as Functional Neurological Disorder(FND), Conversion Disorder and Psychosomatic. This type of disorder is not caused by a disease process but in the realm of what the Movement Dr. told you. I know someone with this disorder and she has struggled for many years to improve her quality of life through different types of Therapy. Many with this disorder spend hundreds of thousands of dollars going from DR. to Dr. and test after test in the belief there is some other cause than a Conversion Disorder. I can imagine it is quite difficult to accept a diagnosis such as Functional Movement Disorder.
Information about Functional Movement Disorder:
http://www.neurosymptoms.org/movement-d ... 4533053142
Best wishes...
Re: Two questions.. last year's brain MRI
Posted: Fri Oct 20, 2017 11:09 am
by LisaH
Snoopy... did you read the rest of my post? She wasn't even sure about the diagnosis herself and wants to have imaging done (on a stronger MRI) to make sure. They called me today and my MRIs (MS Protocol for brain) are scheduled for November 4th. She even told me that potential findings would likely be in the cervical spine based on my symptoms. If my symptoms aren't "real" then how would imaging show a possible correlation? There was obvious weakness in my arms and legs and other signs on the exam that something is wrong. I'm not in denial about her suggestion of a "functional movement disorder". I just simply think it's a lazy fallback diagnosis for patients who don't fit neatly into the MS or Parkinson's diagnosis. The fact that it's the third most commonly diagnosed disorder at their movement disorder center is very telling. What are the odds that every new patient there without obvious MS or Parkinson's has a "conversion disorder"? That's a lot of past trauma coming out as physical symptoms. No two people present in exactly the same way with any illness, so it seems unfair to jump to such a diagnosis that quickly. Assuming she's right and I do have a possible functional movement disorder... wouldn't it have made more sense to find out what the MRIs show (or don't show) before having such a discussion?
Re: Two questions.. last year's brain MRI
Posted: Fri Oct 20, 2017 1:37 pm
by Snoopy
I read your entire post. I was giving an explanation and link to the possibility of a Functional Movement Disorder diagnosis. I am not suggesting that is what you have only your Dr. can determine what is wrong.
She even told me that potential findings would likely be in the cervical spine based on my symptoms. If my symptoms aren't "real" then how would imaging show a possible correlation?
You won't know if there is a correlation until after the spine MRI.
The fact that it's the third most commonly diagnosed disorder at their movement disorder center is very telling. What are the odds that every new patient there without obvious MS or Parkinson's has a "conversion disorder"?
Recent information has shown an increase in misdiagnosis of MS. One of the conditions that was misdiagnosed as MS was Conversion Disorder. It really isn't surprising your Drs. Office sees that many of conversion disorder cases.
From the link I posted previously
http://www.neurosymptoms.org/symptoms/4533052092:
A functional movement disorder means that there is abnormal movement or positioning of part of the body due to the nervous system not working properly (but not due to an underlying neurological disease).