Need help interpreting an MRI report

[mallymaven]

Hi! I’m a 45 year old female who has had perplexing symptoms for approximately 20 years. Starting with having passing out episodes that Dr’s could not figure out the cause of for years. These passing out spells look like seizures to medical professionals who have seen me have them, and I have suffered approximately 10 concussions with no brain bleeds. Then about 20 years ago, I woke up one day with an elevated heart rate. It was diagnosed as a normal sinus rhythm of someone jogging, of course I was at rest, so they just called it inappropriate sinus tachycardia. Then I’ve had severe migraines, approx 25-28 days per month which have been helped by Botox for migraines every 3 months, severe fatigue. Since last summer, I have had strange things going on. My memory is horrible. I mean I can lose the same ink pen 4-5 times in the same hour. I can’t remember the names of some people I work etc. i forget the name of common objects. I can describe them but don’t know the name. I have suffered with severe back and neck pain for years. I have been through just about every blood test you can imagine and everything is normal. My B 12 is actually very high and so is my vitamin D. I have never once thought of MS nor has any dr ever mentioned it to me. I asked my pcp for an MRI because I started have scary depression, extreme anxiety, mood swings that changed literally about every 15-30 minutes. I would cry for no reason. And I was extremely irritable. My head also felt like what you think it would feel like if you were a snow globe and someone shook it. I wasn’t dizzy or lightheaded really, but it just felt weird like the snow globe description. In January of this year, I had to take 5 weeks off from work without pay it was so debilitating. I got the brain mri with and without contrast and this is what it says:

TECHNIQUE: Multiplanar, multi-sequential MRI of the brain was acquired before and after the intravenous administration of 17 cc of ProHance contrast.

COMPARISON: CTA of the head with and without contrast. (I had this done 2 years ago to look for aneurysms)

FINDINGS:

The ventricles, basal cisterns and sulcal pattern are slightly prominent consistent with parenchymal volume loss. There are scattered punctate foci of T2 and FLAIR hyperintensities in the periventricular and subcortical white matter which are nonspecific and without mass effect and may represent areas of demyelination, chronic small vessel ischemic changes or gliosis in a patient of this stated age. There is no acute mass effect, midline shift or hemorrhage. No extra axial fluid collections are identified.

There are no acute infarcts on diffusion weighted images. Expected signal flow voids are noted in the major intracranial vessels consistent with their patency.

Globes and orbits are grossly within normal limits. Signal abnormality is noted in the bilateral frontal, ethmoid and sphenoid sinuses consistent with mucosal thickening and/or inflammatory changes. Air-fluid levels on the right greater than left sphenoid sinus suggestive of acute sinusitis. The paranasal sinuses and bilateral mastoid complexes are within normal limits.

There is no bone marrow signal abnormality. The sella is unremarkable.


IMPRESSION:

1. Mild periventricular and subcortical white matter T2 and FLAIR hyperintensities which may represent areas of demyelination, chronic small vessel ischemic changes or gliosis. Clinical correlation is suggested.

2. Bilateral frontal, ethmoid and the sphenoid sinus disease as described above.

3. No acute infarcts, intracranial hemorrhage or abnormal enhancing masses or lesions.

I realize no one here can diagnose me with anything, but does anyone see anything in my mri that is indicative of MS? I asked my pcp to refer me to a university hospital neurology department, and when I called to see what my appt status was, they said it had been reviewed by their neurology department and sent to their MS Specialist for review. They said once she reviewed it, if she thought they could help me, I would get an appointment and if not, I wouldn’t. I was STUNNED. This is the first time I had heard the word MS in over 20 years of trying to find out what is wrong with me. I also have suffered with interstitial cystitis for 3 years. I now have times where my fingers tremor or move involuntarily as well as my legs. It feels sort of like when your knee is hit by that instrument the dr uses to look at your reflex. That has been going on for about a year.1 month ago my right leg started aching like a toothache and the front and side of my thigh are numb. Any ideas or insight anyone can give me I would greatly appreciate. Thank you!

[NHE]

Hi Mallymaven,
Welcome to ThisIsMS.

FINDINGS: The ventricles, basal cisterns and sulcal pattern are slightly prominent consistent with
parenchymal volume loss.

You have some noticeable brain atrophy. This could be simply due to age or might be related to an underlying cause. One common cause of brain atrophy is sleep apnea. Another is poor cerebral blood circulation. Do you sleep well? Have you ever been checked for sleep apnea?

There are scattered punctate foci of T2 and FLAIR hyperintensities in the periventricular and subcortical white matter which are nonspecific and without mass effect and may represent areas of demyelination, chronic small vessel ischemic changes or gliosis in a patient of this stated age.

You have some brain lesions that may or may not be consistent with MS. Periventricular lesions are fairly common in MS. "Ischemic changes" refers to a loss of oxygen, or hypoxia. This might be consistent with sleep apnea or may have some other cause.

Globes and orbits are grossly within normal limits. Signal abnormality is noted in the bilateral frontal, ethmoid and sphenoid sinuses consistent with mucosal thickening and/or inflammatory changes. Air-fluid levels on the right greater than left sphenoid sinus suggestive of acute sinusitis. The paranasal sinuses and bilateral mastoid complexes are within normal limits.

This may be related to a long standing sinus infection. Are you aware of having sinus problems? If so, then using a sinus rinse such as the NeilMed with distilled water and sterile saline may be helpful. When I have sinus problems, I usually get pain in my face or upper jaw. Using the sinus rinse nips it in the bud and prevents a full blown sinus infection that would otherwise require antibiotics.

http://shop.neilmed.com/Products/Sinus- ... egular-Kit

Note: I'm not a doctor. You should be checked out by someone who is.

[mallymaven]

Thank you so much for reading all of that and for taking the time to reply! I really appreciate it. I’ve been tested for sleep apnea twice. The most recent was before I had a bariatric surgery which would have been about 4 years ago.