Interpret MRI

[jocelynrenee]

Hello! Can anyone help me interpret my MRI results?

Background: I am a 30 year old white female from Pacific Northwest. Last year I was diagnosed with Trigeminal Neuralgia. Blood tests confirmed no Lyme Disease. Now following up with MRI to rule out MS. Reviewing symptoms of MS, I have noticed several that I have that are mild - moderate impact on my life that I had never correlated together, including intermittent trouble emptying bladder, ocular aching eye pain with eye movement for days at a time, pins and needles sensation in lower back, and fairly extreme fatigue.

MRI Impression: Multiple foci of high signal seen on FLAIR and T2-weighted sequences within the subcortical white matter, best appreciated on the high-resolution sagittal FLAIR sequences. Etiology for the aforementioned finding is uncertain. Differential diagnosis includes foci of demyelination. Follow-up MRI in 6 months may be helpful for further evaluation.

**Findings: 3 mm focus of high signal seen on FLAIR and T2-weighted sequences within the subcortical white matter of the high right frontal lobe. Multiple smaller, subtle foci of high signal seen on FLAIR and T2-weighted sequences within the subcortical white matter, best appreciated on the high-resolution sagittal FLAIR sequences. No evidence of abnormal high signal within the corpus callosum. No evidence of abnormal low signal intensity or high signal intensity lesions within the cerebellum, brainstem, or extra-axial structures.

I also had a full vitamin/WBC/etc. blood test set done in anticipation of appointment with neurologist. Nothing off at all, WBC count was slightly high, but I was just getting over a sinus infection when I had it done.

I have an appointment with a Neurologist next month to follow up, but in the mean time I am really wondering what this all means. My doctor gave me the news when I only had 5 minutes to talk.

[jimmylegs]

hi j and welcome

sry i'm no mri tech but do have questions - from the bloodwork done can you share levels for any of: serum vit b12, vit d3, serum magnesium, serum zinc, serum copper and/or serum uric acid?

[lyndacarol]

Background: I am a 30 year old white female from Pacific Northwest. Last year I was diagnosed with Trigeminal Neuralgia. Blood tests confirmed no Lyme Disease. Now following up with MRI to rule out MS. Reviewing symptoms of MS, I have noticed several that I have that are mild - moderate impact on my life that I had never correlated together, including intermittent trouble emptying bladder, ocular aching eye pain with eye movement for days at a time, pins and needles sensation in lower back, and fairly extreme fatigue.

............................

I also had a full vitamin/WBC/etc. blood test set done in anticipation of appointment with neurologist. Nothing off at all, WBC count was slightly high, but I was just getting over a sinus infection when I had it done.

Since you are "from Pacific Northwest," you have a high risk of vitamin D deficiency. What was the test result number for the vitamin D blood test ("25-hydroxy D") when your "full vitamin blood test set" was done?

Dr. Robert Heaney Speaks on Vitamin D in Calgary on September 19, 2012 (115 min.)


@1:17:10 ( MS Incidence Map shows WA with highest rate of 190-220% average incidence.


The California-based group, GrassrootsHealth (http://www.GrassrootsHealth.net) recommends the blood level should be at least 40-60 ng/mL. Many doctors recommend a level of 80-100 ng/mL in their patients with neurological symptoms.

[jimmylegs]

(with few paying sufficiently responsible attention to cofactors)

[jocelynrenee]

Thanks for your help. Below I will write the test, then my number, then the "standard range."

WBC Differential: There were tons of percentages which weren't flagged. The only thing flagged was the Imm Gran Abs Auto. 0.04x10(9)/L... standard is 0.00-0.03x10(9)/L. I can type the rest out if you need, but there are a lot.

Complete Blood Count w/Differential: Again lots of things, only thing flagged was WBC. 11.6x10(9)/L... standard is 4.0-10.5. Again, I can type the rest out if you need, but there are a lot.

Ferritin: 72... 30-424
B9: 8.0 ng/mL... >=4.0 ng/mL
B12: 724 pg/mL... 232-946 pg/mL
Immunoglobulin A: 272 mg/dL... 70-400 mg/dL
TTG Immunoglobulin A: <0.5 U/mL... <=14.9 U/mL
Thyr Peroxidase Ab: 15 IU/mL... <=34 IU/mL
TSH: 2.08 mcIU/mL... 0.34-5.60 mcIU/mL
Calcium: 9.5 mg/dL... 8.4-10.2 mg/dL
VitD 250H, Total: 27 ng/mL... 20-80 ng/mL

It looks like I am definitely on the low end of standard for Vitamin D, at only 27. But still in the range. Can Vitamin D deficiency cause MS? Or just similar symptoms? Is it related to Trigeminal Neuralgia?

[jimmylegs]

ok thanks for the detailed info that's great.

so from the list above, you have serum vit b12 and vit d3, plus ferritin, b9 and calcium. all good things to know.

your b12 status looks great. not only in the 'normal' range but well into the 'optimal' 500-900 pg/ml range as well. (can be consquences over 900)

to your question re can vit d3 deficiency *cause* ms i would say we cannot lay ms at the feet of vit d3 alone. low d3 is however a finding common to ms patients, and ms risk drops as vit d3 levels get higher. so the good news is that although you appear to share some nutritional issues with ms patients (magnesium also tends to be on the low side), these are things you can readily act on.

so re your serum 25(OH)vitD3 level - yes it's normal, yes it's below what we'd consider optimal, and yes you can aim for the 40 ng/ml to start, but not if your serum mag is also low. these should be worked on together.

given the fact that we're basically all societally low in mag, with a vast array of extremely commonplace consequences, i think we could could assume that your serum mag level is actually low. would be nice to have an actual number though. again, this is an issue anyone can take on readily (starting with reading lots to make sure you have solid information before you do take action)

ferritin i personally like to keep in the 80-100 range. with iron, you need to ensure adequate zinc status though or you can end up with undesirable dysregulation and tissue deposition of iron. another good reason to have that serum zinc test done.

to continue along these lines and help ensure you don't share bloodwork characteristics of a typical ms patient, in addition to serum magnesium and zinc, you can also as mentioned previously ask for serum copper and serum uric acid.

now we're into ones that you don't see red flagged as often where ms is concerned:

folate status also looks very good although i don't have an 'optimal' range for that one off the top of my head.

re calcium that one looks fine but it's a little hard to assess thoroughly without knowing serum magnesium.

[jimmylegs]

one other thing:

http://bit.ly/2lFChUL

"6 Other maladies that commonly are expressed in the orofacial region include trigeminal neuralgia, trauma-induced neuropathy ... Chronic muscle pain disorders such as myofascial pain and fibromyalgia have been associated with a decrease in serum magnesium. Magnesium deficit also is associated with an enhanced inflammatory process, enhanced free radical (superoxide) formation, an enhanced excitatory state in the CNS, and enhanced calcium mobilizing potential (abnormal calcium handling). Travell reported that B-vitamin deficiency is a common perpetuating factor of myofascial pain."

that just reminded me that b6 is needed for proper absorption of magnesium:
Vitamin B6 and magnesium
https://www.ncbi.nlm.nih.gov/pubmed/3959594

b6 is another water soluble vit you can get into trouble with if you get too much into your system (esp via supplements) - 100mg per day is the limit for that one (compare <1 mg in most healthy food servings).

healthy foods rich in b6: http://www.whfoods.com/genpage.php?tnam ... #foodchart

healthy foods rich in magnesium: http://www.whfoods.com/genpage.php?tnam ... #foodchart

[jocelynrenee]

Thanks again for that detailed information.

Anyone have any insight about the MRI Impression or findings?

[jimmylegs]

no prob. chipping in a little more reading re mag depletion and eye movement. research titles:
http://bit.ly/2m5W7M4
i'd consider mag as well for both fatigue (ATP connection) and/or muscle spasticity (including those associated with the bladder).
over to mri matters

[jocelynrenee]

Hi Folks...

If you read this, I am still looking for help understanding what my MRI impression/findings mean. Thank you!

[jimmylegs]

"Etiology for the aforementioned finding is uncertain. Differential diagnosis includes foci of demyelination. Follow-up MRI in 6 months may be helpful for further evaluation." ... "No evidence of abnormal high signal within the corpus callosum."

read: i dunno. if this person gets worse in specific ways over the next 6 months, maybe we'll see something more conclusive then. ... not a poster child for ms.

[jocelynrenee]

Thanks. What does it mean when it says "Differential diagnosis includes foci of demyelination?" Does that mean I have that kind of foci or that a diagnosis would require it and it's not certain that I do?

[jimmylegs]

no worries. again not a pro - probably keeping things in context is best.

"MRI Impression: Multiple foci of high signal seen on FLAIR and T2-weighted sequences within the subcortical white matter, best appreciated on the high-resolution sagittal FLAIR sequences. Etiology for the aforementioned finding is uncertain. Differential diagnosis includes foci of demyelination. Follow-up MRI in 6 months may be helpful for further evaluation."

i would say high signal = demyelination. so 1. you have them and 2. yes docs would normally use these as evidence when looking to establish an eventual dx of some kind and 3. follow up needed means they are not sure which of the possible diagnoses applies quite yet.

A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis
https://link.springer.com/article/10.10 ... 011-6240-5
Although multiple sclerosis (MS) is the most common demyelinating disorder of the central nervous system (CNS), it lacks any definitive diagnostic test. Instead, diagnosis of MS primarily depends upon clinical criteria, supported by abnormalities characteristic of MS on para-clinical investigations including magnetic resonance imaging of the brain and spine, in the absence of an alternative explanation for underlying neurologic symptoms. While many of the potential disorders that may mimic MS in routine clinical practice are either extremely rare, or associated with specific and characteristic distinguishing diagnostic features, some inflammatory demyelinating disorders of the CNS may be particularly challenging to distinguish from MS, especially during initial presentation. In particular, acute disseminated encephalomyelitis, neuromyelitis optica, and idiopathic transverse myelitis may closely resemble MS, impeding prompt and accurate diagnosis. In this review, we describe the clinical features, diagnosis, pathology, and treatment of these other CNS demyelinating disorders. In addition, we review relevant features of other CNS inflammatory disorders that may mimic MS, including Sjögren’s syndrome, systemic lupus erythematosus, Behçet’s disease, and primary CNS vasculitis.

at this point in time, i think we have a lot of room for improvement when it comes to digging in on those alternative explanations.

[jocelynrenee]

Thank you again! That is helpful. I will check out the article you cited as well.

On another note, I have been experiencing tingling sensations (like a bug crawling on my skin) along one wrist and forearm intermittently this last week. Another one of those only mildly annoying symptoms, that is likely related. Uck!

[jimmylegs]

no problem unfortunately you may only be able to access the abstract of the article i haven't checked if it's open full text access.
if i were in your shoes and had 6 months to kill while waiting for more definite answers, i would be really digging in re how to prevent any such thing from happening - how to be the absolute least like an ms patient in all possible ways