Question about Current MRI Report

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sariley
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Question about Current MRI Report

Post by sariley »

Hello, I'm a 48 yr old female and have not been diagnosed with MS at this point. I went back to neurologist due to symptoms of sciatica. I am very active and the pain/discomfort became a hindrance to any activity. I have the following 2 MRI reports as a result of my visit. The spine MRI showed no sciatica issues so the dr stated my pain is from inflammation.

2015 Brain MRI: Mild to moderate altered signal involving cerebral white matter on FLAIR and Ts images - without enhancement. Nonspecific finding often related to chronic small vessel white matter ischemic disease. Evidence of slight progression in white matter disease as compared to 2008.
2016 Brain MRI: Mild foci T2 subcortical white matter hyperintensity appear mildly more prominent than last year. nonspecific appearance not typical of multiple sclerosis although the latter is a clinical diagnosis and is possible, but could also be early onset of chronic small vessel ischemic disease. While a couple new lesions are identified, no active enhancing lesions are identified.

First - thank you for reading my post. Second, does anyone have an opinion as to where this might go? The neuro is having me follow up with an MS specialist. Is it possible to have MS and lesions that are not typical? I do have symptoms that hit me for a period of time and then just go away.
I appreciate any input you may have.
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lyndacarol
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Re: Question about Current MRI Report

Post by lyndacarol »

sariley wrote:Hello, I'm a 48 yr old female and have not been diagnosed with MS at this point. I went back to neurologist due to symptoms of sciatica. I am very active and the pain/discomfort became a hindrance to any activity. I have the following 2 MRI reports as a result of my visit. The spine MRI showed no sciatica issues so the dr stated my pain is from inflammation.

2015 Brain MRI: Mild to moderate altered signal involving cerebral white matter on FLAIR and Ts images - without enhancement. Nonspecific finding often related to chronic small vessel white matter ischemic disease. Evidence of slight progression in white matter disease as compared to 2008.
2016 Brain MRI: Mild foci T2 subcortical white matter hyperintensity appear mildly more prominent than last year. nonspecific appearance not typical of multiple sclerosis although the latter is a clinical diagnosis and is possible, but could also be early onset of chronic small vessel ischemic disease. While a couple new lesions are identified, no active enhancing lesions are identified.

First - thank you for reading my post. Second, does anyone have an opinion as to where this might go? The neuro is having me follow up with an MS specialist. Is it possible to have MS and lesions that are not typical? I do have symptoms that hit me for a period of time and then just go away.
I appreciate any input you may have.
Welcome to ThisIsMS, sariley.

I have no medical background and have no opinion on your MRI reports. I do know that symptoms consistent with MS are also consistent with many other conditions, which must be ruled out before the MS diagnosis can be considered.

I suggest that you request a vitamin D blood test (the "25-hydroxy D") from your doctor, since a deficiency in vitamin D is one of the possibilities to be ruled out. Please request your own copy of the test results – it is important to have the actual number. I had this test in January and was found to have a low level (24 ng/mL) – MS patients are frequently low in vitamin D. If you have already had this test, would you share your test results with us?

Every cell and every organ in your body requires vitamin D. Vitamin D deficiency is very common; it is estimated that over 1/2 of the American population is deficient.
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Scott1
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Re: Question about Current MRI Report

Post by Scott1 »

Hi,

I won't touch the brain scans.

The sciatica could be coming from the periformis muscle which is deep below the glutes. There is a condition called periformis syndrome. It's called a syndrome because it is just a collection of issues with no apparent cause. If your perifomis is tight or has some adhesions on it that will produce pain that can involve the sciatic nerve. You might notice it if you find it difficult to externally rotate your leg (e.g. sit on a horse or swing a leg over a low gate) or you sometimes experience pain if you abduct your leg (move it away to the side). The usual treatment is a cortisone (or botox) injection into the muscle to release it then specific exercises to regain the range. You would be better trying a sports medicine clinic than a GP for that.

Regards,
ElliotB
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Re: Question about Current MRI Report

Post by ElliotB »

"does anyone have an opinion as to where this might go?"

There are about 400 illnesses that mimic the symptoms of MS. A doctor(specialist) with years of experience is in the best position to properly read your MRIs and diagnose you.
sariley
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Re: Question about Current MRI Report

Post by sariley »

Thanks to all who have replied. I'd like to offer a bit more of my history if I may:

2008: started stumbling/tripping which eventually led to 3 pretty bloody falls while running (been running for 25+ yrs- never fallen), exhaustion that was wiping me out, then the left side of my face was going numb on and off, and sensation of warmth going down one leg - thought that I had had an accident. Then i found myself having an accident here and there, nothing major but enough to worry about. I went to my PCP who had me follow up with neuro. MRI showed non specific white matter disease as stated in my original post and neuro said might be mild case of MS but wouldn't say for certain. The issues subsided, so I went on about my life.

In period between 2008 and 2014 I continued to have on and off issues but I'm not the "go to the doctor type" (I was hit by car while out running and duct taped the wounds together so I could go to work ;-)) so I waited it out and eventually it all goes away. I had recurrence of previous symptoms along w a few other minor ones.

2015: Facial numbness became more persistent between eyebrows and then the right side of my mouth felt like it was dropping. I found myself covering my mouth when talking because I was certain that others could see something wrong?? I felt like i was slurring. This would happen for a few minutes and then go away but lasted like this for many months. I was forgetful, trouble carrying on conversation, friends noticed that I was asking same question over and over - but I couldn't remember their answer. Then tripping started again and yet another fall. I was getting frustrated with myself. PCP sent me to neuro who looked at blood work and advised me to take more B and D vitamin but stated my levels all looked good. This was to help with "memory" issues. MRI showed same as last time with slight progression. I walked away with no answers.

Late 2015 -2016: Major bowel issues start. It got so bad that I actually went to a gastro. He did a colonoscopy removed polys and told me to stop eating dairy. I only consume I greek yogurt a day for dairy - it's hard to eat less than that. I left with no answers and terrible stomach issues.

2016(current): sciatica pain, tripping and very persistent bowel issues along with wetting myself (sorry about that :( ) while out on a run. Back to neuro I saw last year to get help for just the sciatica. He acts like my sciatica is a side issue and immediately tells me he wants a repeat brain MRI. I have that done - shows more progression of non specific white matter lesions. He wants me to see an MS specialist to rule out MS.

My question to you all is - can this possibly be MS with increasing "non specific white matter" lesions. I otherwise a healthy individual. I only want answers so that I can either take precaution or whatever is needed to stay healthy and active.

Thanks to all for listening!
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lyndacarol
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Re: Question about Current MRI Report

Post by lyndacarol »

sariley wrote:2015: … PCP sent me to neuro who looked at blood work and advised me to take more B and D vitamin but stated my levels all looked good. This was to help with "memory" issues. MRI showed same as last time with slight progression. I walked away with no answers.



2016(current): sciatica pain, tripping and very persistent bowel issues along with wetting myself (sorry about that :( ) while out on a run. Back to neuro I saw last year to get help for just the sciatica. He acts like my sciatica is a side issue and immediately tells me he wants a repeat brain MRI. I have that done - shows more progression of non specific white matter lesions. He wants me to see an MS specialist to rule out MS.

My question to you all is - can this possibly be MS with increasing "non specific white matter" lesions. I otherwise a healthy individual. I only want answers so that I can either take precaution or whatever is needed to stay healthy and active.
Apparently, you had a vitamin D blood test in 2015. Please call the doctor's office and request your own copy of the test results so that you have the actual number. "Levels all looked good" is not adequate. If your number was evaluated according to the standard range (30-100 ng/mL) suggested by the Institute of Medicine, your level could be quite low and still be considered "good."

Your symptoms could be the result of vitamin D deficiency… or the result of one or more other conditions.

Since there is no definitive test available "to rule out MS," testing must be used to rule out the other possible causes of your symptoms – it is a process of elimination. When everything else is ruled out, MS is the "last man standing."
sariley
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Re: Question about Current MRI Report

Post by sariley »

I will request my Vitamin D level. What is an appropriate level?
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Scott1
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Re: Question about Current MRI Report

Post by Scott1 »

Hi,

It sounds like something is going on. Apart from tiredness after running is fatigue ever an issue? Do your symptoms seem cyclical, persistent, or just becoming more frequent?

Certainly, check the vitamin levels . Also check for underlying infections such as EBV, mycoplasma, chlamydia, Bartonella or babesia. In a perfect world you would get a fasting amino acid panel done to see if you are deficient in any as that can provide a lot of clues. Most doctors don't do it.
When you have the usual blood tests ask for a uric acid test (not urea, that's something else) as well.
It will be a case of building the clearest picture that you can. Standard tests are for healthy people and you have some issues so you will have to get the doctor to look outside the square.

Regards,
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lyndacarol
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Re: Question about Current MRI Report

Post by lyndacarol »

sariley wrote:I will request my Vitamin D level. What is an appropriate level?
GrassrootsHealth (http://www.GrassrootsHealth.net), the California-based nonprofit public health promotion organization, recommends that the serum vitamin D level be at least 40-60 ng/mL.

There are neurologists who recommend that patients with neurological symptoms should reach and maintain a level between 80-100 ng/mL.
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Re: Question about Current MRI Report

Post by ElliotB »

lyndacarol, I know you have done extensive research on Vitamin D, what level/range do you recommend?
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lyndacarol
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Re: Question about Current MRI Report

Post by lyndacarol »

ElliotB wrote:lyndacarol, I know you have done extensive research on Vitamin D, what level/range do you recommend?
I hope you will not regret that you asked. I think the recommendation ("at least 40-60 ng/mL") by GrassrootsHealth is the minimum people should have. A consensus of scientists today says that serum vitamin D should be no less than 40 ng/mL

In an interview, Dr. John Cannell, a recognized vitamin D expert in California and founder of the Vitamin D Council, has stated, "We are not recommending levels of 80, 90, or 100 UNLESS you have a disease in which vitamin D may have some beneficial effect."

In another interview, he gives his educated opinion that "we should never exceed a level of 100 ng/mL."

In a 2013 interview with Dr. Cedric Garland (Vit D expert at University of California, San Diego), he recommended serum levels of 80-90 ng/mL for women and people with MS.

Dr. Robert P Heaney (endocrinologist, vitamin D expert, professor at Creighton University) recommended that a person would not want to go above 200 ng/mL, except under medical supervision. He admitted that "there may be some times when that would be necessary, but not for the average healthy person."

In a 2013 interview, Heaney stated that he was not aware of any adverse effect in a stable serum concentration of 80 to 100 ng/mL.

According to Dr. Heaney, "Outdoor summer workers commonly have values as high as 60-80 ng/mL." [in my opinion, this would be our targeted range, IF WE WERE HEALTHY PEOPLE]


My personal opinion is that people with neurological symptoms should strive to maintain a level of 80-100 ng/mL. Dr. Heaney said more than once in his lifetime that there have been no reported cases of toxicity below 200 ng/mL.
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Re: Question about Current MRI Report

Post by ElliotB »

For the past year or so, I have been in the 150+ range. I have cut back a bit over the last 3-4 months and am due for blood work soon. My 'goal' is to be around the low 100 range or perhaps a bit below 100. Thanks for your reply.
sariley
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Re: Question about Current MRI Report

Post by sariley »

The neurologist that I saw a year ago and then again a few months ago has referred me to an MS Neurologist for further evaluation. He stated that with increase in white matter lesions even though inconsistent with MS could still be MS given my symptoms and the fact that they appear and then go away for a while.
I would love to hear about how others went from possible to probable to certain. I'm not worried or anything like that, as overall I'm in great health and very active. I'd just like to be prepared.
Thanks again for all your advise, input and sharing!
sariley
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Re: Question about Current MRI Report

Post by sariley »

I'd like to attach a few photos from my MRI disk but am not sure how to go about it. All I've succeeded in doing is copying them to a Word Doc :( .
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NHE
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Re: Question about Current MRI Report

Post by NHE »

sariley wrote:I'd like to attach a few photos from my MRI disk but am not sure how to go about it. All I've succeeded in doing is copying them to a Word Doc :( .
Please see this post in the Forums FAQ topic for helpful info on posting a photo to the forums.

http://www.thisisms.com/forum/site-supp ... tml#p40760

In addition, it may be helpful to edit the photo before posting, e.g., to exclude personal information or to resize it. If you don't already have image editing software, then you can get a very capable program for free from http://www.gimp.org . It has many of the same features as expensive commercial programs such as Photoshop.
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