Advice needed!!

Everyday living
1

Hello,

Please can I tell my very long drawn out story and tell me what you think?

I have been dealing with mind fog and exhaustion for at least 10 years. I have struggled with concentration in turn has made it difficult to learn, maintain relationships, drive etc.

in 2012 it was like my body had simply had enough. Along with the above symptoms I had tinnitus, headaches, muscle weakness, muscle spasms, dizziness, blurred vision and many more issues. I was referred to neurology and eventually had an MRI scan to check my ears, for a tumour and MS. The scan came back clear and the consultant flippantly advised me to go back to the gp and sort anti depressants!!! :frowning:

i struggled on with my symptoms. In 2014 I had my second baby and throughout my pregnancy the symptoms were not as bad. 10 months after my baby was born, the symptoms hit me like a train once again and continued. I went back to the Dr and was referred to endocrinology. I was then sent for a scan to check the pituitary gland and had blood tests to check my cortisol levels.

i didn’t hear anything back so presumed all was ok. In 2015 I fell pregnant again and once again, I still had the symptoms but not as bad. My baby was born February 2016. When he recently turned 10 months old history repeated itself. My symptoms have flooded back once again. I reached my limit so returned back to the gp who told me that the scan from 2015 had come back. He advised me that my cortisol levels were low. Not only that, he said that the results re the pituitary were fine but something else was spotted. This is what the report says -

scattered T2 hyperintense foci in the white matter of both cerebral hemispheres predominantly in the frontal regions. Although these are non specific, they are excessive for the patients age. ??? No idea what this means.

Now it seems that having low cortisol, this will have to be re checked. In the case that I have Addison’s disease, this should not affect the brain…

I have a long way to go waiting for the scans etc but I’m struggling so badly and am desperate for answers.

Feel free to give advice!! I’d be utterly grateful! I’m feeling low, like I’ve reached rock bottom and that nobody understands what I’m going through, I’m desperate.

Thanks in advance!!

2

Im not sure but I think they can mean something or not very much. I think they will look at differentiating factors such as number and location of lesions. Here is quote from journal article:

“T2-hyperintense foci are one of the most frequent findings in cerebral magnetic resonance imaging (MRI). They can pose serious diagnostic problems which is reflected by their English name and abbreviation - UBOs (Unidentified Bright Objects).”

3

Hello Bob,

thank you you so much for the reply. I obviously joined this website because I am convinced that ms is the cause of my symptoms. As you know when you’re so ill, it’s a very frustrating time. Maybe I won’t get answers this way and am just acting in desperation. I know I need to be patient for my next appointment but it’s difficult.

Thanks again!!

4

Thanks.

Im sorry u have had such a tough time of it Tansar. And I hope that things get sorted out for you in the near future. Im in a similar boat. I have MRI scans showing a good number of lesions, and a bucket full of MS type symptoms (eyes, ears, muscles, you name it), but they want to do a lumber puncture and evoked potential tests before deciding what they think it is. To add to teh confusion, the hospital in Wales seems unable to get hold of my first MRI from Lewisham. So much for the national health service and the internet.

best wishes

Rupert

5

Received a letter by coincidence of your problem bob, apparently Liverpool Walton cannot get my 1st MRI scan from Wrexham hospital, Wales, I have SPMS, thats diagnosed, but as far as any comparisons between the scans & lesions progression seems I will never know!! Tracey

6

Sorry to diversify from the original post but always purchase a copy of your MRI; legal under the ‘ Freedom of Information’ act.

Cost about a tenner then you always have one for comparison.

The other reason to always have your copy is best explained in an email I received from ‘she who must be obeyed on MRI’s’ Karen.

The last T2 FLAIR scan I did of my brain used 70 slices (on a 3T scanner). The one I had done today - 13 (on a 1.5T scanner). THIRTEEN. THIRTEEN!!!

Thankfully I wrote it out the voxels/T2 reply in Word before posting - to avoid the dreaded time-out! So here it is…

A MRI image typically consists of voxels (3D pixels). Slice thickness is one dimension (on the z-axis if you think of maths). The images you see on the CD show you the other two dimensions (on the x- and y-axes). You can set the voxel size to anything you want, in any dimension; all that happens is that it changes the time the scan takes to run (and therefore, of course, how much it costs). The smallest voxel size used in everyday MRI is typically 1mm x 1mm x 1mm. The “off the shelf” scan that I used to use for this size of voxel had 176 slices. The voxels (and slices) cover the whole brain irrespective of what the voxel size is – nothing is missed out (but see later).

If a standard T2 sequence is used for the scan, white matter gives off a poor signal and shows up as dark whereas lesions (which are full of fluid) give a strong signal and show up as bright.

However, the brightness of a voxel depends on the average of the response from the matter represented by that voxel. So a voxel that is 1mm x 1mm x 4mm will show the signal generated by all matter located in that 4mm3 cube. That is, if the voxel only contains white matter it will be dark in the image, if it only contains fluid it will be bright, but if it contains a mix of white matter and fluid it will look somewhere between dark and bright, depending on the proportion of the different matter types.

So if you have a large voxel (say 4x4x4) and a small lesion (say 1x1x1), the overall signal in the voxel will only be slightly higher than one without a lesion (and therefore look only slightly brighter, and therefore may be overlooked). [NB Small lesions would also not always be completely contained within one large voxel – it is more likely that it would be partially in at least two. So this makes it worse.]

But if you have small voxels and a large lesion, then you will get several very bright voxels (where the matter is all fluid), some intermediate voxels (where there is a mix of fluid and white matter), and some vaguely brighter voxels (that contain predominantly white matter).

In other words, small voxels are much better for detecting lesions.

So, can lesions be missed if you use thick slices? Basically, yes. It is entirely feasible. However, they would have to be much smaller than the slice thickness because if they are closer in size, they would contribute sufficient signal to make the voxels significantly brighter than the surrounding voxels and would (should!) be picked up by a decent radiologist. Saying that, it is possible that it might be missed if a small lesion, by chance, spans lots of voxels (e.g. if it is centred on where four voxels meet on that slice) and the signal is lost by the averaging with the white matter signal in those voxels.

However, there are new “pulse sequences” (the settings that programme the scanner) that are particularly sensitive to fluid. If you use one of these rather than a standard T2 sequence, you will be able to use bigger voxels and still be able to detect lesions relatively easily. And the power of the scanner makes a big difference too. A 3T scanner is much better than a 1.5T scanner.

So, if a hospital has a 1.5T scanner and a neuro is ordering a standard T2 scan, then he should be asking for a high resolution (i.e. small voxel size).

If the hospital has a 3T scanner and the neuro is ordering a FLAIR or another new type of pulse sequence that’s good for fluid, then he can get away with a lower resolution.

[NB A related point: it is possible to set gaps between slices. For example, the MRI may capture signal from 0-4mm, 8-12mm, 16-20mm etc rather than 0-4mm, 4-8mm, 8-12mm etc. This would DEFINITELY miss lesions!]

So the trick to not missing lesions is not so much about the number of slices, but about the voxel size, whether or not the slices cover the whole brain without any gaps, the power of the scanner and the choice of pulse sequence.

George

7

That’s the last thing you need at a time like this! But at least things are in motion and you will have a lumber puncture soon hopefully!! Hopefully your results will show up soon.

Keep in touch and let us know how you get on and remember you’re not alone :slight_smile:

Tanya

8

Im sorry to hear that Tracy. There seems no good reason why they cant do this. If it was a book from Amazon then you would get it the next day.

9

Thanks bob, I’ve resigned myself to the fact my files are rotting in some dusty basement of the Wrexham Maelor Hospital, not on my own, unfortunately! At least I was diagnosed before the lost them, couldn’t face going through it all again Tracey

10

In my own case, but since then iv learned that it is very common, it was the pregabalin that i was taking for neuropathic pain that was causing the brain fog, it was totally debilitating,especially latterly. i asked to be taken off it because it was the effect it was having on the people around me that I cared about that concerned me more than the pain itself. A lot of the drugs they give us for neuropathic pain can cause brain fog and onlookers, in most cases understandably so can assume that it’s us, the person, who is at fault.