BRAIN, THORACIC, C-SPINE MRI RESULTS

New diagnosis and before diagnosis
1

HI ALL, this is my first post. My background: I had Optic Neuritis diagnosed last month. My doc sent me for an MRI since I have had Iritis in the past, and some weakeness in arm (which I always attributed to ergonomics)

The first set of brain results showed “non specific” foci … I could post those results, but I have a newer image since then. I went to the Yale Division of MS and Immunology (Connecticut, in US) and the neuro ordered MRIs of my brain, T-Spine and C-Spine and also a Spinal Tap. She said my symptoms have been “muddy”, so she wants to see everything she can.

The MRI was last week, and the Spinal Tap was this morning. I have a follow-up appt in 2 weeks, but have the MRI report and am wondering about it, naturally. Here it is:

Small, scattered nonspecific subcortical foci of increased T2 and FLAIR signal are noted in the cerebral white matter as detailed above. No acute brain pathology, or lesion enhancement.

No evidence of demyeliniating disease or pathology within the cervical spinal cord. There is minor disc bulging at C5-C6, no significant spinal or foraminal stenosis.

At the T3-4 level, there is a small disc osteophyte complex with indents the spinal cord, small focus of increased T2 signal within the central, ventral aspect of the cord is noted at this point. This could reflect focal myelopathic signal change secondary to the disc osteophyte complex.

At the T2/3 level, there is potential small focus of increased T2 signal in the right dorsal superficial lateral cord. Additionally, at the mid T6 level, there is high T2 signal within the cord without evidence of external compression. There is no pathologic enhancement of the thoracic spinal cord, lepomeninges or vertebrae. These findings are concerning for demyelinating disease/MS.

I see words like “small” and “possible” which aren’t too worrisome. Without knowing how to interpret all of this directly, the last paragraph was worrisome – the “high T2 signal within the cord” … so does that mean lesions on my spinal cord? … and “without evidence of external compression” … that sounds good, but is it? …

The last sentence “These findings are concerning for demuelinating disease/MS” is worrisome, of course … but I am not sure of what it refers to.

I like to learn as much as I can, but do trust my doc to give me the big picture when I see her in 2 weeks … any interpretation you have before then would help me organize my thoughts about all this. Also — if she does not diagnose MS, is there anything else that should be considered? For example, I know the spinal fluid will also be tested for Lyme … what else should be on my radar?

THANKS.

~ Lori

2

Hi Lori, I replied last night but I dont know were my post went.

Your MRI is quite complex and our expert on MRIs (Karen, Rizzo) is taking a break from the form. There are however her stickys available for you to look at. Your brain MRI seems non-specific and your cervical MRI is clear which are the two key areas were MS lesions tend to be seen. Although with the optic neuritis you would expect to see more in the brain MRI. There does seem to be more issues in your Thoracic MRI but these would not cause the optic neuritis. MS lesions on the thoracic area are less common in MS.

I am sorry that I cant help any more. I am afraid you will have to probably wait until you see your doctor again.

3

Hi I was going to try and help a little with your mri results as yours is very similar to mine.

Could you answer these questions first?

  1. Do you or have you ever suffered from high blood pressure?

  2. Have you ever had a spine injury or problem?

  3. What approx age group are you in 20-30, 30-40, 40-50, 50-60.

Sorry for having to ask, it’s very difficult to establish any kind of explanation without a little addtional info.

Best Wishes xx

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Thanks for the reply and no worries. I am 40, I should mention that I had a baby 6mo ago. (I hear that auto immune issues can flare after childbirth). My blood pressure has always been perfect. As for my spine - I have always had a “bad back” that I’ve seen ortho docs for … I’ve had lumbar MRIs and physical therapy. I looked at my last lumbar MRI (from 2 years) and it says "small left para central disc herniation at L5-S1 with mild inferior extrusion; asymmetric left diffuse annular bulge at l4-5 level. " I always accepted this as an ortho issue, mind you the MRI was long before ms was suspected.

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Wow. Sorry for the # of responses! That’s what I get from posting from my phone!!! Cannot figure how to delete some.

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All you need to do is report one and Moderators do the rest - or sometimes we just notice multiple posts and delete some.

Liz [Moderator]

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Hi Delude,

Thank you for providing me with information I asked. I am hoping some details I can give you may. I am not by any means an expert, but I will try to make your MRI Report a little easier for you.:

Firstly, I am glad you do not have high blood pressure, as in many cases a lot of “small nonspesific - also known as bright spots to many of us” that can be seen on brain scans can actually be caused by high blood pressure, age, vascular, metabolic and diabetis. However, normally a Neurologist can ususally rule out vascular and metabolic conditions, especially when appropriate bloods and a brain mri with contrast (brain scanning with contrast highlights active leisions and blood vessels) is performed and in keeping with your symptoms and history.

" Small, scattered nonspecific subcortical foci of increased T2 and FLAIR signal are noted in the cerebral white matter as detailed above. No acute brain pathology, or lesion enhancement. " This means that you had bright spots in various regions of your brain that were not specific to any condition, and no leisons were found that would identify or cause your current symptoms. FlAIR just means the type of scan/s used and to what intensity. Your brain MRI is marked as essentially normal.

" No evidence of demyeliniating disease or pathology within the cervical spinal cord. There is minor disc bulging at C5-C6, no significant spinal or foraminal stenosis." (Demyeniliation means Autoimmune condition of the central nervous system where the mylein sheath which protects the brain becomes damaged and the spinal fluid leaks in slightly, which can cause M.S and a few other conditions. M.S being the most common.) This was not found in the cervial part of your spine (Neck and upper part of your spine. C5-C6 means the 5th and 6th disc down in the cervical spine area, states you have a minor disc bulging. No Spinal or foraminal stenosis means no narrowing of the canal where the spine nerves are. Apart from slight bulging disc this is also normal.

" At the T3-4 level, there is a small disc osteophyte complex with indents the spinal cord, small focus of increased T2 signal within the central, ventral aspect of the cord is noted at this point. This could reflect focal myelopathic signal change secondary to the disc osteophyte complex. ". This means that part of your spine has shown myelopathic change in keeping with disc osteophyte complex. Myelopathic means Spinal injury or, autoimmue disorder (possibly m.s). Disc osteophyte complex can be caused by ageing but mainly seen in people over 55 years of age, it appears more likely that yours is caused by autoimmune disorde or and old spine injury, as your only 40 its unliklet to be anything to do with the ageing process.

“At the T2/3 level, there is potential small focus of increased T2 signal in the right dorsal superficial lateral cord. Additionally, at the mid T6 level, there is high T2 signal within the cord without evidence of external compression. There is no pathologic enhancement of the thoracic spinal cord, lepomeninges or vertebrae. These findings are concerning for demyelinating disease/MS.” I’m not 100% about all aspects of this paragraph, but as I’m understanding it, it means a probable leision resembling possible m.s was identified.

All in all, it would appear you have 1 maybe 2 leisions on your spine at most, no narrowing or external compressions which is great news and your brain mri generally clear, with no specific leisons.

It may good if you could ask how many bright spots/leisions were found on your brain and spine?

Optical Neuritis is not caused by any spine leision, this is caused by the optic nerve from your brain to the back of your eye, it normally rectifies itself but in some case steroids are required. However, unless the mri of the brain was taken very close to the bout of O.N then its unlikely to show as it hasnt on yours, this is very common. The test you need for O.N to show any signs of previous O.N Bout would an VEP (Visula Evoked Potential) test, this would be far more accurate as leisions and inflammtion can dissapear and heal.

The L.P is good, but doesn’t always show, however, twith the other evidence and if you can get VEP done your consultants should be able to give you a definate diagnosis or rule out other conditions.

I hope this helps you a litttle, please try not to worry and in general your results are pretty good, as an example some people with m.s or another autoimmune disease can have 30-40 lesions and are still mobile and working, maybe not for all, but for some people the progression is really slow, plus therr are medications in certain circumstances and stages of the condition, if it is m.s.

Best of luck keep me updated xxxx

"

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This is an excellent definition; I’ve read about some of these “glossary terms” online and this is the best definition so far - thank you.

I feel like this part is a question of what came first, the chicken or the egg? This is a question I’ll ask my neuro about next week - do I have the disc ostephyte complex because I have some kind of autoimmune disorder, or do I have an autoimmune disorder this makes an existing disc osteophyte complex worse? Just curious to learn more about this, mostly because I’ve had orthopedic issues in the past … and reading “indents the spinal cord”, makes me wonder what symptoms have, or might, come of that.

My own reaction to this part … so far, my neuro said everything about me is “muddy” … Optic Neuritis episode did not seem like a classic case (but my Opthamologist diagnosed it, not she) … my brain MRI showed non-specific white spots … weakness in arm may or may not be ergonimics … etc … so this seems like more “muddy” results. They see something, seems more specific than the brain spots, but like you indicated - not like it’s 10-30 lesions. I’m very curious on her interpretation of this specific part of the MRI.

I have access to the patient portal through the MS Center, so I see results when they are posted; my LP results are out there, but I believe all pieces are not back yet. I see nothing about the “Bands” …

CSF Protein: 42 (standard range listed as <50)

Neuromyelitis Optica AutoAb, IgG: Negative

B. burgdorferi Abs, CSF w/ WB Confirm {I understand this is a Lyme test, being that I live in the US/Northeast}: <0.10 (standard range <=0.9)

Glucose CSF: 59 (standard range 40-70)

CSF Culture No Growth, No WBC’s, No Organisms

Angio Convert Enzyme, CSF: 3 (standard range <=15)

She did say that the LP/CSF results come back in stages, and one part takes longer than the others … so I assume the part that counts/test for those oligoclonal bands is not back.

Thank you, overall, for breaking down these results … it helps organize my thoughts for my neuro visit next week.

~ Lori

9

hi people I’m new to the group I have a question that I hope someone can help with :

I moved from England to Scotland be for I moved I was told I have lesions that are both disseminated in time and space

(T2&C6) also had lesions corpus callosum

weakness on left side drop knee (now on both sides) my new dr refuses to discuss and instead insists it’s just sciatica I’m an

expert in sciatica! However I have found out that they haven’t got my medical records and it’s been over a year since I moved

Any help or pointers would be greatly appreciated

10

you need to register with a GP in england and then request a referral to neurology.

your previous hospital have been somewhat negligent.

contact them and tell them that you are unhappy with them for losing your medical records.

if they don’t do anything about this, contact PALS to register a complaint.

it’s not a matter of wanting to complain, just a matter of wanting your new doctor to have sight of your medical records.

it’s only scotland/england, not outer mongolia/england.

if you are unhappy with your current gp, see a different one.

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