Difficulty swallowing, MRI found T2 hyperintensity. Terrified

New diagnosis and before diagnosis
1

Hi all,

I understand that no one can diagnose me over the Internet; I’m simply looking for some guidance. I appreciate your thoughts and advice in advance. I’m 26yo, healthy, no existing conditions. Roughly 6 months ago, one night I experienced difficulty swallowing food. It’s almost as if the food would pause before I would begin swallowing, and I couldn’t initiate the action. The problem was only with solid foods, and lasted for a couple of weeks (during this time, there were a few days where I could eat solid foods just fine). Since then, the problem has been intermittent, but for the most part, seems to have improved/occurred far less frequently. I had seen a gastro and ENT with no luck, so I was finally referred to a neuro. My biggest fear was having some sort of neurological disorder.

The neurologist definitely did not think this sounded like a neurological disorder, but ordered a brain MRI w/wo contrast to be on the safe side. I received the results a few days ago, as seen below:

"The ventricles and extra-axial spaces are normal in size for the patients age. There is no intracranial hemorrhage, hydrocephalus, or mass effect. There is no acute infarction. There are approximately 12 small foci of T2 hyperintensity the peripheral white matter of the paramedian anterior frontal lobes. The appearance is non specific. In a patient of this age, the finding most likely represents sequelae of chronic migraine headaches. Less likely, this may represent chronic micro vascular ischemic changes. **There is no specific evidence of demyelinating disease, however, the possibility of demyelinating disease should also be considered due to the patients age. There is no old infarction. There is no Chiari malformation or hindbrain herniation.

Impression: Small nonspecific foci of T2 hyperintensity in the frontal subcortical white matter as described above. In a patient of this age, the finding most likely represents sequelae of chronic migraine headaches. The T2 changes on the MRI do not appear to be suggestive of any specific neurologic diagnosis. They are not worrisome".

While the overall impression seems good, the bolded part has me concerned. I’m trying not to search the depths of Google, but my initial searches lead me to believe that any sort of hyperintensity at my age is not normal. This obviously has me freaked out. Would I be crazy for seeking out a second opinion given the above? Any other advice is appreciated. Thank you all.

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Hi, The only sensible guidance I can think of is to stop Googling neurological jargon, which is just scary out of context, and relax. Chewing your food thoroughly, before swallowing, may be all that you need to do. And do some more relaxing. Best wishes, Anthony

1 Like
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I agree with Anthony, Dr Google is rubbish at helping people figure out their MRI results.

Chew thoroughly and drink water while you eat, through a straw if you find that water makes you choke (sometimes it does because it’s so much thinner in consistency than other liquids).

And just see how things go. It may help to start keeping a diary, if you do have any further problems with swallowing, or anything else, you could just keep a record of what happens and when.

Best of luck.

Sue

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Thank you both, great advice. I will try to be more careful while eating, and also monitor for any additional symptoms (in addition to stopping the use of Mr. Google)

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Hi everyone. Decided to try to reach out to a community of people who might understand what I’m going through. Lately it’s been tough for me, for approx 3 years I have been struggling with random vague symptoms such as eltrical sensations down arms and legs. Pins and needles on the soles of my feet and serious fatigue. Lately the symptoms have worsened, I’ve noticed they come and go randomly. I have developed trigeminal neuralgia in my face which was awful and really tested my emotional well-being. Recently the symptoms are increasing in severity and frequency, a number of weeks ago I woke up with complete double vision and loss in vision in 1 eye. For the past year I have had suspicions that my symptions may be related to MS, however I felt embarrassed when talking to my doctor about it. Now however I feel that there is a strong possibility that I have MS…i have lately been losing my balance and struggling with complete lethargy. Yesterday I had a strong electrical sensation down my neck and spinal cord, I feel anxious now as I don’t know what to expect if I do have MS. I’m turning 30 years old and work as a counsellor. Thankfully my neurological pain isn’t debilitating, it’s just concerning as I’m so young and just don’t know what to do or who to turn too. Has anyone had similar symptoms? I’m currently under review with a neurologist but have no idea of the diagnostic process. If anyone has any tips or advice that would be great. Thanks in advance

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Hi Kbmcc

Your first stop is to your GP, also a trip to the opticians to have your eyes tested, with your double vision they will write a letter to your doctor explaining what they have found and ask them to investigate.

The eye hospital will then test your eyes and may give you a plastic prism to place on a pair of glasses. If needed. They will ask you to come back in a few months where they will test your eyes again as they did with me they tested my eyes again if there is no change they may send you to have an MRI just in case I didn’t know why but they did. With the MRI if there is anything to worry about they will forward you to an appointment with a neurologist, who if he finds anything will ask for more tests. These maybe another MRI and a lumber puncture and lastly a blood test. These tests where for me but if you tell him about your symptoms he may have different tests for you instead. There are a lot of illnesses that have the same symptoms as MS and they have to eliminate them first before they give a diagnosis. The neurologist is the only person who can tell you have MS and they don’t say straight away it can take time.

This is where I am at the moment, with an appointment with the neurologist in April after having a blood test and lumber puncture in my spine the doctor told me in the letter that I had demyelinating disease like legions in my white matter in one area.

If you get an appointment with your GP keeping track of the problems that you are having will help greatly. A timeline of your symptoms too, also if you go and see the neurologist take someone with you as you may miss a few things.

The neurologist will ask you lots of things about your life childhood any illnesses and then do physical tests like touching your nose with your finger pushing his hand down and you push back. All this takes time it’s been thirteen months so far for me and I don’t see the neurologist again until April. Don’t Google as he is not a good doctor.

This is my journey so far but it will be totally different with you maybe.

Good luck

Kay

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Hello

When you say you’re ‘under review’ with a neurologist, do you mean you’ve been referred and are waiting for the appointment? Or that you’ve seen a neurologist?

You should be aware that while your symptoms could fit an MS diagnosis, they could also fit other disorders and diagnoses. So don’t get too set in the idea that what you have is MS. It’s just as likely not to be.

When you see the neurologist, s/he will, as Kay said, go through your past medical history. And in particular talk about the symptoms you’ve experienced over the last few years. It’s a good idea to plan for this by writing yourself a kind of timeline. Write down as far back as you can remember, what the symptoms were, how long they lasted, whether they completely resolved or remained with you.

The neurologist should then do a physical examination. This will include reflexes, responses to significant tests, hand eye coordination type things, following his/her finger with your eyes, balance tests, and maybe many more.

Once s/he has done all of this, they will have some ideas about what they think could be the problem. Some neurologists will talk through their differential diagnosis (ie, it’s not this, but it could be that, let’s rule X out, that test has crossed Y off), others won’t talk through their thinking process.

It is possible that the neurologist will find nothing abnormal in the physical examination. In which case they may declare that there is nothing neurological wrong and either offer you a follow up appointment with them, or not. Or they may find nothing abnormal, but decide to do an MRI or other tests just to be sure.

Or they might decide that there is a neurological problem and send you for further tests. These could include MRI, bloods, Evoked Potentials, Nerve Conduction and Lumbar Puncture. There could be others depending on what the neurologist sees and thinks could be wrong.

Basically anything is possible, it does depend very much on the individual doctor and how the testing goes. Let us know what happens.

Sue

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Hi, thanks very much for your responses. It’s good to know what to expect. I am under a neurologist at the present moment. However, I was misdiagnosed with epilepsy and my neurologist have been changed, I have been attending appointments for MRI scan of my spine (neck) and a brain scan. I have underwent nerve conduction studies and they came back fine. My symptoms have recently progressed into muscle spasms in my right arm, with chronic twitching in my eye (don’t know if they’re even related). Its hard not reading into the symptoms and putting everything down to a possible ms, I have been trying to focus on putting the anxiety and stress on hold until my appointment with the ophthalmologist, as I have rapidly lost vision in my right eye and now have double vision. The timeline was a great recommendation, it helped me see how my symptoms have gradually increased and I feel it will give me a structure to use in my next appointment. Thanks for the comments :slight_smile:

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Hi The double vision can be easily rectified with a plastic lens which can be put on your glasses. It’s not bad the lens is a little cloudy but it’s better than double vision. I don’t know how they will treat anything else eyes wise. Have you spoken to your GP to see if they can hurry up the appointment, also you can do is phone up your neurologist secretary they maybe give you a cancellation. The tests that you may have are for the doctor to cancel out other illnesses not to prove that it is MS. The lumber puncture and blood tests are very quick and as long as you follow the instructions you should not have the headache, the MRI takes a little longer but it doesn’t have any side effects keeping still is hard but they have ways to help you, some people have fallen asleep, not me to noisy you can talk to them any time and they will put on you a pair of headphones. I hope the appointments come quickly. Kay

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Hello

I was just wondering if you had any update? I am in a similar position, I am waiting to see nuero as they have found hyperintensity on frontoparietal white matter, but states not entirely convincing for demyelination.

Thanks