I’m new and have as yet not officially received a dx.
A few weeks ago I was admitted to hospital with a numb right leg - numb is an understatement, I was dragging it along the floor, had no movement or sensation in it.
I had an MRI and then spent the next 5 days in hospital having a course of IV steroids.
No one mentioned MS until I was given my discharge notes and it reads like this…
MRI Head:
There is confluent T2 high signal change seen anteriorly in the patients periventricular white matter. In addition, there are smaller lesions arranged perpendicular to the ventricular margin in the corpus callosum, seen best on the patients sagittal FLAIR sequences. There is a further, relatively large, cortical lesion seen medially in the patients left precentral gyrus.
MRI Spine:
In the cervical spine, there is anterior high T2 signal seen on sagittal images. The cervical spine, which I think on balance is likely to represent gibb artefact.
Diagnosis:
Demyelination consistent with MS.
The course of IV steroid worked a treat and apart from a small patch of numbness and less strength my right leg is fine. Im waiting for an appointment to see the Neuro.
Does anyone know enough about the medical jargon to say whether there is a high possibility that this is MS?
I can’t help either I’m afraid but I find it shocking, disgraceful and totally irresponsible of the hospital to send you home with that on the discharge letter when no one has talked to you about it!!
I hope you get looked after properly and find out exactly what’s going on soon.
I can interpret the jargon for you, but I must warn you that I am not a radiologist or a neurologist so I could be wrong.
Before I do that, I wanted to agree with Deb - what an irresponsible thing for the hospital to do! I really hope you will make a formal complaint.
A brief intro to the brain that will put the rest in context. There are three main types of brain matter: gray matter (which is where all the encoding, processing, “thinking”, etc is done), white matter (which is the stuff that carries signals between different bits of gray matter) and cerebrospinal fluid (CSF, which acts a bit like the oil in an engine). The outer layers of the brain are made up of gray matter. It is called the cortex and is made up of lots of folds called gyri (the singular is gyrus). The creases between these are called sulci (sulcus is the singular). Anything to do with the cortex is called cortical. CSF bathes the brain, filling all the nooks and crannies. It also lies in sort of reservoirs. These are called ventricles. Anything next to the ventricles is called periventricular.
Now a wee bit about MRI. Different types of brain matter show up as different shades of gray on different types of MRI. Basically, the computer settings are changed to best show up the stuff you are most interested in and the bits of the brain giving off high signal look brighter in the resulting images than the stuff with a low signal. The main types of scan are called T1 and T2. In T1 scans, gray matter looks dark gray, white matter looks pale gray and CSF looks black. In T2 scans, these are reversed so gray matter looks paler than white matter and CSF is white. Lesions do not show up at all well on T1 scans, but have a high signal with T2 settings so show up as anything from pale gray to bright white. It can sometimes be difficult to spot lesions on T2 scans because of all the white from CSF, so a type of T2 scan called FLAIR is used too. This suppresses the signal from CSF so it shows up black instead of white - that way lesions (should) show up nice and clearly.
Just typed all that and realised that it is probably FAR too much info! Never mind - I’ll leave it now
So…
MRI Brain:
“There is confluent T2 high signal change seen anteriorly in the patients periventricular white matter.” means that there is an area of joined / joining up white patches in the forward (towards the eyes) part of the white matter near the ventricles. This basically means that you have a group of smaller lesions that are joining up.
“In addition, there are smaller lesions arranged perpendicular to the ventricular margin in the corpus callosum, seen best on the patients sagittal FLAIR sequences.” The corpus callosum is the main tract of white matter joining the two halves of the brain - it allows the left and right sides of the brain (and body) to know what each other is up to and to work together. It is next to the lateral ventricles (the ventricles in the middle of the brain; one in each half). So there are smaller lesions lying at right angles to the edge of the corpus callosum that is on the same side as the lateral ventricles. These were best seen on the FLAIR images taken in slices from ear to ear, parallel to your nose.
“There is a further, relatively large, cortical lesion seen medially in the patients left precentral gyrus.” There is a relatively large lesion in the middle portion of the gray matter of the precentral gyrus - this is the fold that contains the motor cortex (the gray matter that controls voluntary movements like reaching and grasping, walking, etc). The left motor cortex controls the right side of the body so this will be the source of the problems with your right leg.
MRI Spine:
“In the cervical spine, there is anterior high T2 signal seen on sagittal images. The cervical spine, which I think on balance is likely to represent gibb artefact.” This is nothing to worry about. The cervical spine is your neck. This is saying that there is a white line towards the front of your neck images, running parallel to your spine, BUT it is an error that is well known enough to have its own name. It is not a lesion.
Diagnosis:
“Demyelination consistent with MS.” This does not say that you have MS. Indeed, it would be incredibly wrong of a radiologist to say this because they don’t have all the facts. Demyelination is the term for the process that causes MS lesions. It is also the process that happens in other conditions, some of which are one offs: the patients gets a sudden attack of demyelination, they get better (to varying degrees) and they never get it again. So, although the white patches and spots in your brain are consistent with MS (this is because of where they are and what they look like), it could still be something else.
So you know, the diagnostic criteria for MS stipulate that the patient has to have at least two lesions in particular places (it sounds like you would meet this criterion) and have had at least two attacks (it sounds like you don’t meet this one?). If you would like to know the full details, you can google Polman et al (2011). Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald criteria. ANN NEUROL, 2011, 69, 292-302.
I hope this helps and doesn’t add to your worries. If you want to know more or anything isn’t clear, please just ask - I’ll do what I can to explain.
Thank you all for your responses ~ and thank you Karen for explaining the MRI report. I couldnt make head nor tail of it and spent ages googeling every paragraph to see if it made sense… it didn’t.
I am certainly complaining about this and the general way I was discharged.
Thank you all for your responses ~ and thank you Karen for explaining the MRI report. I couldnt make head nor tail of it and spent ages googeling every paragraph to see if it made sense… it didn’t.
I am certainly complaining about this and the general way I was discharged.
