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Newly diagnose and confusing MRI

Hi all… I’m fairly new to this site but I have been reading through all of the posts and they have been very insightful and helpful so far. I am a 26 year old female diagnosed with ms one month ago, while I was working and living in Australia. I have just returned home n.ire :frowning: for some much needed support from my family and friends!! It hasn’t really hit me yet as in oz I was constantly busy which kept my mind off things and my friends over there were great but we just got back to normal life when I got discharged from hospital (after 10days!!) My first examination findings were: unsteady gait, leaning to right Hall pike manoeuvre positive to left head movement Reduced sensation to sharp/dull across entire right face, including forehead Impaired heel-shin coordination on right. I’m just a bit confused about everything at the minute, like is it definitely MS?. I’m waiting on seeing a neurologist here at home, I seen a neurologist in Sydney and they were great… I was admitted then I had MRI, then lumbar puncture all very quickly… I have the results of my MRI, but I am so confused when reading them and my appointment with my new neurologist isn’t for a few weeks… Hopefully I won’t have to get another MRI as I have my brain and spinal presentation on a DVD from Australia!! Does anyone know will I have to have another MRI or lumbar puncture (I’m hoping not and that it was a once off diagnostic tool!) Any help would be greatly appreciated, while I wait. Ash x

Hi Ash, and welcome :slight_smile:

Whether or not you’ll need the tests done again will depend on the neuro you see: some are happy to accept info from elsewhere, but some are not. I can’t see that there would be any need to have the LP done again if an MRI is conclusive though.

I’m pretty sure that Australia follow the McDonald diagnostic criteria, but from what you’ve written, it sounds like you only had the one attack? If that’s the case, the NI neuro may want to wait to see if you definitely have MS as to diagnose that you need to have had at least two attacks (or a year of worsening symptoms).

If you want to know what the MRI report means, just post it on here and I’ll interpret the jargon for you. You could have a look at my sticky post about the brain & MRI first though: that might explain it without you having to type it on here.

I hope the appointment goes well and that the neuro doesn’t see the need to send you for loads of tests again!

Karen x

Hi Karen, thank you for your reply :slight_smile: Hopefully I won’t have to have another LP, it was horrible!! Yes, they do follow the McDonald diagnostic criteria for identifying MS. I have had only one attack and I was treated with pulsed methylpred for 3 days and my symptoms improved. I did continue to have a headache/nausea post LP but thankfully this gradually improved. I had a look at your post on the brain and MRI, it was awesome!! It has helped me interpreted my results to an extent, but I will post them up anyway if you could just simplify it for me a little bit that would be of great help, I’m a little lost! Findings: There are several small T2/FlAIR hyperintense lesions In the peri ventricular region on the left and in the juxtacortial white matter region in the left frontal lobe. They are not restricted on DWI or enhanced on the postcontrast There is a further T2/FLAIR hypertension lesion located in right brachium pontis, measuring 12x12mm which is the largest of all the identified lesions. It demonstrates modular enhancement but is not restricted on DWI. Also, I am EBV positive (is there any significance to this?) Sorry for rambling on and your time and help is greatly appreciated Ash x

Have to post and run, so no time to do things in detail. Hope it makes sense!

You have several, small, white spots showing on the T2 and FLAIR scans. These are lesions. They are in the left half of your brain, next to the lateral ventricles (periventricular), the “lakes” of CSF in the middle of the brain, and next to the gray matter in the front half of your brain (juxtacortical in left frontal lobe). These lesions are not currrently active. There is also a lesion of the brachium pontis, one of the bits that joins the cerebellum to the pons (in the brain stem). It is 1cm x 1cm, which is a little on the large size for MS (the average lesion is 7mm), but is still perfectly normal for MS. Sorry, but I don’t know what “modular enhancement” means and no time to investigate. The fact that there is no restriction on the DWI scan suggests that the lesion is inactive, but there is some sort of enhancement on the gadolinium scan which suggests that it is.

The neuro must have accepted that the cerebellar lesion was active and the others were not (ie it was new and the others were older), which in the newest application of the McDonald criteria mean that diagnosing MS is possible, despite you appearing to have had only the one attack.

Have to dash. Let me know what’s not clear and I’ll try and reply later.

Kx

Hi Karen, Thanks very much for your reply. Just a few quick questions. If the several small lesions on the left side of my brain are inactive why did I have an unsteady gait to the right? Does the left side of the brain not control the right side of my body?( sorry for my ignorance!). Also, I am a bit worried about the size of the lesion on the right, does this make it abnormal for MS and could it be anything else?. I have given my neurologist here all my notes and scans from oz so now it’s just waiting to see him and take it from there. Thanks again Ash