Other causes for high signal lesions on MRI?

I’ve had various symptoms over the last 18 months, including pins and needles, dead/heavy feeling to right arm and leg, numbness to the right side of my face, burning sensation over various parts of my body, fatigue and other things. Two MRI’s since January have shown multiple high signal lesions in the white matter with possible demyelination. The first doctor I saw said it’s not MS, come back in six months maybe the symptoms would have faded by then. He also told me that evoked potentials were normal ad the MRI results were nothing to worry about I got copies of my MRI scans and they also showed neuroglial cysts in the basal ganglia. As I work in a GP surgery I found out the person I saw is a hospital registrar and not a consultant so I asked for a second opinion. I’ve got an appointment on 3rd November with the clinical lead for MS at another hospital. My GP says he can’t see what else it can be but MS. I’m 48, never had high blood pressure, migraines or high cholesterol, gave up the ciggies years ago so I don’t think I’m at high risk of any vascular disease. Is there anything else that could be causing these symptoms? I’m so worried that I’m going to get the same answer again. Lynne

Hi Lynne, and welcome to the site :slight_smile: There is actually a long list of things that can cause high signal in white matter, but the fact that the radiologist mentioned demyelination should rule out a lot of them - the size, shape and location of lesions give really good clues about possible cause. If you restrict the list to demyelinating conditions, then there are about 30. My MRI “bible” groups them into: - primary demyelinating conditions (basically variants of MS & NMO) - demyelination as a result of infection or vaccination (e.g. ADEM) - demyelination as a result of deficiency (e.g. vit B12) - demyelination as a result of physical/chemical agents (e.g. from radiation) - genetics (e.g. ALD, AMN). If the radiologist was wrong, then there really are hundreds of possibilities :frowning: Neuroglial cysts are a new one on me so I had a quick google - if what I read was right (and I understood it right!), I don’t think they are anything to worry about. It said that they are congenital abnormalities and congenital abnormalities in the brain rarely cause any symptoms as far as I know (i.e. if they were going to cause a problem, they would have done by now). The best advice I can give you is to make a concise list of your symptoms (ideally with approximate dates and durations) to talk through with the neuro (take a copy for him/her, but don’t give it to them until after you’ve talked through it so they can’t just shove it in your file and move on!), take a copy of the radiologist’s report with you just in case the new hospital can’t access it or it hasn’t been forwarded with the referral (take the disc too if you have it), and take someone with you to the appointment to back you up and to provide an extra pair of eyes and ears. I also recommend reading the paper published earlier this year updating the McDonald criteria for diagnosing MS. If I were you, I would want to know exactly how my history, clinical exam, MRI and other test results compare to these criteria. The paper is: Polman et al, Diagnostic Criteria for Multiple Sclerosis: 2010 Revisions to the McDonald Criteria. ANN NEUROL 2011;69:292–302. It’s free to download - just google it. Btw, evoked potentials are not considered to be a robust test for MS. Many people with confirmed MS have normal EPs. If you’re up for more reading, you could also have a go at the NICE CG8 full guidelines for multiple sclerosis. Beware - it’s a monster document! I hope this helps and that you get some decent answers this time. Please let us know! Karen x