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Please help me understand my MRI

Hi all, I am a 24 year old female. 3 years ago I saw a neurologist due to hand tremors. He examined me and said he could see no other symptoms that you see with MS etc. He ordered an MRI. He mentioned that where I was getting the MRI done the radiologists go overboard and pick up every little thing and some of these things can be quite common and normal. After the results came in I was told by a receptionist at my local doctor that I had to come in as the MRI had picked up on some things. I called the neurologist in a panic who told me that he looked at my MRI and it was fine, that he would be happy if it was a scan of his brain. He also reminded me of what he has said about the radiologists in my area and picking up on abnormalities which do not mean anything. I never got a chance to go back and see him. The other day I asked my local doctor about it and she printed me the radiologists report which has really caused some anxiety: The MRI report reads as follows: Findings: The FLAIR and T2 weighted sequences demonstrate several subcortical areas of hyperintensity within the right occipital and occipitoparietal regions. A small punctate area of hyperintensity within the left sided lateral temporal subcortical white matter area. Elsewhere there is minor bilateral frontal subcortical white matter hyperintensities. These findings are subtle, of 1mm each. The remainder of the corpus callosum and septocallosal junction, brain stem, cerebellar hemispheres, cerebellar peduncle and optic nerves appear satisfactory. Normal signal void within the dural venous sinuses. MRI CERVICAL SPINE: The cervical canal appears normal. The cervical cord appears normal down to approx the T4 level. No evidence of bright signal area within the cervical cord. Normal signal voids within the basilar artery. DWI normal. CONCLUSION: Several intracranial white matter hyperintensities are shown, predominantly within the right occipital and parietoccipial and to a lesser degree small hyperintensities elsewhere. Intracranial demyelination needs to be considered. Should I be concerned or should I be satisfied with what the neurologist told me over the phone. I rarely get tremors anymore only when I am extremely stressed or feeling ancxious or haven’t eaten for an extended period of time. I have no other symptoms. Please help me understand these findings. The MRI was taken when I was 21. I made an appointment to see him but not until November 11. Thank you kindly for any help you can provide.

Hi it sounds like it would be a good idea to get a 2nd opinion. I would be pretty miffed if my MRI report said that and the neurologist said it was fine. Could be something minor but you need some answers. Good luck hun. Oh and I would insist on a cancellation before November! That’s ridiculous x

Hi there is a ‘sticky’ at the top of the newly dx page called ’ a brief beginners guide to the brain and MRI’ have a read through it, it might help you make sense of the report. When you see the neuro ask them to explain exactly what the report has shown and try and find some answers as to why you have the tremor even if it’s infrequent. Good luck

Thanks heaps. Do you think there is a likelihood of MS? The tremors increase with anxiety but only to a level that I notice them.

Thanks heaps. The tremor is really on and off over the years and I notice it when I am anxious or extremely stressed. It is never to a point that someone else has noticed it. Do you think there is a strong likelihood of MS based on the hyperintensities the report mentions. I know what the neurologist said over the phone but I am feeling really sick about it all and hoping someone can put my mind at ease.

Hi Thaid,

Most of this is a bit heavy duty for me, but as I did with a similar post, I will pick out one phrase which to me is key:

Intracranial demyelination needs to be considered

This is not as strong as saying it’s obviously MS, or anything like it, but they are saying some thought should be given to it. So I’m not entirely happy with your neuro dismissing this as over-zealous radiologists. You are young - were even younger then - 21. Although minor, benign, brain abnormalities CAN develop with age, multiple hyperintensities - even small ones - are not a normal finding at just 21! He’d be happy if it was him? How old was he, I wonder? Perhaps OK if he is 70?

I do think you’d be perfectly justified in seeking a second opinion. Besides, three years have now passed, and symptoms have not resolved completely, so it doesn’t seem unreasonable to request a review, without seeming obviously to challenge the verdict of the first neuro.

On the plus side, if it was anything sinister, you’ve had remarkably little trouble from it, for a period of three years, and that can only be a positive thing. If it’s not quite the “fuss about nothing” your neuro seemed to insist, at least it hasn’t been very aggressive.

Whilst there can never be any guarantees with MS (IF it was that), the best and only guide we have to how it might behave in future is how it’s been 'til now. Three years without a major problem is pretty good.

Do ask for a second opinion.

Tina

x

Thanks heaps Tina! The stuff he said to me after the MRI was over the phone and I was suppose to go in for an in depth discussion but never got around to it. I almost feel that when I think about the MRI or possibilities of MS the tremor comes back so I don’t know if it is just anxiety related. Thanks again for your comments. I might see if I can see someone before November because otherwise I might go crazy.

Since the hand tremor is the only symptom, I would have thought, even if it had been accepted as demyelination (I know next to nothing about it) it would have been in keeping with CIS at worst. CIS is one attack, MS is more than one, separated in time and space (different regions of the central nervous system).

Having said that, there are questions to be answered - radiologists are the experts on reading MRI scans not neurologists.

With a diagnosis of CIS nothing would be done in the UK. Remyelination (recovery) is usually incomplete so I wouldn’t worry about that too much. 50% of those diagnosed with CIS do not go on to MS.