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three page letter with big words help!!

following a second opinion request from my gp and specialist nurse(as i had to accept a diagnosis of m.e) i am now armed with a three page letter with big words…help!!i have to have a new mri next friday and he has stated if any further lesions he will diagnose m.s.

findings in m.r.i a year ago.

a couple of areas of increased signal in a peri-ventricular distribution with a couple sub-cortially placed in keeping perhaps with inflammatory demyelination…???

physical exam…

lower limbs…there is a suggestion of increased tone bilaterally with a hint of hip flexion weakness.there are pathalogically brisk reflexes with spread and a couple of beats of clonus,however plantas where down going???

this is clearly a difficult case,however i do believe that there is underlying inflammotory demyelination given last years brain scan results and the clinic findings in her legs???

i understand most of the rest of the 3 pages!!!help!!

tracey

Rizzos the one to interpret for you. Hopefully shell see your post.

It`s a minefield, I know!

pollxx

i know i was waiting for her to see it…but maybe i wont as i have kaeildescope eyes at the minute!!

tracey

“a couple of areas of increased signal in a peri-ventricular distribution” means that you have two lesions (or two areas of damage) next to the lateral ventricles. The lateral ventricles are the main reservoirs of cerebrospinal fluid in the brain. They are in the middle of the brain and are surrounded by white matter (the stuff in the brain that does all the communication between different areas). Lesions are very common there in MS.

“a couple sub-cortially” means that you have a couple of lesions in the white matter next to the gray matter of your brain, the stuff that forms the outer layers of the brain and does all the thinking, encoding, storage, etc. If you read my sticky post about the brain & MRI, this will hopefully make more sense.

“in keeping perhaps with inflammatory demyelination” is saying that your lesions look like they are due to MS or another type of condition that causes demyelination (the loss of the myelin coating on nerves) through inflammation. Sorry, it’s a bit tricky to explain this without repeating the words “inflammatory” and “demyelination”!

“lower limbs…there is a suggestion of increased tone bilaterally” means that your legs are stiffer than they should be because of tight muscles. This is normally a sign of a problem with the upper motor neuron, the pathway between the brain and the spinal cord that tell muscles when to relax.

“with a hint of hip flexion weakness” means that your hip flexors (the muscles at the top of our thighs that we use to pull our knees upwards) are weaker than they should be.

“there are pathalogically brisk reflexes with spread and a couple of beats of clonus” means that when the neuro did your knee reflexes, your legs shot up more than they should and then your foot tapped a couple of times. This is another upper motor neuron sign.

“however plantars where down going” means that despite the above, when the neuro scraped the soles of your feet, your feet made a normal (downward) response. An upper motor neuron problem often results in an abnormal plantar response – hence the “however”.

“this is clearly a difficult case” is either true or it’s the neuro telling the previous neuro that he/she was wrong

“however i do believe that there is underlying inflammotory demyelination given last years brain scan results and the clinic findings in her legs” means that the neuro believes that your MRI and the abnormalities in your lower limbs that showed up in your clinical exam (when he did the reflexes, etc) mean that you have something going on that is MS or another condition that causes demyelination. Given that the neuro has told you he’ll diagnose MS if you have new lesions, he clearly thinks it’s MS and not another condition. There are other possibilities though and you should certainly ask him to explain what else he’s considering so you are fully informed.

I hope the MRI sorts everything out for you!

Karen x

i knew you would help!!!i understand it a bit more now.thank you.tx

You’re welcome :slight_smile:

Kx

its a bit sad that you are waiting for a new lesion so you get a diagnosis…no body wants m.s but nobody wants to go untreated for longer than is necessary!tx

its a bit sad that you are waiting for a new lesion so you get a diagnosis…no body wants m.s but nobody wants to go untreated for longer than is necessary!tx

The update to all this is this is the fourth week that i can not walk.its like walking on my knees.every day my carers have tried to get me outside i get as far as two doors down,very slowly and by looking at my feet to help my legs work.then i get slower and slower and my legs aren’t there…my gp faxed neurologist at the onset but no response as i knew he would wait for the new m.r.i results.i had it 9 days ago on a friday so what do i do now.ring gp and make them aware i still cant walk?or email neurologist secretary with update to see if any results or both?i know this condultsnt isn’t a great lover off iv steroids so therefore i guess its a time factor i was treated a year ago with 4 days of iv steroids and i didn’t respond immediately but improved within a couple of weeks.whether that was the steroids or not i don’t know.either way i cant go on like this.i have a four year old and sm having to stay with family to look after him.help rizzo.tx