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Thread: Help me understand this Lingo Pls.....

  1. #1

    Question Help me understand this Lingo Pls.....

    I just received this but I need help understanding the particulars and language - can someone help me out with more laymans' terms, and offer your opinions on my Provisional Diagnosis.

    MRI BRAIN and ORBITS

    Sagittal T1 weighted, axial proton density and T2 weighted sagittal FLAIR and axial post-gadolinium T1 weighted sequences of the brain were performed. Multiple areas of demyelination are evident throughout the periventricular white matter. The changes are most prominent in the right occipital lobe where the periventricular white matter is diffusely increased T2 signal intensity. Many of the individual smaller lesions have their long axis perpendicular to the ventricular margin and are typical of demyelination. Following the administration of Gadolinium there is enhancement of two left temporal lesions and a left parietal periventricular lesion. There may be subtle enhancement of a second left posterior frontal subcortical white matter lesion. The coronal spur sequence of the orbits demonstrates no significant interval change.

    MRI CERVICAL SPINE

    Sagittal T2 weighted, axial MEDIC sequences of the cervical spine were performed. Degenerative changes with posterior disc prominence and ridge osteophyte formation are evidence at C4-5 and C5-6. There is mild bilateral C5 and C6 foraminal narrowing. The spinal cord signal intensity is normal throughout.

    A small lesion in the left lateral aspect of the medulla is noted.
    ____________________

    What would be the diagnosis of these results???
    Last edited by jessgypsy; 08-10-2011 at 10:13 PM. Reason: typo

  2. #2
    Hi,
    I will ask Dr Young to comment when he can. Meanwhile, I suggest you discuss these findings with your doctor who ordered the test.

    AAD

  3. #3
    Quote Originally Posted by jessgypsy View Post
    I just received this but I need help understanding the particulars and language - can someone help me out with more laymans' terms, and offer your opinions on my Provisional Diagnosis.

    MRI BRAIN and ORBITS

    Sagittal T1 weighted, axial proton density and T2 weighted sagittal FLAIR and axial post-gadolinium T1 weighted sequences of the brain were performed. Multiple areas of demyelination are evident throughout the periventricular white matter. The changes are most prominent in the right occipital lobe where the periventricular white matter is diffusely increased T2 signal intensity. Many of the individual smaller lesions have their long axis perpendicular to the ventricular margin and are typical of demyelination. Following the administration of Gadolinium there is enhancement of two left temporal lesions and a left parietal periventricular lesion. There may be subtle enhancement of a second left posterior frontal subcortical white matter lesion. The coronal spur sequence of the orbits demonstrates no significant interval change.

    MRI CERVICAL SPINE

    Sagittal T2 weighted, axial MEDIC sequences of the cervical spine were performed. Degenerative changes with posterior disc prominence and ridge osteophyte formation are evidence at C4-5 and C5-6. There is mild bilateral C5 and C6 foraminal narrowing. The spinal cord signal intensity is normal throughout.

    A small lesion in the left lateral aspect of the medulla is noted.
    ____________________

    What would be the diagnosis of these results???
    jessgypsy,

    Depending on your symptoms and history, the first diagnosis that pops up is multiple sclerosis. Multiple areas of diagnosis in the brain would be consistent with MS. However, the detailed description suggest that the demyelinated zones are not typical of multiple sclerosis which tend to cause "plaques" with "lumpy-bumpy" appearance. The descriptions of your demyelination zones are not consistent with plaques.

    I would therefore consider acquired toxic demyelination symptoms and leukodystrophies as potential diagnoses, described in the following site http://spinwarp.ucsd.edu/NeuroWeb/Text/br-840.htm. Several of the lesions enhance, which happens with adrenoleukodystrophies. The diagnosis will depend on how long you have had symptoms, how old you are, whether you are immune-compromised, history of infectious disease, and family history of leukodystrophies.

    Wise.

  4. #4
    Interesting. I am 52 yrs old, and this diagnosis was just given to me July 15th. I have started Copaxone treatment - I just wonder though, it trauma to the head could cause lesions. My EX bashed my head in the wall four times..on the upper left side of my head in 2005. I have had severe headaches, facial pain, and pain behind my left eye since.

    I am concerned that the doctors are misdiagnosing me. That is why I will now research your link for more info. Thank you for helping me out.

    I also have Optic Neuritis, as the back of my left eye is White, and the Neurologist cannot see the optic nerve - however the right eye is normal and pink. Seems too many correlations, so I am wondering if the trauma could cause these conditions.

  5. #5
    Jessgypsy, your brain lesions and optic neuritis are highly suspicious for MS, but if you are concerned that you might have been misdiagnosed, I think it would be a good idea for you to have a lumbar puncture. The lumbar puncture doesn't always lend support to the clinical diagnosis, but in many (if not most) MS cases, it does; it is also useful for ruling out some other conditions, especially in conjunction with extensive blood testing. MS has many mimics and those need to be ruled out prior to committing to treatment with Copaxone. (Indeed, you might have already had a lumbar puncture, as my neuro told me that most insurance companies will not pay for Copaxone without lumbar puncture supporting a diagnosis of MS - not sure if that is still the case.)

    Did you discuss your prior abuse and trauma questions with your doctor? This is something he really needs to know, especially since you began to experience headaches, eye and facial pain afterward. You might have sustained injuries in addition to MS. I don't know the answer to your question about whether or not abuse could produce the lesions seen on MRI - please do share your concerns with your doctor, if you haven't already done so. The more information he has, the better your treatment is likely to go. Best wishes to you.

    Edited to add: Have you had x-rays of the skull and cervical spine? I'm wondering if you've sustained fractures.
    Last edited by Bonnette; 08-13-2011 at 07:04 PM.

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