Sunday, December 20, 2009 gautamrats asks

Q: Do i have MS ?

hi..

I am a 33 year old male, i had twitching in my eyes 9 -10 months back which did not go for 3 months, so my doc recommended a brain MRI. Later on twitching spread out to other parts of the body aswell. My Vitamin B 12 level too was low 150pg / ml.

my lipids to were bad.
LIPID Profile
® CHOLESTEROL 250.00 mg/dL 130 - 220
TRIGLYCERIDES 351.00 mg/dL 50 - 150
H.D.L. CHOLESTEROL 41.00 mg/dL 30 - 75
L.D.L. CHOLESTEROL(DIRECT) 143.00 mg/dL 30 - 100
SERUM VLDL CHOLESTEROL 70.20 mg/dL 10 - 30
SERUM CHOLESTEROL-HDL RATIO 6.10 : 1
SERUM CHOLESTEROL - TRIGLYCERIDE 0.71 : 1
RATIO

Here are the MRI findings

MR imaging of the brain was performed and high resolution T 1 and T2 weighted serial sections obtained in the sagittal and axial planes. Contiguous fast flair images were also obtained in the coronal plane on a 1.5 Tesa scanner using a dedicated 8 channel phased - array surface coil. Intracranial MR angiography was performed using 3 D Time of Flight technique with MOTSA and the angiogram viewed in multiple projections . T 1 weighted serial sections were also obtained in the sagittal, axial and coronal planes after injections of intravenous (gadodiamide) .
The patient has complaints of pares thesis and fasiculations
The study reveals multiple small T2/ Fast Flair hyper intense focal lesions in subcortical and periventricular white matter of supratentorial brain parenchyma showing corresponding mild hypointense signal on T1 images. None of the lesion is showing any post contrast enhancement .
No restriction is seen on diffusion weighted images . No focal area of signal alteration is seen on the corpus callosum. Remaining brain parenchyma is unremarkable . Bilateral basal ganglia . thalami and internal capsules are normal. No abnormal meningeal enhancement is seen.
The cerebellum , pituitary and brainstream are un remarkable.
The lateral, third. Fourth ventricles are normal in size, shape and position. The basal cisterns, fissures and sulci are normal.

Intracranial Mr angiography reveal normal caliber and flow signal of bilateral intracranial internal carotid arteries. Bilateral anterior, middle abd posterior cerebal arteries are normal in course , branching and flow signal. Right vertebral artery is hypoplastic representing a normal variation. The visualized vertebrobasilar system is unremarkable. No evident AVM/aneurysm/flow limitation is seen.
Opinion: Mr findings are suggestive of multiple focal non enhancing T2/ fast flait hyperintense focal lesions in supratentorial white matter. These are non specific in appearance and may representing demyleniating/ chronic ischemic foci. On comparison with previous MRI(done 4 months before this mRI) No significant interval change is seen .

Now the situation is that Neurologists says that clinically i don't have MS , but these lesions may be because of MS, which has really disturbed me.

Can these lesions specify MS ?
Can they be harmless througout ?
Can these lesions be caused because of my Vitamin B 12 deficiency ?
Can they be by birth ?

Please give me your opinion on this?

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Answers (1)

Lisa Emrich, Health Guide

12/20/09 7:32pm

Hi,

It is certainly scary and frustrating when going through the diagnosis process but not getting a definitive diagnosis. Thank you for sharing so much detail in the MRI report. Basically the concern is with the "multiple small hyperintense focal lesions" in the white matter. Lesions can be caused by different events or diseaeses.

The radiologist mentions possible causes include a demyelination (such as in MS) or chronic ischemic causes (which could be migraines, vaculitis, TIA, and other things I can't speak to). Read What is a Lesion?

Your neurologist is saying that these lesions look like ones seen in MS. Finally lesions on an MRI is not the only thing which is necessary to diagnosis MS. There is no definitive test and basically evidence of demyelinating and changes over time is necessary before a diagnosis can be made. Since you had and MRI done 4 months previously and no changes were seen, the neurologist can't officially diagnose you with MS. Read Beginner's Guide to MS: Do I have MS? What does it take to get diagnosed with MS?

Did your neurologist recommend additional testing, such as Evoked Potentials testing or a Lumbar Puncture, to look for other evidence of possible MS? The tricky thing with vitamin B12 deficiency is that many of the symptoms are the same as symptoms for MS. B12 deficiency can even cause demyelinating lesions in the brain and spinal cord.

What did you neurologist say is the next step? Does he/she want to repeat the MRI scans in 6 months, maybe including the spinal cord with the brain? What are you doing to treat the B12 deficiency? Lots of questions, I know.

But just that your neurologist says that these lesions could be caused by MS, and that you don't clinically have MS, it sounds like he/she will be watching for evidence of another MS "attack" or evidence of change on the MRI in the future. So for the meantime, you are in limboland. I'm really sorry about that, it is no fun indeed. But for an MS diagnosis to be made, certain criteria must be met (read linked post above).

If you've got any other questions, please feel free to ask.

gautamrats

12/20/09 10:23pm

Hi... Thanks for writing. I got Evoked potential test done which was normal.I showed to a couple of Neurologists, One advised me to have another MRI after 6months , the other one which i felt was more experienced
did not feel need of another MRI. As per him lesions may be because of many reasons and he did not find any clinical symtoms so he did not fell need of an MRI. For Vitamin B 12 I am taking Methylcobal medicine , at present my Vitamin B 12 levels are good
around 600 pg /ml and My eye twitching has vanished but yes twitching at other parts of the body is still there which may be because of BFS, Only concern is that Do people have non specific lesions like My MRI report said "Opinion: Mr findings are suggestive of multiple focal non enhancing T2/ fast flait hyperintense focal lesions in supratentorial white matter. These are non specific in appearance and may representing demyleniating/ chronic ischemic foci."
If yes then what are the chances ? I am still un married at this time and have been delaying so, as i am scared about the disease. Do u feel that this may be just starting of disease where lesions are there but not symtoms as of now and if it is caused by MS then how long it may take to show the effect or another attack ?

What if after 6 months of MRI there is no change in MRI findings ?

Lisa Emrich, Health Guide

12/20/09 10:47pm

I'm sorry, but there is no clear answer. We can never know what will happen in the future. People can have non-specific lesions as they get older just as part of aging. Lesions can be caused by many different things.

Even when someone has MS, the presence of lesions does not mean symptoms at times and symptoms do not necessarily mean new lesions. Lesions can come and go and we may never know it.

The very good news is that you are already seeing improvements with addressing your vitamin B12 deficiency. That's great!!

Nobody can predict the future, but my recommendation would be to NOT delay living your life. Do not put things on hold.

Without symptoms showing at the time, it is difficult for a neurologist to make a diagnosis when there is not enough evidence present. It sounds like the neurologist who advised a repeat MRI in 6 months will be looking for any changes on MRI. I don't know the answer to this, but maybe fixing the B12 deficiency might cause the lesions to go away. I really don't have the answer.

Sounds like you have already sought a 2nd opinion which is wise. Perhaps the part which is important to realize is that the presence of lesions does not mean that you will develop disability sooner or later, or even develop MS in the end. Even if you do have another attack, it might not be for 10-15 years (which is not uncommon). If you have another attack within the next year, then you will have your answers sooner.

But most importantly, you may never develop MS. If you begin to have new symptoms (perhaps numbness on one side of the body or limb, loss of balance, visual problems, weakness, or other typical MS symptoms) then definitely contact the neurologist you are most comfortable with.

gautamrats

12/21/09 4:14am

So can we reach a conclusion at this moment that these lesions which i have are not due to MS ?or Can it be my first attack was a silent attack as i never came to know about it but it left lesions ?

Suz

12/21/09 8:32am

Hi - I just wanted to share with you my situation - 1 1/2 years ago I also had nystagmus and double vision, extreme fatigue, weakness. Tremors came abotu 4months after the initial event. they come and go as along with many other things and fatigue and stress make the old ones come back. Prior to the event (abotu 1 year prior) my right hand was tingling (like pins and needles) for 6 months - but I never saw a doc for that and really disregarded it at the time. One morning I woke up and it was just gone. when I went to the doc due to vision, balance and fatigue issue (i couldn't ignore them), I went thru the battery of tests it sound like you've gone thru -

I did not have b12 deficiency however - which is a mimicer of MS. I was tested for all the mimicers and all was normal except low D and A. besides my MRI which showed a large lesion on cerebellum and two non specific lesions and other hyperintence signals - inflammation in brachium pointis - i am still in this state of "limbo". I have been diagnosed with a "clinically isolated symdrome" which means I've had the one clinical attack. They haven't found any new lesions since the event. MY EVPs, spinal etc. were all normal - and won't give an official MS diagnosis. It couldve been a virus they said - but I happen to know that the week of undo stress is what pushed my body over the edge. I wasn't sick no fever no pain etc. at the time this happened. Just felt as if I was going to die.

There is no quick answer - they go by the macdonald criteria and certain events and testing has to come back to meet that criteria b4 or if a firm MS diagnosis happens. I went to one doctor who after telling me all of this said "well it's about as clear as mud now right?"

I'm sorry you have gone thru this - I know how frightened i was when I heard them say we think you could have MS and probable MS. It's been a long journey so far and I've learned so much inthe process. I spent many months trying to figure out the puzzle and was devistated every time they said nothing new because I was never "myself" after the initial attack - I had to take a deep breath and just let it be. Dealing with issues that come up as best I can by rest and pacing myself and i also keep a journal of any unusual things that happen to present to the doc when you have follow ups.

Keep doing what you can to help yourself and inform yourself. I wish you the best and hope for clarity for you.

Suz

gautamrats

12/23/09 11:21am

Can i do weight training ? Any precautions to be taken ?

gautamrats

12/24/09 4:39am

Hi Lisa..

Though i dont have any of the symtoms which suggest MS , can i workout normally at the gym ? and what else cause "multiple small hyperintense focal lesions ", are there other causes of the same ?

Lisa Emrich, Health Guide

12/24/09 8:06am

Hi,

I'm not a medical professional, just another patient who has MS, but possible causes of lesions include MS, migraines, vasculitus, normal aging, and more. I do not know ALL of the possible causes just some of the more common.

I also can't give specific advice regarding exercise and things. There is nothing about MS (or having lesions) which directly means that one cannot work out or weight lift within their capabilities. There are not specific dangers for that.

Do take care of your physical health. Keep your body in as good physical condition as well. Weight lifting and going to the gym are good things for all of us in general, but even still each person has their own needs and requirements.

I am not allowed to tell you that it is safe for you to lift weights or go to the gym. No matter what medical conditions we each might have (or not have), it is wise to consult with your personal physician before being any exercise program.

What is safe for you might not be safe for the next guy, or the same in reverse. Talk to your doctor to see if he/she feels that it is appropriate for you to be lifting weights and engaging in heavy physical training and activity. That's the best answer I can give.

Take a deep breathe and let it out slow. Do that again....and again. Things WILL be okay. You WILL be okay.

Q: Do i have MS ?

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