Thursday, August 06, 2009 KJ asks

Q: Help With Medical Terminology

I just received a copy of my medical records and was looking at my MRI results. I could use some help with some of the jargon.

Under FINDINGS it says, "There are a few small focal areas of T2-FLAIR signal hyperintensity in the white matter of the corona radiata and centrum semiovale, the largest of which appears to measure 7mm and involves the left central semiovale. There are no areas of signal drop-out seen on the gradient images to suggest hemorrhage or calcification."

Under IMPRESSION it says, "There is a mild amount of nonspecific focal white matter disease in the corona radiata and centrum semiovale bilaterally. The differential diagnosis includes demyelination (including chronic ischemic demyelination), vasculitis or post infectious etiology. Clinical correlation is advised."

My neurologist has told me that she believes MS is a possibility but that the lesions she has seen are "normal for my age". She wants to do a lumbar puncture in the near future to help "rule out" MS.

Thanks for the help,

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Answers (3)

Lisa Emrich, Health Guide

8/ 7/09 2:31pm

Hi KJ,

These MRI reports can be fascinating and quite confusing. Before I tackle some of the jargon, let me tell you about a webpage I just found from which you can look at images with different parts of the brain labelled. Pretty cool. See here. Just click on the phrase associated with each location. Look specifically at the White Matter category.

"small focal areas of T2-FLAIR signal hyperintensity" - this describes lesions (focal areas, signal hyperintensity) which can be seen on the film when they used the T2-FLAIR pattern of imaging.

"corona radiata and centrum semiovale" - these are different areas of the white matter in the brain. See that link above for images.

"nonspecific focal white matter disease" - this is based on the lesions described above.

"demyelination (including chronic ischemic demyelination)" - this could mean MS or one of the many other causes of demyelination, including carbon dioxide poisoning.

"vasculitis" - inflammation of the walls of the blood vessels resulting in damage

"post infectious etiology" - caused by previous infection

The lumbar puncture and testing of the cerebrospinal should reveal O-bands if you have had active demyelination going on. They also test for specific proteins too.

The lumbar puncture provided enough evidence for me to get the "probable MS" diagnosis at the time. Then, it was just developing new lesions in the following months which earned me the definite MS diagnosis.

Sounds like you are getting one step closer. Hang in there.

8/ 7/09 6:29pm

Thank you VERY much! Though my cognitive situation is better than it has been in a long time, I frequently question what I think I understand and need a second set of eyes (and a brain) to help me through it.

I'm recovering from eye surgery right now. They discovered a growth behind my eye when they did the MRI and the neurologist thought the growth might account for some of my visual problems and, therefore, help disprove the MS. They went in on Monday and removed a cyst. The biopsy results haven't come back yet, but the docs don't think it was cancerous. Unfortunately I still have as much double vision as before and the number of flashes, shadows, and other odd visual things are also about the same. At least now that we have the vision problem checked out we can go back to considering neurological causes.

Thanks so much,

Lisa Emrich, Health Guide

8/ 7/09 7:55pm

I'm glad you are recovering from the surgery. Sorry about the continued symptoms, or maybe it's a good thing if it gets you closer to an accurate diagnosis. Hope you're doing well and enjoy the weekend.

8/ 8/09 3:36pm

Thanks Lisa,

I'm still just laying around the house trying not to rub my sore eye. I hope to get the stitches out on Monday and will try to set up a lumbar puncture (oh boy!) for sometime soon.

Hollyk

8/10/09 1:37pm

Hi KJ, it looks like your getting closer to a diagnosis; sorry about having to heal from surgery; but I'm glad that you had that taken care of. How is it "normal" for you lesions for your age? You look about my age-if so, it isn't normal to have any lesions. I don't think it is supposed to be normal at any age...but, I'm not a doctor.

I know it stinks to have to sit around and suffer while they try to figure things out; my doctor pulled back on the steroids after having me go in and waste a bunch of time. He wanted another blood test first (the same one they already did; but I guess the 1st and 2nd negative weren't good enough) to prove I do/don't have an antibody autoimmune disease. So, they make a statement such as "We know it seems cruel to let you suffer without getting any relief-but we have to do more testing while there is nothing in your system." Ugh!

At least you have some very good results for getting a more definitive diagnosis. I'll keep praying for you and your family to get the answers you need. Take care!

8/10/09 8:30pm

Thanks Holly,

I'm sorry to hear about the wasted time with the steroid injections. I was hopeful that, if you responded to the steroids, it would help with a diagnosis.

I asked a few months ago what's normal about my lesions? I was told that it is normal to start seeing a few small age-related lesions at about this age - I'm 48. She did say that a 7mm lesion is not that small.

I found out today that the cyst they removed from behind my eye was completely benign, but it was a little larger than expected. The doctors were hopeful that the cyst was the cause of my double vision but they now think that the double vision may be related to "the other series of problems" (neurological) that I have. I left a note with my neurologist asking for her help in setting up a lumbar puncture now that the eye problem has been addressed.

I haven't had any kind of serious flare-up for a long time. I've had worse than usual tremors and twitches, but I can live with that just fine as long as my mind continues to functional normally.

Thanks for the prayers and I'll keep you in mine,

Mandy

8/17/10 4:32pm

Hi,

My MRI reads Timy punctate focus of white matter signal bightening in the left posterior corona radiata and centrum semiovale are noted... Unfortunately my neurologist isn't exactly so great - I am in the process of switching an hopefully getting some answers.... Let me know how yours turns out... I'm 27 by the way and I'm not so sure at my age this is normal or not...?

Mandy

8/19/10 7:01pm

Hi,

I'm not sure at all what normal is anymore. I went through a very rough time last year but am feeling very healthy right now. My doctor told me at my last check up that I should come right in and get scheduled for anothe MRI if and when I have new or worsening symptoms. Until then I should just not worry about things. That sounds easy enough right now while I'm feeling good, but I still feel like I'm in limbo and just waiting for the next odd symptom.

Q: Help With Medical Terminology

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