Do I Have Ms ?

Question

Asked by gautamrats

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?

Answer

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.