Can anyone pls help me understand these MRI results?

[lauriannem]

Here is what the report says:

"The study demostrates a few foci of high signal seen in the periventricular white matter, particularly along the posterior (isn't that my bum?) aspect of the lateral ventricle on the right. There are a few foci of increased signal seen in the body of the corpus callosum on the saggital proton density images. A few scattered subcortical white matter foci of high signal are noted. There is no diffusion abnormality and one of these abnormal areas show enhancement. The cerebellar tonsils (I know I had those removed :) are low-lying but do not appear to be ectopic. The orbits appear normal. A polyp/cyst is seen in the left maxillary sinus."

Any thoughts? Can't see neuro for over a month - it does say at the end that the impressions are:

Foci of abnormal signal consistent with history of MS. No abnormal diffusion signal or enhancement is seen to suggest acuity.

Low lying cerebellar tonsils (there they are again)

Left maxillary sinus disease.

I'll pay for your assistance! Candy, bottle of tequila, whatever it takes :-)

Thanks!


Laurianne

[Howie]

Here is mine (Don't look Joan) from almost 10 years ago. Some of the same terms. Never had another, yet I walk, drive, mow my own grass. MY opinion, live your life and don't worry about it.

Clinical Indication: SIX CRANIAL NERVE PALSY, EVALUATE FOR MS OR MASS.
:MRI OF THE BRAIN AND ORBITS: 7/9/98

:Technique:
Sagittal and axial T1 and T2 weighted images were obtained. Following
Gadolinium axial and coronal images were obtained. Additional axial
images were obtained through the orbits.

:Findings:
The orbital study demonstrates mild thickening of the left optic nerve
within the apex of the orbit as well as extending toward the chiasm.
There is enhancement of these areas consistent with optic neuritis.

Intracranially there are multiple high signal abnormalities on the T2
weighted images in the periventricular white matter corpus collasum and
left temporal lobe.The posterior fossa structures have normal signal
characteristics.

Following Gadolinium enhancement there are focal abnormal areas of
enhancement in the anterior left temporal lobe as well as in the right
frontal lobe just anterior to the anterior horn of the right lateral
ventricle. The lesion in the right frontal lobe also enhances along the
ependymal lining of the lateral ventricle.

A smaller focus of enhancement is evident in the left occipital lobe
just anterior to the occipital horn of the lateral ventricle.

:Impression:
Classic findings of multiple sclerosis with optic neuritis involving
the left optic nerve. Intracranial images post Gadolinium demonstrate
active plaques in the left temporal lobe, left occipital lobe and right
frontal lobe.

[Ikoiko]

Your neuro can discuss the results over the phone.

[lauriannem]

Long story short - I live where Katrina hit and my neuro went away after the storm. The current neuro is not very good, but she is local. She never takes time to call and is very difficult to get in to see. I am thinking of trying to get in to see a woman that I've heard good things about, she's 4 hours away.

If anyone can help decipher these results that would help, for now.

Thank you!

[Jakaloke]

Foci of abnormal signal consistent with history of MS. No abnormal diffusion signal or enhancement is seen to suggest acuity.

You have MS lesions. There doesn't appear to be any active inflammation (you're not relapsing at the moment).

Low lying cerebellar tonsils (there they are again)

Cerebellar tonsils (http://en.wikipedia.org/wiki/Cerebellar_tonsil) are masses in the cerebellum. Chiari I malformation (http://en.wikipedia.org/wiki/Arnold-Chiari_malformation) is a condition wherein the tonsils are quite low. According to American Journal of Neuroradiology (http://www.ajnr.org/cgi/content/abstract/7/5/795), a low degree of ectopia (congenital displacement), probably isn't anything to be concerned about.

Left maxillary sinus disease.

You have a cyst or polyp-like mass in your maxillary sinus cavity. I believe these are pretty common, so if it isn't causing you any breathing difficulty, it's probably nothing to worry about.

Scott

[lady_express_44]

Of course I am just guessing, but . . .

“a few foci of high signal seen in the periventricular white matter, particularly along the posterior (isn't that my bum?) aspect of the lateral ventricle on the right. There are a few foci of increased signal seen in the body of the corpus callosum on the saggital proton density images. A few scattered subcortical white matter foci of high signal are noted.

Sounds like all MS-related brain lesion talk.

Posterial = in the back

"There is no diffusion abnormality and one of these abnormal areas show enhancement."

This doesn’t make sense; “no diffusion abnormalities”, then “one of these abnormal areas” . . . ?? Should that say "none" instead of one?

"The cerebellar tonsils (I know I had those removed are low-lying but do not appear to be ectopic."

The cerebellar tonsil (amygdaline nucleus) is a rounded mass, situated in the hemispheres of the cerebellum. (part of the brain)

http://en.wikipedia.org/wiki/Cerebellar_tonsil

Everything I found on low-lying tonsils had to do with Chiari malformation, which is another disease. Although yours are low lying, it does not appear they are “ecoptic”.

Cerebellar ectopia is a term used by radiologists to describe cerebellar tonsils that are "low lying" but that do not meet the radiographic criteria for definition as a Chiari malformation. The currently accepted radiographic definition for a Chiari malformation are cerebellar tonsils that lay at least 5mm below the level of the foramen magnum. Some clinicians have reported that some patients appear to experience symptoms consistent with a Chiari malformation without radiographic evidence of tonsillar herniation. Sometimes these patients are described as having a 'Chiari 0'.

http://en.wikipedia.org/wiki/Brain_herniation

The orbits appear normal.

Orbits = eyes

A polyp/cyst is seen in the left maxillary sinus."

Maxilliary sinuses are the ones on either side of your nose.

http://en.wikipedia.org/wiki/Maxillary_sinus

He seems to be saying there may be a cyst or polyp in your left one. Do you get sinus infections and have a hard time getting rid of them? My same sinuses were riddled with polyps, which they had to remove, due to allergies.

http://en.wikipedia.org/wiki/Nasal_polyp

Or, it may be cyst, which are apparently no big deal:

http://yourtotalhealth.ivillage.com/should-sinus-cyst-be-removed.html

Cherie

[lady_express_44]

Oops, looks like Scott beat me to the punch, while I was busy researching :)

Cherie

[Lady]

This may help or confuse you more. I was cleaning up my computer and found this. I don't have the link to it, sorry.
Lady

The Brain And Multiple Sclerosis

Clinical Profile
Findings
Discussion
Pathology
Variants
On MRI
Differential Diagnosis
Suggested Reading
*
Clinical Profile:
H/O diminished vision on the right side, headaches, giddiness,* gait imbalance, neck pain, paresthesias in all four limbs and a weak grip since two months.

Findings:
There are diffuse and focal hyperintense lesions on the T2W and FLAIR images within the parietal periventricular white matter and centrum semiovale bilaterally,* right periventricular white matter, medulla, pons and right middle cerebellar peduncle. There is fullness of the ventricular system and slight prominence of the cerebral cortical sulci.
This patient also had lesions in the spinal cord.

Discussion:*
Multiple sclerosis is a primary demyelinating disorder (myelinoclastic disease-myelin destruction whereas there is relative sparing of the axons).

Patients usually present with weakness, numbness and tingling of one or more extremities, gait disturbance or visual impairment or diplopia. They usually have a relapsing/remitting pattern. Severe spinal cord affliction is more common with the chronic progressive type.


Pathology:
The exact etiology is unknown. One of the prevailing views is that an initial viral infection is subsequently followed by an auto-immune reaction with a resultant attack on the myelin. The MS plaques are usually found in the white matter of the cerebrum, cerebellum, brain stem, spinal cord and the optic nerves, chiasm and tracts. CSF may show the presence of oligoclonal bands.

Acute MS plaques
There is destruction of the myelin with axonal sparing. Usually they occur in a perivenular distribution. This perivascular demyelination is seen as a finger pointing along the vessel axis-"Dawson's fingers". Neuroglial infiltration, perivascular mononuclear cells/lymphocytes and oligodendrocytes are also seen. There is a transient break in the blood-brain barrier.
Chronic MS plaques
They usually show gliosis, atrophy and cavitation. Remyelination may be noted.

*

Variants:

Classic-Charcot Type:
Most common form (discussed above).
Acute-Marburg Type:
In younger patients. Usually preceded by fever and has a relentless course.
Neuromyelitis Optica-Devic's disease:
Acute onset of spinal cord and optic nerve demyelination.

Diffuse Sclerosis-Schilder Type:
Seen in children. Psychiatric problems are more common. There is confluent, asymmetric demyelination involving both cerebral and cerebellar hemispheres and brain stem.

Concentric Sclerosis-Balo Type:
Has a concentric or lamellar pattern. Areas of demyelinated and myelinated (? remyelination) white matter alternate. Is progressive and seen in young people.


On MRI:

MS plaques are seen as discrete foci with well-defined margins. They are hypointense on the T1W images and hyperintense on the T2W, Proton and FLAIR images. Occasionally larger lesions may coalesce to form confluent lesions.

The plaques usually involve the corpus callosum, cerebral and cerebellar white matter, brain stem, internal capsules and visual pathways. Subcortical U fibres are commonly involved.

Acute plaques may have a*hyperintense rim on the T1W images or a hypointense rim on the T2W images (? due to free radicals, proteins or fat-laden macrophages).

The periventricular lesions are commonly located along the lateral margins of the occipital horns and atria. The perivenular location gives then an ovoid shape. They are perpendicular to the lateral ventricle.

The corpus callosum lesions are best seen on FLAIR sagittal images. Late in the disease thinning of the corpus callosum is commonly seen.

Occasionally the grey matter of the cerebral cortex and basal ganglia are involved.
The posterior fossa lesions are usually seen to abut the cisterns or the fourth ventricle or aqueduct.
The area of inflammation reduces in size with time. The residual plaque is more linear or punctate.

Optic neuritis is commonly seen. The STIR images are especially sensitive and the nerves appear hyperintense. Enhancement is best seen using fat saturation images.

Late in the disease cerebral atrophy and ventricular dilatation is common. Increased iron deposition may be seen in the basal ganglia (increased hypointensity on the T2W images).

Acute lesions may enhance following Gd contrast administration. Nodular or ring enhancement is seen. The lesions enhance for eight to twelve weeks after acute demyelination. Meningeal* enhancement may be seen rarely with acute relapsing MS.

Following steroids there may be a definite reduction in lesion enhancement and size.



Differential Diagnosis:
White Matter Ischemia:
Usually spares the corpus callosum and the subcortical U fibres. Cerebral arteritis can result in periventricular hyperintensities and/or cortical infarcts (Usually have systemic features).

Virchow Robin(VR) Spaces:
Usually round with an approximate diameter of 1-2 mm. Commonly seen in the deep white matter on higher sections and basal ganglia. They are usually isointense to CSF.

Lacunar Infarct:
Usually isointense to CSF. May have a hyperintense rim on the Proton, T2W or FLAIR images (gliosis).
Progressive Multifocal Leukoencephalopathy(PML):
Usually the patient is immunocompromised. The lesions affect the peripheral white matter and tend to be patchy with an asymmetric distribution.

Other white matter diseases (metabolic and inflammatory or infective processes) can also mimic MS.

Migraine:
Periventricular hyperintensites are noted which usually mimic white matter ischemia. History is fairly typical.
*

Suggested Reading:
Simon JH: Neuroimaging of multiple sclerosis: Neuroimaging Clin North Am 3:229-246, 1993.
Yetkin FZ, Haughton VM, Papke RA, et al: Multiple Sclerosis: specificity of MR for diagnosis . Radiology 178:447-451, 1991.
Hesselink JR: White Matter Disease. In: Edelman RR, Hesselink JR, Zlatkin MB: Clinical Magnetic Resonance Imaging, W.B. Saunders, Volume 1, pp:851-879, 1996.
*




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[lauriannem]

Thanks Cherie - I was hoping you'd wander by :-) Thank you to everyone else for your assistance.

I'm a little concerned about the "tonsil" thing as so many of my ongoing symptoms would seem to fit the bill for a Chiari malformation...of course they could be MS too (such is the fun of our illness).

I've been suffering for some time with lightheadedness (not dizzy, not off balance) that is stopping me from doing many things. We were trying to find out what is going on. I wonder if the sinus issue could be to blame? My dr. didn't even address it when she had her nurse call me.

Thanks again!

[lady_express_44]

You are welcome. Scott said it much more succinctly though. :-P

Do you have a confirmed dx of MS at this point?

Here's a symptom chart for Chiari:

http://www.nfra.net/Symchart.htm

As far as the brain MRI results for Chiari vs. MS, apparently for Chiari:

"MRI scanning, especially on sagittal images, will detect the malformation. MRI of the brain is otherwise normal, as is CSF." Did you have a LP?

http://www.neurology.wisc.edu/publications/07_pubs/Neuro_2.pdf

There are other demylinating diseases that can cause similar lesions though:

http://spinwarp.ucsd.edu/NeuroWeb/Text/br-840.htm

More info on MS brain lesions:

http://www.radiologyassistant.nl/en/4556dea65db62

Syringomyelia is often associated to Chiari, which causes a "syrinx" in the spinal cord. My sister was being checked for MS at one time, based on her symptoms (and the fact that I have MS) and they EVENTUALLY dx Syringomyelia (but not Chiari, which is apparently unusual).

What I haven't found, is any information on is those "tonsils" being associated with MS. I suppose it's possible you could have both MS and Chiari. :eek:

Apparently dizziness is common with Chiari too . . .

"The resulting pressure on the cerebellum can block the flow of cerebrospinal fluid (the liquid that surrounds and protects the brain and spinal cord) and can cause a range of symptoms including dizziness, muscle weakness, numbness, vision problems, headache, and problems with balance and coordination."

http://www.ninds.nih.gov/disorders/chiari/chiari.htm

Dependant on how big that polyp/cyst is, it might not cause you any problem what-so-ever. I was "riddled", and they caused headaches, numb gums, constant sinus infections, dizziness, etc. but that was with MANY.

Cherie

[Braindead]

This might help show what is MS stuff in the report.

Braindead


http://home.ix.netcom.com/~jdalton/img5.gif

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http://home.ix.netcom.com/~jdalton/img6.gif

[lady_express_44]

Just wondering how your neuro appt went, Laurianne?

Cherie