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Being evaluated for MS and done with MRI. Does the finding support diagnosis?

Nov 2013
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I'm being evaluated for MS and my MRI showed "several bilateral small deep white matter and subcortical foci of T2 hyperintensity predominantly within the anterior centrum semiovale and frontal lobes at the basilar aspects". My neurologist suggests i show most of the classic symptoms. Do these MRI findings support her diagnosis?
Posted Wed, 10 Jul 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 20 minutes later
Thank you for posting your query.

I have noted the MRI findings. I would like to tell you that these findings are not specific for a diagnosis of migraine (I noted from your medical history that you have migraine). In addition, these can also be a sign of small vessel ischemia (lack of blood flow to brain). However, I agree that these could also occur in MS.

Further investigations that could help in ruling in/ruling out MS would include MRI of spine (to look for spinal lesions of MS), and CSF analysis (lumbar puncture) to look for oligoclonal bands.

I hope it helps.
Please get back if you require any additional information.

Best wishes,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,
My personal URL on this website:
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Above answer was peer-reviewed by
Follow-up: Being evaluated for MS and done with MRI. Does the finding support diagnosis? 1 hour later
Thank you for your response.

Given my symtoms of tingling/burning/numbness in my face and extremities, extreme fatigue, weakness inhands and legs (often drop things or trip) and forgetfulness (struggle to remember things i just did), along with a new onset of gastroparesis, how would you assess the likelihood of MS vs migraine-related issues or blood flow to the brain?

Also, could you expand on the other two possibilities? Could ischemia imply a mini-stroke?
Answered by Dr. Sudhir Kumar 7 minutes later
Thank you for getting back with more details.

Given your symptoms, MS would be more likely.

Migraine over a period of time does lead to white matter changes in brain, mainly involving deep white matter, periventricular regions, etc. However, these are not of any serious consequence, except in a few, where it may increase the risk of brain stroke (specially among those who smoke).

Ischemia does imply a mini-stroke. Since you do not have any risk factors for the same (such as high BP, sugar, cholesterol, etc), this is unlikely in your case.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
Follow-up: Being evaluated for MS and done with MRI. Does the finding support diagnosis? 2 hours later
Thank you again.

As a next step, do you expect my neurologist would order a lumbar puncture to further assess if MS? What other tests might be necessary or prudent? I've heard diagnosing MS is a mix of lab tests ans other symptoms. I'm just curious what other factors would come into consideration.
Answered by Dr. Sudhir Kumar 3 hours later
Thank you for getting back.

For confirming a diagnosis of MS, following tests may be required:

1. MRI of brain and spine with contrast,

2. Visual evoked potential, to look for any optic nerve dysfunction,

3. Lumbar puncture to look for elevated CSF protein, and presence of oligoclonal bands.

Results of the above, along with clinical details, are sufficient to make a diagnosis of MS.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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