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Can ill defined bilateral lesions in pons be glioma? What could cause bilateral pattern?

Nov 2013
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Practicing since : 1994
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I have been going crazy for the last two years. In 2011 I had an attack where my left side face, ear, and back of head felt numb for approximately 4 weeks. It felt like someone injected me with novacaine. I went to the neurologist and they found 2 multiple ill defined bilateral pontine hyperintensities in the pons. One lesion was in pons and one in the dorsal pons. I had multiple mri's without contrast (due to allergies) and in 2012 one mri said the lesions were gone and I had a remarkable study. So I stopped going to the neuro. This summer August 2013, I was being treated for fibro? with rheumatologist I began to get numbness in my upper lip and nose. Gradually I became numb on the left side of face, ear, and back of head like in 2011 but this time I had leg numbness as well on left side. The doctor told me that I should go back to the neurologist because I was showing signs for MS. I was also checked for ana and came back positive with a low titer of 1:80 nuclear that fluctuates weekly however came back for all other ana tests.This time the attack lasted straight for 3 and a half weeks. I still get intermittent numbness however no chronic. I went to NYU and they feel that although I shows signs for MS these lesions did not look like the atypical MS lesions. I asked them if this could be a stroke they said no. I asked them if it could be a tumor they said no. However, the radiologist spoke to me on request and explained these lesions need to be monitored for life to make sure they do not turn malignant. She also kept implying that these are not tumors to further investigate MS. I also want to note that I had blood work done and my LD came up 218 when it should be between 100-200. On the front of the lab work it said that LD levels might be increased due to a problem with the blood was coagulated and spun. Now I am scared the LD could mean cancer, stroke, etc... Please help also can ill defined bilateral lesions in pons be glioma? What could cause a bilateral pattern? Please answer all questions I am at wits end!
Posted Sun, 17 Nov 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 9 days later
Brief Answer:
The most likely diagnosis is demyelinating disease

Detailed Answer:
Thank you for posting your query.

I have gone through your case in detail and analysed your symptoms and MRI findings.

The most likely cause of these lesions and recurrent neurological symptoms is demyelinating illness, and the most likely is multiple sclerosis (MS). However, at present, the MRI criteria for diagnosis of MS is not fulfilled. Therefore, we need to do half-yearly or annual MRIs of brain and spinal cord, to see if you develop typical MS features in the future or not.

The other demyelinating illness, where the lesions can disappear and reappear is called ADEM-acute disseminated encephalomyelitis. Symptoms and MRI findings could be similar to MS, but the long term outcome is better in ADEM, as the progression of disease is uncommon.

Please keep me informed about the progress or otherwise of your symptoms.I hope it helps. Please get back if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Click on this link to ask me a DIRECT QUERY:
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