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What Does This MRI Report Regarding Fatigue And Memory Lapses Indicate?
Question: Good Day, I asked you a question 2 nights ago (referenced below). You said you wanted to see my MRI results. I got back my MRI results:- "Brain MRI w/ and w/o contrast
Findings
Brain and dura: No hemorrhage, edema, or mass effect. There are scattered small subcortical an deep white matter lesions in the frontal and parietal lobes. Roots of the 7th and 8th nerves appear normal. No intracanalicular masses are seen. The membranous labyrinth is intact bilaterally. There are no areas of restricted diffusion. There is no abnormal contrast enhancement.
Ventricles and sulci are normal.
Vascular flow voids are preserved.
Marrow signal is normal. Craniocervical junction intact.
Orbits, sinuses, and facial soft tissues are normal.
Conclusion: Scattered nonenhancing cerebral white matter lesions are nonspecific and could represent the chronic sequela of infectious/inflammatory conditions, demyelinating disease, migraine headaches, or small vessel ischemia. No acute abnormalities identified."
What do you think? See below for my prior question asked 2 nights ago.
Good Night,
I have been having really strange symptoms I think as early back as 5 years ago on and off, but really noticeable and exacerbated in the last several weeks. These include terrible fatigue, memory lapses, cognitive issues, poor focus, word finding and pronunciation problems, tripping while I walk, clumsiness, coordination issues, and intermittent heaviness in my left foot causing sort of a dragging of my left leg or a limp when I walk, generalized weakness, muscle stiffness/tightness/aches, numbness in extremities, sometimes on one side or just in hands and feet, neck stiffness, handwriting changes, heat/cold intolerance. I have also had really bad tingling in my extremities and up and down my spine. I have had blurry and distorted vision, fogginess in one eye, eye tremors (primarily in the left eye), at one point my right eye rolled back in my head, it happened in a matter of seconds. I also had an episode where I was eating cheese puffs and they tasted like oranges. I have had intermittent constipation and diarrhea (a long standing issue). I am hypertensive even though not managed medically. My BP has been high at my last ob/gyn visit and at my primary care provider visit, and high when I checked it outside of the providers' office, neither addressed it. My CMP was normal except for a slightly elevated chloride. Ferritin in normal range but significantly low. TSH - 2.43, CBC normal. Initial neuro assessment was normal. Head MRI without acute abnormalities per my primary clinician, but I have not seen the MRI report yet. I am 29 years old, black female. My primary clinician is insisting she wants to treat me for depression and anxiety, but I feel that would not address all the symptoms I am having. I have suggested that I do an A1C to rule out Diabetes she does not think symptoms are Diabetes-related. I have suggested further thyroid tests to rule out an underlying thyroid issue that may be masked with a normal TSH. She doesn't think that is needed at this time. I have suggested B12 deficiency or Celiac disease and she does not feel any tests are needed to rule those out at this time. She just wants to treat me for anxiety and depression. Do you have any advice for me at this time? I feel my symptoms are valid and go beyond depression and anxiety. PS. I am aware the depression and anxiety can cause some of the symptoms I am having, but I am also aware that just treating the anxiety and depression could just be putting a bandaid on a potentially more severe problem. I thank you in advance for any advice or help you can give me.
Warmest Regards,
XXXXXXX
Findings
Brain and dura: No hemorrhage, edema, or mass effect. There are scattered small subcortical an deep white matter lesions in the frontal and parietal lobes. Roots of the 7th and 8th nerves appear normal. No intracanalicular masses are seen. The membranous labyrinth is intact bilaterally. There are no areas of restricted diffusion. There is no abnormal contrast enhancement.
Ventricles and sulci are normal.
Vascular flow voids are preserved.
Marrow signal is normal. Craniocervical junction intact.
Orbits, sinuses, and facial soft tissues are normal.
Conclusion: Scattered nonenhancing cerebral white matter lesions are nonspecific and could represent the chronic sequela of infectious/inflammatory conditions, demyelinating disease, migraine headaches, or small vessel ischemia. No acute abnormalities identified."
What do you think? See below for my prior question asked 2 nights ago.
Good Night,
I have been having really strange symptoms I think as early back as 5 years ago on and off, but really noticeable and exacerbated in the last several weeks. These include terrible fatigue, memory lapses, cognitive issues, poor focus, word finding and pronunciation problems, tripping while I walk, clumsiness, coordination issues, and intermittent heaviness in my left foot causing sort of a dragging of my left leg or a limp when I walk, generalized weakness, muscle stiffness/tightness/aches, numbness in extremities, sometimes on one side or just in hands and feet, neck stiffness, handwriting changes, heat/cold intolerance. I have also had really bad tingling in my extremities and up and down my spine. I have had blurry and distorted vision, fogginess in one eye, eye tremors (primarily in the left eye), at one point my right eye rolled back in my head, it happened in a matter of seconds. I also had an episode where I was eating cheese puffs and they tasted like oranges. I have had intermittent constipation and diarrhea (a long standing issue). I am hypertensive even though not managed medically. My BP has been high at my last ob/gyn visit and at my primary care provider visit, and high when I checked it outside of the providers' office, neither addressed it. My CMP was normal except for a slightly elevated chloride. Ferritin in normal range but significantly low. TSH - 2.43, CBC normal. Initial neuro assessment was normal. Head MRI without acute abnormalities per my primary clinician, but I have not seen the MRI report yet. I am 29 years old, black female. My primary clinician is insisting she wants to treat me for depression and anxiety, but I feel that would not address all the symptoms I am having. I have suggested that I do an A1C to rule out Diabetes she does not think symptoms are Diabetes-related. I have suggested further thyroid tests to rule out an underlying thyroid issue that may be masked with a normal TSH. She doesn't think that is needed at this time. I have suggested B12 deficiency or Celiac disease and she does not feel any tests are needed to rule those out at this time. She just wants to treat me for anxiety and depression. Do you have any advice for me at this time? I feel my symptoms are valid and go beyond depression and anxiety. PS. I am aware the depression and anxiety can cause some of the symptoms I am having, but I am also aware that just treating the anxiety and depression could just be putting a bandaid on a potentially more severe problem. I thank you in advance for any advice or help you can give me.
Warmest Regards,
XXXXXXX
Brief Answer:
The MRI is inconclusive-need a neuro opinion
Detailed Answer:
Dear XXXXXXX,
Thanks for reverting back to me.
I gone through the MRI report and reviewed your symptoms details.
As I suggested earlier there is evidence that you need to be evaluated on line of multiple sclerosis as there is few MRI changes which can be found in a patient with multiple sclerosis. Other than that your age, gender are the most susceptible for occurrance of multiple sclerosis.
Many of your symptoms can be found in this demyelinating disorder.
There are two things that indicative of non MS diagnosis
Firstly you did not report any episodes for almost all symptoms except few like visual symptoms. But in case you have acute excerbations over the last five years and few of your days were good and few days were bad athe possibility of MS diagnosis is increased.
Secondly there are no changes in MRI of recent origin. This is the strongest point against diagnosis of MS. In most of the patients we see change in MRI brain when there are acute symptoms.
Considering all these facts my first impression is to get an neurologist opinion again. I am aware that the initial opinion was unremarkable but with new MRI report you need an another opinion. There is possibility that your neurologist will ask for serial MRI to compare the changes across time to confirm the diagnosis of MS.
Having said this going for treatment of anxiety and depression is required. Few of your symptoms indicate functional etiology and can not be explained on basis of any known organic disorder. Other than that many of the patients with anxiety and depression over a long period of time develop somatic symptoms that mimic physical illness. At this moment other that slightly abnormal MRI there is no evidence of any other pathology which can explain few of your symptoms.
'Hope this answers your query. If you have any further questions I will be happy to help".
Thanks
The MRI is inconclusive-need a neuro opinion
Detailed Answer:
Dear XXXXXXX,
Thanks for reverting back to me.
I gone through the MRI report and reviewed your symptoms details.
As I suggested earlier there is evidence that you need to be evaluated on line of multiple sclerosis as there is few MRI changes which can be found in a patient with multiple sclerosis. Other than that your age, gender are the most susceptible for occurrance of multiple sclerosis.
Many of your symptoms can be found in this demyelinating disorder.
There are two things that indicative of non MS diagnosis
Firstly you did not report any episodes for almost all symptoms except few like visual symptoms. But in case you have acute excerbations over the last five years and few of your days were good and few days were bad athe possibility of MS diagnosis is increased.
Secondly there are no changes in MRI of recent origin. This is the strongest point against diagnosis of MS. In most of the patients we see change in MRI brain when there are acute symptoms.
Considering all these facts my first impression is to get an neurologist opinion again. I am aware that the initial opinion was unremarkable but with new MRI report you need an another opinion. There is possibility that your neurologist will ask for serial MRI to compare the changes across time to confirm the diagnosis of MS.
Having said this going for treatment of anxiety and depression is required. Few of your symptoms indicate functional etiology and can not be explained on basis of any known organic disorder. Other than that many of the patients with anxiety and depression over a long period of time develop somatic symptoms that mimic physical illness. At this moment other that slightly abnormal MRI there is no evidence of any other pathology which can explain few of your symptoms.
'Hope this answers your query. If you have any further questions I will be happy to help".
Thanks
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for all your help and for providing this second opinion. So, I was wondering, do you have any suggestions as to what disease processes could have caused the lesions they found? This is the first time I have ever done an MRI, and the first time I have ever known officially of having lesions in my brain. So I am just curious. Thanks again once more, and I will certainly look into getting a referral to a neurologist.
Brief Answer:
High blood pressure is likely cause
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
First of all a very big thanks for your positive feedback.
In regard to the lesions in my view the high blood pressure could be likely cause as you mentioned high blood pressure. This is a well known fact that prolonged untreated high blood pressure leads to white matter changes in the brain. The lesions occur in quite similar fashion as in your case.
I am not sure how long you are having high Blood pressure as it was discovered recently in at the time of Ob/gy visit. But this is another well known fact that people suffer with high blood pressure for years before it is detected.
This reason for this lies in the fact that high blood pressure does not cause any symptoms in majority.
The second possibility is any past infection to your brain. This cause is unlikely as per available history as you did not mention anything significant from the past history.
The other cause we already discussed. Multiple sclerosis is demyelinating disorder and it causes white matter changes in the brain.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
Thanks and regards
High blood pressure is likely cause
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
First of all a very big thanks for your positive feedback.
In regard to the lesions in my view the high blood pressure could be likely cause as you mentioned high blood pressure. This is a well known fact that prolonged untreated high blood pressure leads to white matter changes in the brain. The lesions occur in quite similar fashion as in your case.
I am not sure how long you are having high Blood pressure as it was discovered recently in at the time of Ob/gy visit. But this is another well known fact that people suffer with high blood pressure for years before it is detected.
This reason for this lies in the fact that high blood pressure does not cause any symptoms in majority.
The second possibility is any past infection to your brain. This cause is unlikely as per available history as you did not mention anything significant from the past history.
The other cause we already discussed. Multiple sclerosis is demyelinating disorder and it causes white matter changes in the brain.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback.
Thanks and regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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