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What Causes Multiple Lesions In The Brain?
Question: I recently had a brain mri (without contrast) which showed multiple lesions. Following up with a neuro next week to rule out MS. What other possible reasons for the lesions? What questions should I be prepared to ask Neuro?
Brief Answer:
MS more likely
Detailed Answer:
I read your question and I understand your concern.
It would have been helpful if you had told us a little more about your symptoms. Do you have now or in the past symptoms like loss of vision, double vision, weakness or numbness in the limbs, lack of balance or coordination. If yes their evolution in time is also very important. Other medical conditions you might have matter as well.
Also if you can make a scan/photo of the MRI report so that I can know the distribution of those multiple lesions and the MRI sequences they are noted in it would be useful.
Reasons for multiple lesions apart from multiple sclerosis can be multiple strokes, infections, inflammation, brain metastases or primary brain tumor etc.
However given your age Multiple sclerosis does look like the most likely cause. The fact you have been suggested that by the radiologist reinforces that as well as some of those causes I mentioned would've been readily visible on MRI.
As for questions you should make if the neurologist thinks about multiple sclerosis are:
-necessity of further tests to confirm the diagnosis like contrast MRI, lumbar puncture, visual and auditory evoked potentials.
-even if he's sure necessity of contrast MRI to assess disease activity by differentiating new from old lesions.
-the type of MS you have, whether the common relapsing remitting form or some rarer type like the primary progressive which responds little to treatment and has a worse prognosis.
-discuss the choice of disease modifying therapy, between the traditionally used interferons or glatiramer acetate, known and studied for decades now, or the newer treatments recently in the market which seem promising but will need years for their long term efficacy and safety to be well known.
I remain at your disposal for further questions, possibly with the info I asked for so that I might be more specific and helpful.
MS more likely
Detailed Answer:
I read your question and I understand your concern.
It would have been helpful if you had told us a little more about your symptoms. Do you have now or in the past symptoms like loss of vision, double vision, weakness or numbness in the limbs, lack of balance or coordination. If yes their evolution in time is also very important. Other medical conditions you might have matter as well.
Also if you can make a scan/photo of the MRI report so that I can know the distribution of those multiple lesions and the MRI sequences they are noted in it would be useful.
Reasons for multiple lesions apart from multiple sclerosis can be multiple strokes, infections, inflammation, brain metastases or primary brain tumor etc.
However given your age Multiple sclerosis does look like the most likely cause. The fact you have been suggested that by the radiologist reinforces that as well as some of those causes I mentioned would've been readily visible on MRI.
As for questions you should make if the neurologist thinks about multiple sclerosis are:
-necessity of further tests to confirm the diagnosis like contrast MRI, lumbar puncture, visual and auditory evoked potentials.
-even if he's sure necessity of contrast MRI to assess disease activity by differentiating new from old lesions.
-the type of MS you have, whether the common relapsing remitting form or some rarer type like the primary progressive which responds little to treatment and has a worse prognosis.
-discuss the choice of disease modifying therapy, between the traditionally used interferons or glatiramer acetate, known and studied for decades now, or the newer treatments recently in the market which seem promising but will need years for their long term efficacy and safety to be well known.
I remain at your disposal for further questions, possibly with the info I asked for so that I might be more specific and helpful.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your response. As for my history leading up to the Mir, I have seen my primary care dr for left shoulder pain with numbness in my hand and 4 &5th fingers. She referred me to physical therapy with rx of Celebrex and cyclobenzaprine. After 4 pt sessions the pain had mostly subsided but numbness had not. Pt believes my issue is thoracic outlet syndrome. I recently had new numbness in both feet and felt a slight numb sensation in my right hand as well. I saw my dr that day. We discussed a lot. I said I have been extremely fatigued (but was thinking it was a side effect of the muscle relaxers), had general feeling of weakness and foginess along with a few short term memory loss instances (again I attributed this to lack of sleep from shoulder pain and muscle relaxers). I have also felt very clumsy and have been dropping objects. My dr had me do the tandem walk test and I stumbled miserably. She then ordered cervical spine mri and brain mri.
I am an otherwise healthy person.
I am working on getting you a copy of the report. I am cant attach a scanned document to this site and am having poor quality come out when I try to take a photo.
I forgot to mention that my cervical spine mri showed a slight herniation of c3-c4.
I attached photos of report but am doubtful you will be able to read it. If necessary, I can just type the info you may need. Just let me know.
I am an otherwise healthy person.
I am working on getting you a copy of the report. I am cant attach a scanned document to this site and am having poor quality come out when I try to take a photo.
I forgot to mention that my cervical spine mri showed a slight herniation of c3-c4.
I attached photos of report but am doubtful you will be able to read it. If necessary, I can just type the info you may need. Just let me know.
Brief Answer:
MS unlikely.
Detailed Answer:
Thank you for providing some more info on your symptoms and the report. The report was perfectly readable.
I wish you could have said something on the time course of your symptoms, when did the first ones begin and when the subsequent new symptoms appeared.
After reading that MRI report I now consider the diagnosis of MS not that likely anymore. The description and distribution of the changes was not characteristic about multiple sclerosis.
The description of those foci seems more compatible with simple gliosis, changes in the brain which might have been present there for a long time, it is a remnant of any neurological process like trauma, chronic migraine, infections, small vessel stokes, a gliosis is basically like a small scar, you know there is some injury there but you can't determine the cause based on that only.
However considering some of the symptoms you refer and depending on the signs found by the neurologist on neuro exam, another MRI with contrast would be recommended to determine whether there is an active process going on in these foci, whether they are acute, recent lesions or only remnants as I said. Contrast exam should have been done the first time around since MS diagnosis was suspected to determine whether there were new lesions.
Slight hernia at C3-C4 is unlikely to be the cause of your symptoms either. Neither does thoracic outlet syndrome explain all your symptoms.
I believe the neurological exam should give indications on whether there are signs of central nervous system involvement (if that is the case contrast MRI is indicated) or perhaps the symptoms are related to peripheral nervous system. In that case other tests might be required like nerve conduction studies/electromyography.
Also, depending on his physical exam findings, other recommended tests to search for the cause of your neurological symptoms might be routine blood count, blood sugar, liver and kidney function, electrolytes, Vitamin B12 level, thyroid function, inflammation tests and tests for connective tissue disease.
I hope to have been of help.
MS unlikely.
Detailed Answer:
Thank you for providing some more info on your symptoms and the report. The report was perfectly readable.
I wish you could have said something on the time course of your symptoms, when did the first ones begin and when the subsequent new symptoms appeared.
After reading that MRI report I now consider the diagnosis of MS not that likely anymore. The description and distribution of the changes was not characteristic about multiple sclerosis.
The description of those foci seems more compatible with simple gliosis, changes in the brain which might have been present there for a long time, it is a remnant of any neurological process like trauma, chronic migraine, infections, small vessel stokes, a gliosis is basically like a small scar, you know there is some injury there but you can't determine the cause based on that only.
However considering some of the symptoms you refer and depending on the signs found by the neurologist on neuro exam, another MRI with contrast would be recommended to determine whether there is an active process going on in these foci, whether they are acute, recent lesions or only remnants as I said. Contrast exam should have been done the first time around since MS diagnosis was suspected to determine whether there were new lesions.
Slight hernia at C3-C4 is unlikely to be the cause of your symptoms either. Neither does thoracic outlet syndrome explain all your symptoms.
I believe the neurological exam should give indications on whether there are signs of central nervous system involvement (if that is the case contrast MRI is indicated) or perhaps the symptoms are related to peripheral nervous system. In that case other tests might be required like nerve conduction studies/electromyography.
Also, depending on his physical exam findings, other recommended tests to search for the cause of your neurological symptoms might be routine blood count, blood sugar, liver and kidney function, electrolytes, Vitamin B12 level, thyroid function, inflammation tests and tests for connective tissue disease.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your time and advice. While relieved to hear you are doubtful my prognosis will be MS, I feel I am in for a long journey in figuring this out.
My sincerest thanks again!
My sincerest thanks again!
Brief Answer:
Thank you!
Detailed Answer:
Thank you for your appreciative words!
I hope things will work out for the best.
Thank you!
Detailed Answer:
Thank you for your appreciative words!
I hope things will work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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