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White lesions in sub cortical region, finger like projection from corpus callosum to lateral ventrical. MRI scan. Recommendations?

Hi. I recently had an MRI brain scan without contrast and the radiologist saw 10-12 white lesions, many of which are located in the subcortical region. He described a "finger like projection" extending from the corpus callosum to a lateral ventrical. His findings were "while these findings are not completely typical of MS, it is included in the differential diagnosis along with Lyme's disease, vasculitis and small vessel ischemia". The radiologist did say the nu,ber of lesions were well beyond the normal for someone my age. I am a 44 y.o. female. Could the "finger like projection (lesion) be a Dawson's finger? Thank you for your time.
Asked On : Sat, 6 Apr 2013
Answers:  2 Views:  144
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Radiologist 's  Response

The diagnosis of Multiple Sclerosis is a clinicoradiological one. It is very important to correlate the patients symptoms and signs with the MRI scan. Thus, a detailed neurologist examination would be essential before making such a diagnosis.

Also, on MRI, modified McDonald's and Barkhof's criteria are applied before diagnosing MS and as per these two sets of criteria should be satisfied. In your case, 'dissemination in space' appears to have been satisfied but a repeat scan after 3 months (or this scan done after 30 days of symtpom onset) is needed to prove 'dissemination in time'. Dawson's fingers are classical in multiple sclerosis but we would need to see the scan to definitely say that the finger like projections described are definitely Dawson's fingers.

There are several other causes of subcortical white matter signal abnormalities like those mentioned in your report. However, they may also be non-specific or age-related. The description in your scan fits that of Fazekas Grade 1 (lesions not confluent) changes which are of no significance or worry, especially if you are above 40-50 years of age. However, if they worsen on follow up MRI, especially in young patients (less than 40 years), it maybe an indicator for predisposition to development of dementia early in life.

Overall, it is probably a good idea for you to take an expert neurologist opinion and get a repeat scan done in 3-6 months, before coming to any conclusion.

Answered: Sat, 27 Apr 2013
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Internal Medicine Specialist Dr. Omer's  Response
"Dawson's Fingers" is the name for the lesions around the ventricle-based brain veins of patients with multiple sclerosis. The condition is thought to be the result of inflammation or mechanical damage by blood pressure around long axis of medular veins.
Dawson's fingers spread along, and from, large periventricular collecting veins, and are attributed to perivenular inflammation. Lesions far away from these veins are known as Steiner's splashes
your plausible causes for subcorical white lesion can be ADEM(acute demyelinating encephalomyelitis ... a form of MS....or it can be due to syphilis or viral post encephalitis....multiple sclerosis occurs when you have 2 or more episodes of multiple white lesion with distant time interval
take care
Answered: Thu, 25 Apr 2013
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