Brief Answer:
Hyperintense lesion on MRI

Detailed Answer:
Good morning Ms. XXXXXXX My name is Dr. Dariush Saghafi and I am a neurologist from XXXXXXX Ohio, USA.

I understand that you've been feeling a lot of funny sensations mainly in the left hand which radiate up to the arm and face. You also are mentioning funny buzzing sensations in the neck and down the spine with calf cramps and weakness. It was also confirmed that you weren't having a stroke. However, the MRI does show a single 4 mm. hyperintense lesion in the deep white matter.

You would like to know what the meaning of this lesion is and if it could be indicative of MS. You'd also like to know if you could have lesions in your spine.

Well, first allow me to say that I commend you for taking the time to study what's been going on with you and trying to learn all you can while at the same time organizing your thoughts and feelings in a cohesive document for me to review. And of course, you're living your life which I'm sure is itself filled with much activity and things to do.

We need to understand a few things about what's happening.

Collectively, the funny feelings you had (buzzing, tingling, zings, and stabbing sensations) are referred to as PARESTHESIAS. So if you see that word in your reading that's what that means.

Next, the lesion itself is described as HYPERINTENSE. This means that it appears BRIGHT if you were to look at the MRI film itself. It's that way because of the way the technician sets up the MRI machine to take the pictures. Being bright is usually indicative of the presence of water, nothing more. You'll notice the report also says "no cerebral oedema".....or in Yankee English, "edema!" LOL! You may say, "you just said there's water in the lesion because it's hyperintense." And you may know from your reading that "edema" means WATER. So can that be? Well, EDEMA really refers to EXCESS water in a body tissue or organ.....the water inside that 4 mm. lesion is present to be sure.....but not excessive enough to be called EDEMA.

I hope that was clear.....yeah right she says....as clear as Cotton Candy! LOL....

So, If you can get a digital copy of the scan to upload I'll be happy to look at it. The location of this lesion is at the junction of the frontal lobe and insular cortex (deep white matter on the right side, frontally oriented).

You will need a neurologist to sit down with you to get a detailed history to see if there are other events that you've had in the past which you may not have paid attention to very much to see if they could be considered part of this picture or did all of this as described start exactly 3 weeks ago with no antecedent history? Although I'm sure you're aware of the possibility that MS could be a diagnosis based upon the presence of this lesion but there are other things that could be in the differential as well.

That is why a full examination by a qualified specialist should be your next order of business and you should avoid the temptation of making your own self directed cconclusions from the internet.

Thank goodness medical schools were never dependent upon the internet to train its students back in the times of Hippocrates and Plato, wouldn't you agree...
I fear though that we are moving toward a dangerous point in medicine where young doctors coming out sometimes seem to be relying entirely upon these technologies instead of using the most incredible computer in the universe.....their own brains!?? ! :)

The presence of sensations you describe up and down the spinal column and legs may represent the presence of lesions other than the brain. On the other hand, it's possible that the single solitary lesion seen on the MRI is in fact, all that there is and strange as it may seem even something as small and isolated as that can cause symptoms over a range of geographic territories in the body.

Once again the guidance and expertise of a neurologist will be very important in setting up future tests and diagnostic studies in order to assess your situation to its most complete possibility.

If any of this information was useful to the cause of answering your questions would you do me the favor of a written piece of feedback to let me know if I hit the mark or not? Also, if there are no more questions or comments on what I've written I'd appreciate your CLOSING THE QUERY on your end which will signal to the network that I've satisfactorily addressed your concerns and that the case if ready for being credited and archived for future reference.

All the very best to you and I hope you'll consider staying in touch to let me know what you discover. You may address future questions directly to my attention (DARIUSH SAGHAFI, MD) or you may wish looking me up for a live webcam consultation at www.healthtap.com/drsaghafi I am on live Wed-Sat from 3a-6a (New York City Time Zone).

This consult required 47 minutes of physician specific directed time for review, research, and final draft documentation for envoy.

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Brief Answer:
Cervical Spine Results Noted-

Detailed Answer:
Good morning again. Thanks for the updated information on other aspects of things going on with you to give a more complete picture than the first question provided.

I reviewed the details of the cervical spine report and don't find them impressive enough in terms of some of the minor defects reported by the radiologist to be of clinical import or relevance to what you're talking about. Especially in light of the MRI report of the T2 signal lesion you described.

I wouldn't refer to this entity as a plaque since we really don't have a CLINICAL DIAGNOSIS yet of ANYTHING let alone MS...right? It's a lesion and that's the most correct thing anybody can definitely say at this moment. However, YES..l am of the opinion based on what you've told me about your symptoms and after reading the Cervical Spine report that the most likely entity causing the sensations is this SINGLE LESION. As I said in the other answer, you'd be surprised sometimes at how small something is to cause symptoms. Not only that the anatomic location of the lesion being on the right side of the brain fits the symptoms that are on your left since the brain tends to be cross wired.

Having said that, we also agreed that an MRI of the spinal cord itself with gadolinium (and I would probably include the ENTIRE cord; cervical, thoracic, and lumbar) should be done to see if other lesions appear.

I'm glad you have no other symptoms of those you mentioned. Perhaps, it will stay that way. Also, once you are able to be fully examined by a neurologist it is possible they may find it appropriate to start you on medication or intervention to keep things as they are.

I'm not sure what you'd find in the way of vascular diseases or vitamin deficiencies in a person as young as yourself but there certainly couldn't be anything wrong with your wanting to optimize your diet and health. I highly recommend getting vitamin D levels up to a nice robust range. My preference is to see serum levels of 60-80 although lab ranges are said to be normal above about 25. In all my neurology patients I get them up and keep them there. You should also check out B12, Thyroids, folate, calcium, and I would even throw in Vitamin C if you can do a specific assay. Vitamin C supports the immune system. I actually have my wife and son on high dose and it has helped them immensely with their asthma symptoms.

Certainly, good exercise is always a plus. If there is any better weight you could be at or better condition your heart could be in then, that too should be looked at and finally, stop smoking, limit drinking, and no funny other pills, smokey stuff, or the like...if you know what I mean! LOL.

As far as hope that it's not MS....you said you wanted honesty in my response. Therefore, I echo what I've said earlier.

You have a lesion which is on the MRI scan. I believe this is more likely the cause of your symptoms than anything having to do with minimal degenerative arthritic types of changes in the cervical spine. However, what simply has to happen before any diagnosis can be made or not is you need a neurological exam. You say you have to wait 1 month to see the specialist.

Take a skip across the pond if you'd like and I'll be happy to see you in beautiful XXXXXXX OHIO-- and even show you the way to some of our world renowned centers of medical excellence that evaluate these sorts of things day in and day out.

So I think you can definitely start doing some proactive things from a health perspective as I've described above but the diagnosis cannot yet be made until you've seen A NEUROLOGIST.

If this information has been useful please send me a little written feedback and a STAR RATING and I'd be very appreciative.

Regards for all the best to follow you!

This query was 60 minutes in duration.

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