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Would MRI findings correlate to MS? Giddiness, nausea, vomiting, blurry vision, delay in urination.

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Neurologist, Surgical
Practicing since : 1996
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Question about MRI findings in relation to MS

I guess I should give you a little history:
My daughter was diagnosed with Chiari and Syringomyelia a few years back when she was about eighteen.She had a PFD that resolved her syrinx and then had a SFT that resolved many of the other symptoms. Her balance still seemed to be less than on par and she was still prone to falling. We actually asked about MS and we were assured that it would be revealed in an MRI, if present, and she did not have it. Here recently she has been falling much more regularly, having regular bouts of nausea sometimes leading to full vomiting, and her vision has been going blurry. These are all symptoms that she had been experiencing years ago prior to her original Chiari diagnosis. She is also having an issue of it taking a long time for her to be able to start peeing. Her doctor ordered an updated brain MRI. It of course mentions post surgical changes and whatnot. However, it also says: "There are a few white matter punctuate signal foci noted about the parietal, frontal, and occipital lobes...This is best demonstrated on the FLAIR images. These typically represent small vessel ischemic changes." It is three weeks before we can get into the neurologist; in the meantime would the findings on the MRI and the symptoms correlate with a diagnosis of MS? One of her last MRIs noted PVLs which I was told was no big deal due to her prematurity, but this MRI does not mention any PVLs and does note these foci (and does not mention that they are unchanged). Is it possible that these are the same findings noted in a different manner (Both scans were done at the same hospital)? I am not sure why, given that I have done really well at not 'freaking out' over the years with Tasha's conditions, but for some reason, the idea of MS has me totally overwhelmed.
Thank you for your time, and any help and insight you can give me. XXXXXXX
Posted Tue, 8 May 2012 in Brain and Spine
Answered by Dr. Praveen K Nath 2 hours later

Thank you for posting your query.

I understand your health concern regarding XXXXXXX

I have gone through all the detailed history of your daughter’s disease.

Prima facie it appears that she is suffering from XXXXXXX chiari malformation with Syringomyelia. (Operated and resolved).

Symptoms of giddiness, nausea, vomiting, delay in micturition etc. may be secondary to XXXXXXX chiari malformation as such.

Multiple punctate small white matter ischemic changes can also explain these symptoms but mostly these small punctate lesions in MRI ( Magnetic Resonant Imaging) can be differentiated on a good quality MRI of the brain.

MRI on Multiple sclerosis shows demyelinating changes which are different when compared to ischemic changes.

Additionally diagnosis of MS (Multiple Sclerosis) is based on waxing & waning of neurological symptoms which is specific in distribution.

You can discuss all these things with your Neurologist & Neuroradiologist.

Wishing a speedy recovery.

Dr. Praveen k Nath XXXXXXX Consultant Neurosurgeon
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