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kimo31
kimo31, Doctor (MD/DO)
Category: Health
Satisfied Customers: 48
Experience:  Family Practice resident.
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on a recent mri, without contrast, the impression is...small

Resolved Question:

on a recent mri, without contrast, the impression is...small vessel ischemic disease.

I do not have high blood pressure, nor diabetes, I do have atrial fib. 2 valves
are involved..do have regurgitation. I do have copd..am slightly over weight.
for my 5'9" height. I am 80 years old.

The mri exam of the brain demonstrates the ventricals, cisternal spaces and
cortical suici are appropriate for the patient's age. There is no midline shift
or extra axial collection. There are numerous foci of increased signal within
the periventricular and subcortical white matter which are nonspecific and
may represent the sequela of small vessel ischemic disease. The diffusion weighted images demonstrate no acute ischemia. There is normal vascular
flow voids. The visualized paranasal sinuses are clear. The mastoids are well
aerated.

I am worried about MS ( I don't know why)and if I should follow up with
another mri to compare. This mri was done 5/17/12. I'm just plain worried!
Submitted: 11 months ago.
Category: Health
Expert:  kimo31 replied 11 months ago.

kimo31 :

Hello, I am happy to assist with your question today!

kimo31 :

I understand that you are worried about your old MRI findings and that you have a concern for MS.

kimo31 :

May I begin by inquiring as to what has you concerned for Multiple Sclerosis?

Customer:

I was reviewing the details of my mri findings...on the computer and ma was a

Customer:

suggested by computer inquiry

kimo31 :

I see.

kimo31 :

Lets begin by reviewing Multiple Sclerosis.

kimo31 :

This is a diagnosis based largely on symptoms, or a combination of MRI and symptoms separated by both space (different anatomical relationships) as well as in time.

Customer:

please begin

kimo31 :

It is typically diagnosed in women > men between ages 15 and 50. In fact, this isn't typically picked up at age 80.

kimo31 :

Have you had any neurological impairments that have "come and gone"?

Customer:

what impairmens should I be feeling - coming or going

kimo31 :

This could include visual disturbances, weakness, trouble walking straight, pain, sensation, etc.

kimo31 :

If you have not experienced a symptom that has been noticeable to you, then I would suggest that we keep this in the back of our minds as we continue to discuss the MRI findings that can be typical of those described in your question.

Customer:

I have noticed my left eye - toward the nose is sometimes blurry. Head feels heavy

kimo31 :

I understand, these are certainly troubling symptoms but do not sound to be entirely fitting with MS.

Customer:

I have a regular gate. Some arthritis

kimo31 :

Small Vessel Ischemic disease is where small blood vessels in the brain tissue begin to show evidence of things like plaque deposits and calcifications. In parts of the brain, this can lead to decreased blood supply to regions that are normally supplied by very small blood vessels.

kimo31 :

In some instances, it can lead to symptoms of dementia, but typically doesn't manifest as what we would describe as "focal" deficits that we would expect to see in MS.

kimo31 :

The statement of "numerous foci of increased signal within the periventricular and subcortical white matter which are nonspecific" is a common finding that fits with small vessel ischemia, as these are areas that are commonly affected by this type of process.

Customer:

what are the concequences. I have many interests and don't feel lame

kimo31 :

periventricular, juxtacortical, infratentorial, or spinal cord lesions would be more specific to multiple sclerosis.

kimo31 :

Well I am very happy to hear this!

kimo31 :

The consequences are that over time, you may discuss with your provider the need to monitor for signs of dementia.

kimo31 :

This is not something that will absolutely be the case, but might be something to watch out for, as there are treatments to help with symptoms.

kimo31 :

You may also discuss with your provider whether you should pay particular attention to high cholesterol and also aspirin.

Customer:

I must tell you that as a younger person I read about a study done at the University of

kimo31 :

Are you currently on anticoagulation for atrial fibrillation?

Customer:

Pennsylvania - a two year study...which concluded that people of age have

Customer:

different priorities and should not be considered laame, unless, of course there are

kimo31 :

I absolutely agree. There is no place for disrespecting or otherwise diminishing any patient's concerns. I am sorry you feel that this would be the case.

kimo31 :

I hope that you have found some resolution to your question about Multiple Sclerosis. If you have any remaining questions about what we have discussed, I am happy to answer them for you.

Customer:

some evidence to suggest it. I don't feel that is my case. Yes I take 25miligrams of

Customer:

digoxin, once a day.

kimo31 :

I do not suggest that you are having symptoms and I have not heard this to be the case. I am advising that you work with your provider to take measures to prevent them from occurring.

kimo31 :

have you taken a medication called coumadin in the past?

Customer:

I understand and thank you - I am releived about the MS! I am on coumidin for quite a

Customer:

few years

kimo31 :

So it sounds like your atrial fibrillation may be rate-controlled then. Typically people with atrial fibrillation take coumadin to prevent blood clots from traveling from the heart to the brain.

kimo31 :

This may be a factor in some degree of ischemic disease in a scenario such as this, which may account for why theses findings are showing on your MRI.

kimo31 :

Not a problem at all. I am very happy to discuss this very important topic with you today.

Customer:

I do test levels, and it seems that when I'm around a reading near 3 I get very

Customer:

uncomfortable with pain seemly everywhere.

kimo31 :

Well I am sorry to hear that. It sounds like you are doing a good job of keeping on top of your anti-coagulation though. Good work.

kimo31 :

The pain will be a concern to discuss with the clinic to see if they have any recommendations.

Customer:

thank you

kimo31 :

As always, I appreciate the opportunity to chat with you today. If you have no further questions about the topics we have discussed today, kindly rate our interactions with positive feedback. I will be grateful for your rating!

Customer:

I don't like taking medications because of the many side effects

kimo31, Doctor (MD/DO)
Category: Health
Satisfied Customers: 48
Experience: Family Practice resident.
kimo31 and 4 other Health Specialists are ready to help you
Expert:  kimo31 replied 11 months ago.
Thank you for the excellent feedback! I recently worked with you in regard to your concern about your MRI findings.

If you have any further questions, please do not hesitate to contact me again. You can even request me specifically when asking future questions by saying so in the title of your question. I look forward to providing you with the best experience possible!

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