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Janne Nissinen
Janne Nissinen,
Category: Health
Satisfied Customers: 47
Experience:  Neurology Fellow at University of California San Diego
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I just had a Brain MRI and have the results online. I want

Customer Question

i just had a Brain MRI and have the results online. I want to know if it indicates MS at all. Would someone be able to read the results and let me know the conclusions and if there is any indication of MS
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Submitted: 9 months ago.
Category: Health
Expert:  Janne Nissinen replied 9 months ago.

Hello,

I'm Dr. Nissinen, a board certified neurologist. How may assist you today?

Customer: replied 9 months ago.
I just had a MRI of the Brain and have the results online. I had the scan to rule out MS. Would you be able to read the report and interpret it for me and let me know of any indication of MS?
Expert:  Janne Nissinen replied 9 months ago.

I can help you with that yes.

Customer: replied 9 months ago.
TECHNIQUE:
Routine noncontrast MRI of the brain an additional axial T1-weighted
series.COMPARISON:
MRI dated March 31, 2008FINDINGS:
The cerebellar tonsils are again located within the lower range of
normal position.There are again subcentimeter T2 and FLAIR hyperintensities in the
hemisph***** ***** matter. Lesions predominate in the periventricular
white matter, corona radiata, centrum semiovale, bilateral frontal
and parietal lobes, as well as the bifrontal subcortical white
matter. Lesions are essentially stable. There is no definite
involvement of the corpus callosum. There is no restricted diffusion.
Considerations include small vessel ischemic change, migraine
headache, vasculitis, multifocal gliosis, and Lyme diseaseThere is no significant cerebellar atrophy. There is no hydrocephalus.There is fluid within several right-sided mastoid air cells.There are chronic small effusions within the posterior aspect of the
temporal mandibular joints .IMPRESSION:
There are again multiple nonspecific subcentimeter T2 and FLAIR
hyperintensities in the hemisph***** ***** matter without significant
interval change.
Customer: replied 9 months ago.
This is the report can you please let me know what it all means?
Expert:  Janne Nissinen replied 9 months ago.

So the MRI is showing T2 and FLAIR hyperintensities which are two sequences on the MRI to show damage in the brain. They can signify many things however and their location aids in the diagnostic process of determining their etiology. They can be caused by high blood pressure, diabetes, strokes, multiple sclerosis among others.

Multiple sclerosis lesions tend to dominate in the region near the ventricles which are the normal fluid filled spaces in the brain. What we call "periventricular white matter lesions" are suggestive of multiple sclerosis but no necessarily diagnostic. To diagnose multiple sclerosis you need two points in time. Either a "clinical attack" which is one where you have neurological symptoms, or two MRI's showing new lesions in the second, or a single MRI showing old lesions and "active" lesions which would require contrast to see.

Have you had an MRI since 2008? Have you ever had symptoms?

Expert:  Janne Nissinen replied 9 months ago.

My apologies, I misread the date of the MRI. Since the MRI has been stable since 2008 whatever process cause the T2/FLAIR hyperintensities is stable.

Expert:  Janne Nissinen replied 9 months ago.

Without seeing the MRI it is a bit difficult to judge what the MRI looks like based on report. Again a clinical history is important.

Customer: replied 9 months ago.
I have not had a brain MRI since 2008. I was diagnosed with Fibromyalgia and I believe the MRI in 2008 showed nothing remarkable. Lately I have been extremely weak on my left side, unsteady walking, increased difficulty swallowing liquids, pain behind my left eye. I have a new PCP and did this MRI to rule out MS. I have all the symptoms of MS, but they are also symptoms of Fibro which makes it hard.
Expert:  Janne Nissinen replied 9 months ago.

Have you ever lost vision in one eye, or had your vision fade out in one eye? Have they ever performed a lumbar puncture on you? Is there any family history of multiple sclerosis?

Expert:  Janne Nissinen replied 9 months ago.

Also, have they ever imaged your neck and thoracic spine with MRI?

Customer: replied 9 months ago.
I have not lost vision in that eye. I don't have a family history of MS. The only lumbar puncture I had was in August 2015 to rule out meningitis since my blood work had indicated an infection somewhere. I was later found a week after to have pneumonia and sepsis
Customer: replied 9 months ago.
I did have a neck MRI and results are here for ringing in ears
History:Left-sided pulsatile tinnitus.Findings:No previous neck MRA is available for comparison.The bilateral common carotid arteries demonstrate no focal stenosis.
The bilateral internal carotid artery origins demonstrate no focal
stenosis. No internal carotid artery stenosis is seen up to the lower
skull base. Left vertebral artery is larger than the right as a normal
variant, without focal stenosis to cervical segments.No clear evidence of cervical segment carotid or vertebral artery
dissection is seen.Impression:No focal cervical segment carotid or vertebral arterial abnormality is
seen.
Expert:  Janne Nissinen replied 9 months ago.

A lumbar puncture can be used to gather supportive evidence for multiple sclerosis, but a negative result does not necessarily rule it out. An MRI of the thoracic and cervical spine can aid in diagnosis as if there are T2/FLAIR lesions there as well it is more suggestive of multiple sclerosis. A contrast MRI can help if multiple sclerosis is being rule out as it rules out any active disease at the time of the scan.

That all being said, again T2/FLAIR hyperintensities can be non-specific and related to blood pressure, diabetes, high cholesterol etc.

Expert:  Janne Nissinen replied 9 months ago.

The second study you posted is an MRA or an MR-Angiogram which looks at blood vessels in the neck. It shows that your carotid arteries are open and without atherosclerotic disease which helps to say that the T2/FLAIR hyperintensities are not small strokes caused by plaque detaching from your carotid arteries

Customer: replied 9 months ago.
History:Low back pain extends to 2 left back and left foot.Findings:Images are compared to October 27, 2006 examination.There is dragging of lumbar lordosis seen. No focal level of disc
desiccation is seen. No focal bone marrow edema seen no fractures
noted. The distal spinal cord appears unremarkable.At L5-S1 level mild facet joint degenerative changes are seen, subtle
annular bulging cause no significant thecal impression is, no focal
protrusion is seen no L5 foraminal narrowing is noted.At L4-L5 level there is left eccentric mild anterior thecal impression
seen, due to a broad shallow left posterolateral protrusion,
compressing the left L5 nerve root in the left lateral recess, series
6 image 14, without dimensional spinal stenosis seen. The protrusion
continues somewhat into the left L for neuroforamen, without
significant narrowing, without L4 neural impingement seen.L3-L4 level left eccentric disc bulging cause minimal thecal
impression no spinal stenosis is seen. Left L3 neuroforamen as not
significantly narrowed.At L2-L3 level minimal annular bulging causes no significant thecal
impression, no L2 foraminal narrowing is seen. At L1-L2 level minimal
right eccentric disc bulging cause minimal thecal impression. No
spinal stenosis is seen, no foraminal narrowing noted.When compared to previous 2006 examination the L4-L5 leftward
protrusion is new, the L3-L4, L2-L3 and L1-L2 disc bulging is similar.Impression:Now visible broad left posterolateral protrusion at L4-L5 level causes
thecal impression, compromises left L5 nerve root in the left lateral
recess.This is a lumbar i had in 2014 for back painMinimal disc bulging is again seen at L1-L2 L2-L3 and L3-L4 levels,
without spinal stenosis without focal foraminal narrowing seen.Mild L5-S1 facet degenerative changes are also seen
Customer: replied 9 months ago.
I couldn't have contrast due to CKD stage 3
Expert:  Janne Nissinen replied 9 months ago.

While it shows that you have mild degenerative disease in your low back, it does not unfortunately aid in diagnosing multiple sclerosis as the disease, when present, affects the brain, cervical spine and thoracic spine but not the lumbar spine.

CKD stage 3 is a definite contraindication to contrast.

Again though, since there has been no change in your MRI since 2008, even if you were to have multiple sclerosis it would be VERY slowly progressive and some physicians may not even start treatment for it. Unfortunately without actually seeing the MRI I cannot make a firm determination. Multiple sclerosis is more common in individuals in their late 20s and early 30s and in females more than men.

Expert:  Janne Nissinen replied 9 months ago.

I hope that this information is helpful for you.

Let me know if you have further questions or concerns and I will get back to you as soon as possible.

If my answer has been helpful and to your satisfaction please remember to leave positive feedback. Thank you and Best Regards,

Kristoffer Nissinen, MD

Expert:  Janne Nissinen replied 9 months ago.

If there are any other questions please let me know.

Sincerely,

Kristoffer Nissinen MD

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