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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 10337
Experience:  14 years experience in the field of Family Practice
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S! I am so grateful service as I am trying to manuver my way

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Hello Doctors! I am so grateful for this service as I am trying to manuver my way through a very rural political hospital system and I know I'm going to have to go to bigger cities for help. I'm 53 female, in reasonably good health prior to all this with the exception of lifelong anxiety (came out of womb hyper - a family history as well) and arthriitis - also big family history. In 2009 I had a very bad fall (about 20 feet and landed only on my head my nose breaking my fall. Lost conciouness and it appears I did not recall alot of the advice given at that time - don't even remember my MRI. Had a car accident in October and had another closed head injury and neck whiplash exacerbating the already horrible MRI of my last four cervical vertibrae (listed on this site I believe last time I contacted you. BEFORE i GO ON YOU HAVE NO IDEA HOW GRATEFUL I AM TO HAVE YOU AS A RESOURCE !!! For the first time since I was 15 I'm not working 90 hours a week and have basically lost the major revenue of my 24 year old company. So I'm disabled by both pain and limiation of movement from neck and COGNTIVIE problems and fatigue. The caps was me trying to stress this point. :) and of course PCC symptoms. Again lost conciousness and was kept in hopsital for the october car accident just like the 2009 20 foot fall. October: observation in ICU due to confusion - cognitive issues remain as well as emotional issues. I've worked two jobs every day of my lfe so this is not easy - but it is what it is and I'm being shuffled in 10 diffferent directions - but oddly had to figure for a neurologist referrral. Got one had the MRI on brain on Friday. It reads: Ventricles are normal size, no mass, mass effect, midline shift hemorrage, ishemia or extra axial fluid collection is present. Posterior fossa trucures are normal. normal flow voids are preserved. Intraorbiatal contents are normal. Here's the part that bothers me (i think) I'm not sure how strong the radiologists feelings are on her ideas about the "pattern". BTW I have no migraine history. And have never had one - just rebound headaches after concussion of car accident.Radiologist writes on the Friday MRI: multiple foci of abnormal periventricular signal hyperdensity are noted: some orientated perpendicular to the orientation of the ventricles. The part that bothers me is written in both the regular part of MRI as well as items 1) on IMPRESSION: 1.multiple foci of periventricular white matter signal hyperintensity. The pattern raises the possibility of demylinating disease. Early chronic ischemic change, vasculitisand sequela of migraine headaches could also have this appearance.2) mild simusitisI of course called the neurologist - though nice - has NO time as he's the only one in 4 eastern Wisconsin counties. He will be able to see me first on 4/1. His comment to me (i never said a word abour MS - just asked what he thought about the MRI). He's nice and proactive - but I"m new here - have no clue if he's good.His comment was this: "I saw your MRI report and it doesn't read like MS. I pushed to see if he saw the pcitures (he hadn't a chance to today) but told me it didn't read like MS. " Obviously i need more opinions. I was supposed to go to NYNY to go through cognitive testing for a private purchased disability policy I bought after the fall. I'm supposed to leave in 10 days - I really need to do that but in a way I feel like I could stroke out or something........but the bigger picture may be the MRI radiologists ideas of patterns - none of it sounded good to me except the migranes and that is NOT my issue - your thoughts? As many and as detailed and as much time as you can take to help will be most appreciated. I'm not getting much feedback here - and wont' until I get into a city like Milwaukee or Chicago. I'm lost and I'm a bit scared by that MRI. The neurologist does not think I'll stroke out (I'm only half joking but my BP is okay) and thinks I should go get the cogntive testing as the guy in NY is the best and it's my one chance to get answers there. More importatntly please do not be afraid to tell me your real thoughts and if you don't think it's a good possibilty I have bigger probems - I can handled that too..........like I said, I'won't be to Milwaukee for advice until the end of the month after NYNY and I will pay for EVERYTHING you can give me advice our counsel wise as well as time you need to investigate. I absolutely guarantee you are actuallly arlready taking more time than my current help lol. Sadly
Submitted: 9 months ago.
Category: Medical
Expert:  Anthony Bray, MD replied 9 months ago.

Hello!

This seems to emerge as a very common concern on these MRI reports ...periventricular foci of hyperintense white matter lesions >>

Yes these type findings COULD be consistent with multiple sclerosis lesions BUT in your favor it would seem that 1) limited and scattered findings would not on its face seem to suggest any aggressive expression of MS

2) you report history of closed head injuries but not neurological deficits that sound like progression of MS ...So your history to me sounds that you do not have a clinical history that seems to fit with MS

3) the scattered nature of these lesions sounds like her small blood vessels that have closed off / lead to lesions / mini mini strokes if you will probably more likely in our 50's ( yeah I'm there too...) so it sounds horrific but let's take a step back and look at this issue ...a major stroke might wipe out an area of brain the size of an orange ...a minor stroke the size of a marble ...these are areas about the size of a grain of rice ...so very minor in scope is the point ....

These could have been caused by physical injury of your closed head injuries ( bruising / small vessel tears /micro- injuries )

Your history of the TBI s seems to most fit with that ...

Chronic small vessel disease due to high blood pressure and other risk factors is possible .. Yes ...this may be part of your assessment .....

In sending this portion of response but still working on reply.......

Expert:  Anthony Bray, MD replied 9 months ago.

Your neurologist will review actual films ( or copy on computer) and review your exam and history ...

Multiple sclerosis may mimic similar type findings on MRI in appearance but active cases of MS usually has a clinical history that shows flares of activity and enlarging lesions of the demyelinating process...the description so far does not seem to fit MS ..

I can't of course guarantee you that MS is not a problem but the findings do have overlap with that potential BUT it does not sound to me that your history points to MS as the cause of the small scattered white matter lesions ...

MS is an autoimmune disease that attacks the brain ...it does have treatments but not a cure ....

As I said your history and findings I think point much more to other causes of the small irregularities seen on the MRI ...

I more suspect that if we could go back in time and erase those closed head injuries that you probably would now have a normal MRI ....

I hope that this information is helpful for you

Let me know if you have further questions or concerns

I will be happy to get back with you

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

Anthony Bray MD