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Dr. J
Dr. J, Neurologist (MD)
Category: Neurology
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Experience:  Chief Resident
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I had an MRI Cervical spine without and with contrast. Findings

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I had an MRI Cervical spine without and with contrast. Findings: 3 cm of active high signal identified in the ventral aspect of the cerical cord behind the C2 vertebral body. This shows minimal enhancement. Minimal cord swelling. Alignment: Normal
Canal: Relatively capacious. Vertebral marrow: Normal. Vertebral cortex/endplate: Normal.
Impression: Upper cerical cord central right and left hemicord high signal change with mild degree of cord swelling with minor degree of irregular enhancement appearances consistent with tumefactive demyelinating disorder differential less likely low grade cord tumor.

Can you put this in layman's terms for me?
Submitted: 3 years ago.
Category: Neurology
Expert:  Dr. J replied 3 years ago.
Hi,
The spinal cord runs from the base of the brain down to the lower back. This report indicates that there is some abnormal activity going on in a small area of the spinal cord located in the upper neck area. I assume you got the MRI because you are having some sort of neurological dysfunction of your arms or legs. The lesion seen in the spinal cord may account for these symptoms.
The radiologist is not 100% sure what the abnormality is but he thinks it is probably related to inflammation, which is the body's immune reaction to infection or sometimes an auto-immune reaction. (Auto-immune means that the body mistakenly reacts to it own organs, in this case the spinal cord). One other possibility, although less likely is that the abnormality is related to a tumor.
Depending on what is already known about your case, you may need further testing to know exactly what it is. A common next test would be a spinal tap and blood tests.
Hope this helps.
Customer: replied 3 years ago.
My mother was diagnosed with MS in 1978 and passed away about 10 years ago around the age of 72. Is there a high degree of probability this could also be MS?
Expert:  Dr. J replied 3 years ago.
MS is definitely high on the list of possibilities. Although it is a little less common to be diagnosed at your age. There are other diseases that could cause the inflammation seen on the MRI and "mimic" MS. It is then likely that your doctor will need more blood tests and a spinal tap. You might also need MRI's of other parts of the spine and brain to see if there are lesions similar to the one you already know about. This would make MS more likely.
Customer: replied 3 years ago.

they did do a brain MRI at the same time. The findings are..

There is no intraparenchymal hemmorrhage, acute infarct, mass or midline shift. There is no hydrocephalus or extracerebral fluid collection. There is mild cortical volume loss and there are multiple subcortical deep white matter due to hyperintensities which are nonspecific. Some of these lesions do appear oval shaped and periventricular and this could represent demyelination or chronic ischemic microvascular change. The visualized portions of the orbits, paranasla sinuses, mastoid air cells, and sella are normal. Normal signal flow voids are noted at the skull base.

Impression: No acute infarct. Mild cortical volume loss and nonspecific subcortical and deep white matter due to hyperintensities. Differential includes demyelination or chronic ischemic microvascular change.

 

I don't understand this either. Does it lead one to lean toward MS?

 

Expert:  Dr. J replied 3 years ago.
As you can tell, the radiologist is not giving a definite answer and obviously not being able to see the scan myself makes it hard for me to say, but those brain lesions in combination with the spinal cord lesion makes MS even more likely.
Traditionally MS has been diagnosed based on a history of two or more discrete episodes of neurological impairment affecting two or more different parts of the nervous system. However, with good quality MRIs, the diagnosis is now being made if there is one episode and multiple lesions on the MRI.
What symptoms lead you to get the MRI? Is this the first time you have had Neurological symptoms?
Customer: replied 3 years ago.
I had a headache and a stiff neck. I went to my chiropractor who made an adjustment. The headached went away, but I still had a "sensitive feeling" down my left arm. He was concerned enough to send me to the Emergency room. I was there for 12 hours while they "worked me in" for the scans. The drs in the emergency room said the tests were inconclusive. Currently I have a "sandy feeling" in both of my hands. I would not call it tingling or numbness. More it feels like I have sand on my hands like if I were at the beach. Other than the initial headache, I have not been in pain. I am diabetic and wear a pump, taking about 48 units daily with my bolus amounts. My recent A1c was 7.1. Could this be diabetic related?
Expert:  Dr. J replied 3 years ago.
Diabetes can lead to nerve injury that affects the feeling in both hands, but it usually comes on over a long period of time and wouldn't show up on an mri. A lesion in the area of the spine as you have could certainly cause symptoms in both hands at the same time.
If you got these scans from the ER and don't have a Neurological follow up I would make an appointment to see a Neurologist fairly soon. That way you can have the appropriate additional tests to expedite the diagnosis, which very well might be MS given the other lesions seen in the brain which you likely have had for a long time but didn't know because they weren't causing any symptoms.
Customer: replied 3 years ago.

Thanks for your help. I appreciate it. I'm in the process of trying to find a neurologist. I called the MS society, they sent me a list. I'd like to find someone who specializes in MS and Diabetes, but don't know how to find such a dr. I'm a little leary of my endos recommendation becuase I fear he'll just suggest someone in his "group".

Expert:  Dr. J replied 3 years ago.
What part of the country do you live in?
Customer: replied 3 years ago.
Charlotte, NC.
Expert:  Dr. J replied 3 years ago.
I'm not that familiar with that area, but I'm guessing that Duke has a good neurology program with specialists is MS and other demyelinating diseases.
Good luck!
Dr. J, Neurologist (MD)
Category: Neurology
Satisfied Customers: 7
Experience: Chief Resident
Dr. J and other Neurology Specialists are ready to help you
Customer: replied 3 years ago.
Thanks, you've been very patient and I understand your repsonses. I appreciate it. I understand it's pretty cold up there in the North with lots of snow. Stay warm.

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