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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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are multiple Foci seen an an enhanced MRI something that should

Customer Question

are multiple Foci seen an an enhanced MRI something that should be a concern? I have been having numbness and tingling sensations like hands and feet falling asleep and burning sensations in my thighs when walking I have also had a major decrease in vision in the last 2 years as well as headaches that do not fo away they are not migraine like headaches but more of a pressure type like my head is going to explode type feeling and they are much more sever if I am bent over it is like a tidal wave sensation when bending over and I get very dizzy all of a sudden when I bend over.. Also when riding in a car I can not stand to have the windows down the sound or pressure of the air going through the windows kills me it makes my head feel like its in super exploder mode any help or input as to what might be the cause of some if these issues will be greatly appreciated I do have some bulging discs and MRI showed mass lesions and multiple T2signal Foci Thank you. Trying to get a follow up appt her is close to Mission impossible I waited 16 months to get my initial appt with neuro.......
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.
Hello. Small T2 weighted foci of hyperintensity seen in the paraventricular white matter is a non specific finding, and can be seen in patients with migraine, as well as other disorders. I would like to read your MRI report if you have it, as that might tell me more specific information regarding size and location. What do you mean by mass lesions? Please get back to me to discuss. Dr Frank T
Customer: replied 1 year ago.
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You don't have permission to access "http://www.justanswer.com/neurology/7qxow-multiple-foci-seen-enhanced-mri-something.html" on this server.


Reference #18.84240e6b.1367968116.cb0bfdb


This is what I am getting when I try to attach the report of my MRi is there something I can do?


 

Customer: replied 1 year ago.

Examination MRI Brain before and after 17cc magnevist IV contrast


 


Findings:


 


There are enhancing intra -axial and ectra-axial mass lesions. There is no abnormal leptomeningeal enhancement or parechymal enhacement. multiple nonspecific scattered foci of T2 signal are present within the paraventricular white matter and deep subcortical white matter mastoid air cells show no signal abnormalities there are no hyperintense t2 signal air fluid levels in paranasal sinuses there is mild chronic bilateral maxillary sinus mucosal thickening


 


Impression


 


no acute intracranial pathology


 


nonspecific scattered t2 signal foci withinn paraventricular white matter and deep subcortical white matter Differential consideration in sequelae from demyleimiting process in proper clinical setting

Expert:  Dr. Frank replied 1 year ago.
Hello. I really cannot be sure from here, but I would say that you left out some words here, the most important would be the "no" enhancing extraaxial or intra-axial lesions, there is no leptomeningeal enhancement, etc.....

there was a mistake in your MRI report or a mistake in typing the report into the record here. The reason? It would have been stated again in the impression. (The impression is no acute intracranial pathology, which means no new lesions)

The last section is what I was saying earlier, this is "non specific" and these foci are common in patients with migraine, or "normal aging" in the setting of hypertension, high cholesterol, diabetes, smoking, etc. You can see this type of change if you have MS, or lupus vasculitis, but you need a clinical history to suggest MS, or lupus, etc. So essentially this is a normal MRI scan from this report (if I am correct about the mistakes in the report? ) If the "no" was left out, you need to call the radiologist and have him make a correction to ther report. Dr Frank T
Customer: replied 1 year ago.

It does not say no it says there are enhancing....... I did not leave the word out.... Would it be normal for a previous MRI to not mention any of these things my previous MRI was a yr prior and showed nothing not even any mention of white matter it was a totally noramal mri they had thought I had a TIA as I lost vision for about 45 minutes but they could not find anything on MRI and cat scan was normal as well so would these jsut pop up all of a sudden like this? I do not get migraines I do get cluster headaches but I have had them for 20 years if they were the cause I would believe they would have shown on previous MRi as well? I do not have Diabetes nor high cholesterol.... and as I mentioned my blood pressure is low so not sure why you put in hypertension did you read my original question and concerns and symptoms?...... you have not referenced any of the symptoms I asked in my first question to you... Please refer to my first contact with you as those are my major concerns as well as the Foci which yes you gave me the same definition I got when I googled it.......

Expert:  Dr. Frank replied 1 year ago.
Hello. You discussed this previously with another expert, and he told you that it was consistent with neoplasms in both the brain and outside the brain. The only way you could have this and an earlier normal MRI would be to have metastatic cancer, and you would know that clinically. In this situation, if you have a neurologist or a neuroradiologist, they would have been jumping all over you, to find out what is wrong. As mentioned earlier, these reports are written to be descriptive of positive AND negative findings in the first section, then in the Impression, to restate the positive findings that are important. No report is going to say "there are enhancing intra-axial, and extra-axial mass lesions" (and no leptomeningeal enhancement, which would have been part of having extra-axial lesions) and then in the Impression, say, "normal study" THIS IS A MISTAKE.
Please call the radiologist and get back to me on this, do not rate my answer until you find out, I would appreciate that. thank you.
Customer: replied 1 year ago.

If you would tell me a way to send report I would gladly send it I ampicking up the actual scan discs tomorrow but not sure if I will be able to transmit those either? I have had ovarian cancer I want to know if theres a chance that this could be a type of cancer that is what is freaking me out. I live in an are that is not known for its medical experts I am travelling to California in 2 weeks with reports and scans and hoping I will get some answers from a neurologist there but the waiting is killing me the not knowing and not getting any very good answers if you tell me how to send you the report I will gladly send it on to you so that you may see it word for word yourself.

Expert:  Dr. Frank replied 1 year ago.
Hi. there is no reason to send the report. You can read and I believe you, but you need to call the MRI center where that report was written, tommorrow, and ask them if there is a mistake in the report. You can upload the DVD as a single file to www.dropbox.com, then come back here with the webaddress, and I would be glad to look at your films. But a much better solution is to call the MRI center as this is a major mistake, if it is a mistake. You can have extraaxial and intraaxial lesion in metastatic ovarian carcinoma. sorry I cannot help more from here
Customer: replied 1 year ago.

not sure if I did this right please let me know if you are able to view MRI images.... I spoke with radiologist his exact words were he does not make mistakes and the final report states the exact as the prelim report stating in the first line there are enhancing mass lesions......https://www.dropbox.com/l/KAlDfKokC96wjs6SQkxO6b

Customer: replied 1 year ago.

https://www.dropbox.com/l/KAlDfKokC96wjs6SQkxO6b

Expert:  Dr. Frank replied 1 year ago.
Hello. You do have small punctate lesions in several areas of white matter that are seen on the T1 FLAIR imaging sequences. Since the radiologist says they enhance ( I do not have those images on this CD) then they could be consistent with demyelinating diseases, and you need to see a neurologist about a work up for MS, Lupus, Vasculitis as associated with autoimmune diseases, Lyme disease, etc. This is not the features you would expect from cancer metastasis. Please get back to me to discuss this further, or rate my service if satisfied. Dr Frank T

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