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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Neurology
Satisfied Customers: 53643
Experience:  Medical Doctor Trained at a Top Academic Institution
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My recent MRI report said - There are five or six small, sub

Customer Question

My recent MRI report said -
There are five or six small, sub centimetre diameter linear non-enhancing high T2 signal foci within the paracallosal white matter bilaterally, all perpendicular to the corpus callosum. There is another small high signal focus within the left parietal lobe adjacent theleft lateral ventricle trigone. In the clinical setting the appearance is consistent with a demyelinating disorder.My doctor said it is highly likely I have MS and has referred me to a neurologist. My Dad and 3 cousins have MS. I have experienced burning sensation in my fingertips of my left hand on odd occasions over the last 3-4 years as well as hyper-sensitivity of skin. These episodes last 12 hours or so. I recently experienced blurry vision in my right eye which lasted for approximately 20mins.I saw a neurologist today who said that I am in the "grey zone" of a diagnosis. He said the white spot on my scan could be anything - e.g. I may have been born with it, or it may be a vessel or something. He said the blurry vision was not optic neuritis and rather a silent migraine (although I didn't have any pain??!). He said Optic neuritis is a loss of colour vision in the eye that has some pain associated with it that develops over a few days to being a loss of visioning the eye which lasts for a week. He said my options were to ignore the MRI results or get a scan in 6months time to see if there were more spots though conceded that even people who have had MS for 10 years or more generally get only 1 or 2 more white spots in a year so I may not develop any more spots in such a short time but that still doesn't rule out MS. He said he doesn't do lumbar punctures as a matter of course as it still doesn't rule out or in MS. He said the skin sensations I experienced weren't related to MS as I only experience them for short periods of time whereas MS sufferers experience these symptoms for days or weeks at a time. Due to how long it takes for the inflammation to leave the body.Interested to hear your thoughts on whether it is likely to be MS and if this wait and see approach is recommended. I don't want it to be MS but i don't want to have my head in the sand about it either and not be on treatment early to potentially stop the progression. Thanks
Submitted: 11 months ago.
Category: Neurology
Expert:  Dr. Frank replied 11 months ago.

The Grey Zone he describes is actually a good representation of your situation. Unfortunately, you are stuck between a rock and a hard place. Pretty much everything you wrote, and what your neurologist wrote, is correct. Your description of the white spots, although I assume there was not any gadolinium enhancement (you did not mention it) is consistent with MS old demyelinating lesions, BUT, it is well known that asymptomatic family members of patients with MS can have these lesions and it does not mean they have MS. Additionally, the statements about possible optic neuritis made by the neurologist is correct, sounds like you did not have it. You do not describe, nor do I expect the neurological exam show, weakness or ataxia or eye findings like an INO (intranuclear ophthalmoplegia) or any other well know signs of MS, just the sensory findings that are subjective and could be seen with anxiety for instance. Anxiety or "pseudoexacerbations" are a common finding in MS patients, and/or family members unfortunately, in part because this disease is hard to diagnose and treat, and there is no cure. Conversely, we know that early treatment is the hallmark to reducing the chances of a more aggressive progression of disease, so you have to stay on this until you get an answer. CSF testing would help in my opinion, as they now have new biological markers being developed in addition to oligoclonal banding that if positive for 3 or more bands would suggest active disease. But for now, it sounds that you have possible MS (using the old diagnostic scheme that was thrown out), without active lesions, no true objective findings, and an MRI that is compatible with being in the family. So your options are to keep looking, repeat the scan, repeat the exam until there is something more definite. I hope that helps. Please get back to me with questions and I will reply. Or if satisfied, please remember to rate my service by clicking on the rating stars, as that is how I am compensated for this work. thanks *****

Customer: replied 11 months ago.
Thanks Dr Frank I appreciated your responses to this question a few months ago and had hoped you would reply again - was hoping I wouldn't have to pay again though!
I understand what you are saying and the neurologist. I was just confused about the optic neuritis as I have read that blurry vision (less than an hour in duration) in an early sign of MS. Like I said I don't want it to be MS but I also don't want for the disease to progress more than it needs to without receiving treatment if that makes sense?
What do you make of the skin sensations I have experienced? Also he didn't ask about fatigue or any memory issues - I am guessing that this is because these symptoms can be caused by many other conditions/factors other than MS??
Expert:  Dr. Frank replied 11 months ago.

sorry, but I am not allowed to work for Free. Dr Frank

Customer: replied 11 months ago.
I apologise as that is not what I was insinuating. I simply was referring to a comment you made when I asked if I would have to pay again in regards ***** ***** question if I wanted to know more after seeing the nurologist and you informed me that I wouldn't have to pay again as it was in regards ***** ***** same question and so I assumed that meant we could simply continue where we left off. I apologise as I mean no offense and greatly appreciate your expertise
Expert:  Dr. Phil, MD replied 11 months ago.

Can I help?

Customer: replied 11 months ago.
Would be interested in your thoughts.
Expert:  Dr. Phil, MD replied 11 months ago.

Do you have any other medical issues at all?

Customer: replied 11 months ago.
No just interested on your opinion on whether you think it's likely to be MS. Like I said, I don't want it to be MS but I don't want to not be getting treatment to halt progression if I do have it
Expert:  Dr. Phil, MD replied 11 months ago.

I think this is likely early MS

I think you should do an MRI in 6 months to 1 year to check on it

6 months might be too soon

Expert:  Dr. Phil, MD replied 10 months ago.

Thanks for this question.

Please don't forget a positive rating. I appreciate it

If you have more questions, just reply