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What Do These MRI Findings Regarding Frequent Migraines Indicate?
Question: I am a 46 year old female who recently had an MRI of the brain w/ and w/o contrast due to severe and more frequent migraines, constant headahes, lower extremity weakness & parasthesia, abnormal gait, severe fatigue. My findings were as follows: Few scattered foci of signal abnormality in the right and left periventricular deep white matter, demyelinating disease or multiple sclerosis should be considered. Chronic microvascular ischemic change can have a similar appearance. Mild diffusevolume loss, indeterminate in etiology but greater than expected for patient age. What are your thoughts on this? Recent C-spine MRI shows moderate bulging discs and degeneration, along with narrowing of foramenal opening in from C1 all the way to T1, every single one. Lastly, L-spine MRI shows L3,L4,L5,S1 all with mild bulging discs, narrowing of foramenal openings, mild loss of disc height/space and arthropathy. My Neurologist is completely puzzled! What now?
Brief Answer:
Close watch on clinical symptoms and follow up MRI scan required in 6 month
Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Having seen MRI scans regularly I will be glad to share my thoughts with you.
Please find my observations below.
1. There are few areas in both side of the brain in the white matter region around the ventricles. This is an area where there is a concentration of nerves. The appearance of white spots in these areas can be due to a number of reasons. It can be due to multiple sclerosis which is a condition due to destruction of the nerves and it requires proper treatment or it can be microvascular ischemic changes which is a benign condition due to mildly reduced blood supply to certain parts of the brain. While multiple sclerosis is a disease that requires immediate attention, microvascular ischemic changes can be acceptable at advanced age. However microvascular ischemic change at your age is unusual unless you have conditions like hypertension or diabetes or any other medical condition.
2. Your brain size is showing slight signs of aging with no particular significance attached to this finding.
Your neurologist has to think of all possibilities before making a final diagnosis and correlating with clinical examination.
Multiple sclerosis is confirmed by closely observing patient symptoms and repeating the MRI scan with contrast once again. In the MRI confirmation of multiple sclerosis we follow the McDonald criteria which specifies appearance of new findings in space and time in subsequent MRI scans as a diagnostic feature of multiple sclerosis.
3. There are multiple level degenerative changes in your neck and lower back due to bulging discs pinching on nerves. There are many treatments for nerve root pinching and these procedures include the following.
Epidural injections
Facet joint procedures—intraarticular joint steroid injection, medial branch block, and radiofrequency ablation.
Disc Interventions
Spinal Cord Stimulation.
Peripheral Nerve Stimulation.
Increasing dose of pain relief medications and including specific medications and opioid analgesics.
Physical therapy might not give him sufficient relief from the pain as the cause of pain is mainly in the operated area.
Surgery for disc problems are considered only if the above conservative treatment methods do not help.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Close watch on clinical symptoms and follow up MRI scan required in 6 month
Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Having seen MRI scans regularly I will be glad to share my thoughts with you.
Please find my observations below.
1. There are few areas in both side of the brain in the white matter region around the ventricles. This is an area where there is a concentration of nerves. The appearance of white spots in these areas can be due to a number of reasons. It can be due to multiple sclerosis which is a condition due to destruction of the nerves and it requires proper treatment or it can be microvascular ischemic changes which is a benign condition due to mildly reduced blood supply to certain parts of the brain. While multiple sclerosis is a disease that requires immediate attention, microvascular ischemic changes can be acceptable at advanced age. However microvascular ischemic change at your age is unusual unless you have conditions like hypertension or diabetes or any other medical condition.
2. Your brain size is showing slight signs of aging with no particular significance attached to this finding.
Your neurologist has to think of all possibilities before making a final diagnosis and correlating with clinical examination.
Multiple sclerosis is confirmed by closely observing patient symptoms and repeating the MRI scan with contrast once again. In the MRI confirmation of multiple sclerosis we follow the McDonald criteria which specifies appearance of new findings in space and time in subsequent MRI scans as a diagnostic feature of multiple sclerosis.
3. There are multiple level degenerative changes in your neck and lower back due to bulging discs pinching on nerves. There are many treatments for nerve root pinching and these procedures include the following.
Epidural injections
Facet joint procedures—intraarticular joint steroid injection, medial branch block, and radiofrequency ablation.
Disc Interventions
Spinal Cord Stimulation.
Peripheral Nerve Stimulation.
Increasing dose of pain relief medications and including specific medications and opioid analgesics.
Physical therapy might not give him sufficient relief from the pain as the cause of pain is mainly in the operated area.
Surgery for disc problems are considered only if the above conservative treatment methods do not help.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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