d********1
发帖数: 77 | 1 Sorry I cannot type Chinese on this computer.
My wife (33 years old) has some 腿麻, 胳膊麻 etc lately. Her numbness is
sometimes on the left or right leg, arm, toes, fingers, and even face, but
never on all these places at the same time.
We went to our family doctor and he ordered a non-contrast brain MRI for her
. It turns out there is a sub-centimeter focus on her brain. Then our doctor
ordered a contrast MRI, the sub-centimeter focus is still there. Report 1)
below is the full report by the radiologist who read her non-contrast MRI
images. Report 2) below is the full report by the radiologist who read her
contrast MRI images. BTW, the contrast MRI was done 9 days after the non-
contrast MRI.
Now our family doctor suggested us to see a neurologist. I saw there are
several experts on this borad, so I am seeking some opinions here too.
3X a lot!
Report 1 (non-contrast MRI):
PROCEDURE REASON: Disturbance of skin sensation
* * * * Physician Interpretation * * * *
HISTORY: Disturbance of skin sensation
TECHNIQUE: Routine MRI of the brain without contrast.
MR Contrast: No gadolinium administered.
COMPARISON: None
RESULT:
Small, ovoid area of T2/FLAIR hyperintensity involving the pericallosal and
subcortical white matter of the left paramedian parietal lobe just dorsal to
the left posterior body of the corpus callosum demonstrates mild associated
T1 isointense signal and measures approximately 9 X 7 mm in maximum AP and
transverse dimension. There is no associated restricted diffusion,
susceptibility change or significant associated mass effect. Although
nonspecific, primary differential considerations include demyelinating
disease (considered more likely given given patient age and gender) or low-
grade glioma. Consider follow-up contrast-enhanced exam. The brain
parenchyma is otherwise normal in signal intensity and morphology.
There is no restricted diffusion to suggest the presence of an acute infarct
. The major intracranial vascular structures demonstrate flow voids
suggesting patency. No extra-axial collection present. No abnormal signal on
susceptibility weighted images to suggest sequelae of intraparenchymal
hemorrhage.
Ventricles and basal cisterns are normal in size and configuration.
Hypothalamic, pituitary and pineal regions are normal. Cerebellar tonsils
are normally positioned. No significant marrow replacement process
identified. The imaged paranasal sinuses are clear with exception of
moderate left axillary mucosal thickening.
IMPRESSION:
SINGLE SUBCENTIMETER OVOID FOCUS OF LEFT PERICALLOSAL T2/FLAIR
HYPERINTENSITY WITH DIFFERENTIAL CONSIDERATIONS AS ABOVE.
Report 2 (contrast MRI):
PROCEDURE REASON: Nonspecific (abnormal) findings on radiological and other
examination of skull a * * * * Physician Interpretation * * * *
MRI OF THE BRAIN WITH AND WITHOUT IV CONTRAST
HISTORY: Abnormal findings on other radiologic exam of skull COMPARISON: MRI
brain July 31, 2012
MR Contrast: Magnevist Contrast Dose: 11 cc Route of Administration: IV
RESULT: Again appreciated is a poorly delineated area of abnormal flair and
T2 signal involving cortex and subcortical white matter at the posterior
left cingulate gyrus. This has no mass effect or enhancement. No additional
white matter lesions are appreciated. The remainder of the brain shows no
additional focal parenchymal abnormality. Ventricles and sulci are normal in
size for the patient's age. No abnormal enhancement is present. Diffusion
and susceptibility weighted examinations are negative.
IMPRESSION: No significant interval change of nonspecific cortical and
subcortical white matter abnormality of posterior left cingulate gyrus.
In addition to benign focus or low-grade astrocytoma, an area of cortical
dysplasia and DNET should be considered in the differential. Three month
follow-up examination recommended. | l*h
发帖数: 4124 | 2 this is a case that there is no standard answer to the question what to do
next in the short term. if you go to different doctors, you will get
different opinions that can be mainly classified as the following:
1. close follow-up with MRI, do nothing in the interim.
2. close follow-up with MRI, treat as demyelinating disease in the interim.
3. biopsy.
if the description of her symptoms is accurate, the probability of a
demyelinating disease (such as multiple sclerosis) is much higher than other
diseases such as low grade tumors (low grade glioma, DNET etc.) MRS may be
considered, but its use in differentiating demyelinating diseases and low
grade tumors is not standard and the interpretation requires a
neuroradiologist who has done some research in this area.
has she had limb weakness? has she had seizure?
her
doctor
)
【在 d********1 的大作中提到】
: Sorry I cannot type Chinese on this computer.
: My wife (33 years old) has some 腿麻, 胳膊麻 etc lately. Her numbness is
: sometimes on the left or right leg, arm, toes, fingers, and even face, but
: never on all these places at the same time.
: We went to our family doctor and he ordered a non-contrast brain MRI for her
: . It turns out there is a sub-centimeter focus on her brain. Then our doctor
: ordered a contrast MRI, the sub-centimeter focus is still there. Report 1)
: below is the full report by the radiologist who read her non-contrast MRI
: images. Report 2) below is the full report by the radiologist who read her
: contrast MRI images. BTW, the contrast MRI was done 9 days after the non-
| d********1
发帖数: 77 | 3 3X a lot for your detailed response!
The description of her symptoms is as accurate as I can describe (she has
some 腿麻, 胳膊麻 etc lately. Her numbness is sometimes on the left or right
leg, arm, toes, fingers, and even face, but never on all these places at
the same time).
She did not have obvious limb weakness.
What do you mean by "seizure"? 抽搐/癫痫？If so, she does not have it. But
some times (very occasionally, I would say less than 6 times a year in
recent years), she has brief leg/foot抽筋。Not sure whether this is sth. to
consider.
BTW, our family doctor also mentioned that it could simply be some kind of
先天发育问题。He also said that if it is some kind of tumor, usually there
are several focuses, rather than just one focus in her case. What do you
think about these?
3X again!
this is a case that there is no standard answer to the question what to do
next in the short term. if you go to different doctors, you will get
different opinions that can be mainly classified as the following:
1. close follow-up with MRI, do nothing in the interim.
2. close follow-up with MRI, treat as demyelinating disease in the interim.
3. biopsy.
if the description of her symptoms is accurate, the probability of a
demyelinating disease (such as multiple sclerosis) is much higher than other
diseases such as low grade tumors (low grade glioma, DNET etc.) MRS may be
considered, but its use in differentiating demyelinating diseases and low
grade tumors is not standard and the interpretation requires a
neuroradiologist who has done some research in this area.
has she had limb weakness? has she had seizure?
【在 l*h 的大作中提到】
: this is a case that there is no standard answer to the question what to do
: next in the short term. if you go to different doctors, you will get
: different opinions that can be mainly classified as the following:
: 1. close follow-up with MRI, do nothing in the interim.
: 2. close follow-up with MRI, treat as demyelinating disease in the interim.
: 3. biopsy.
: if the description of her symptoms is accurate, the probability of a
: demyelinating disease (such as multiple sclerosis) is much higher than other
: diseases such as low grade tumors (low grade glioma, DNET etc.) MRS may be
: considered, but its use in differentiating demyelinating diseases and low
| l*h
发帖数: 4124 | 4 "BTW, our family doctor also mentioned that it could simply be some kind of
先天发育问题。"
this is possible but not likely, judging from her symptoms.
"He also said that if it is some kind of tumor, usually there
are several focuses, rather than just one focus in her case."
This is NOT correct.
right
to
【在 d********1 的大作中提到】
: 3X a lot for your detailed response!
: The description of her symptoms is as accurate as I can describe (she has
: some 腿麻, 胳膊麻 etc lately. Her numbness is sometimes on the left or right
: leg, arm, toes, fingers, and even face, but never on all these places at
: the same time).
: She did not have obvious limb weakness.
: What do you mean by "seizure"? 抽搐/癫痫？If so, she does not have it. But
: some times (very occasionally, I would say less than 6 times a year in
: recent years), she has brief leg/foot抽筋。Not sure whether this is sth. to
: consider.
| d********1
发帖数: 77 | 5 3X!
Do you have any follow-up comments based on my answers to your previous
questions?
Sorry for so many questions. We are really concerned :-(
She did not have obvious limb weakness.
What do you mean by "seizure"? 抽搐/癫痫？If so, she does not have it. But
sometimes (very occasionally, I would say less than 6 times a year in recent
years), she has brief leg/foot抽筋。Not sure whether this is sth. to
consider. | l*h
发帖数: 4124 | 6 yes, they were included in my thoughts.
I suggest you read something about multiple sclerosis, including patients'
own accounts of their symptoms. Be prepared that on her first visit to a
neurologist, a lumbar puncture is very likely to be done. Protein analysis
will be done in addition to routine analysis.
recent
【在 d********1 的大作中提到】
: 3X!
: Do you have any follow-up comments based on my answers to your previous
: questions?
: Sorry for so many questions. We are really concerned :-(
: She did not have obvious limb weakness.
: What do you mean by "seizure"? 抽搐/癫痫？If so, she does not have it. But
: sometimes (very occasionally, I would say less than 6 times a year in recent
: years), she has brief leg/foot抽筋。Not sure whether this is sth. to
: consider.
| d********1
发帖数: 77 | 7 3X a lot!
We will pay our first visit to a neurologist later today, and will update
here how it goes.
You are so helpful!
【在 l*h 的大作中提到】
: yes, they were included in my thoughts.
: I suggest you read something about multiple sclerosis, including patients'
: own accounts of their symptoms. Be prepared that on her first visit to a
: neurologist, a lumbar puncture is very likely to be done. Protein analysis
: will be done in addition to routine analysis.
:
: recent
| d********1
发帖数: 77 | 8 Just came back from the neurologist. His major opinions:
1) The sub-centimeter focus is too small to cause the symptoms (she has some
腿麻, 胳膊麻 etc lately. Her numbness is sometimes on the left or right leg
, arm, toes, fingers, and even face, but never on all these places at the
same time). He thought her numbness was caused by other factors, but not by
the brain focus.
2) If the focus is some kind of tumor, her symptoms will stay and will not
go away. Now my wife's numbness is better than 2 weeks ago, i.e. less
duration/degree of numbness. BTW, her numbness has been on and off since the
beginning.
3) He simply said her symptoms do not look like multiple sclerosis, but did
not provide any reasons/explanations.
4) Biopsy is not necessary for now. But if MRI shows the focus grows in size
after several months, biopsy may be needed.
5) He mentioned the brain focus might simply be some kind of inflamation,
but this again needs to be confirmed by future brain MRI (to see if the
focus diappears).
He ordered several tests for my wife, including some blood tests, MRI
Cervical Spine (W/ and W/O Contrast), EMG/NCT (2 Extremities Left upper ext
Left lower ext), and VERS (Visual Evoked Potential Test). He said depending
on the results of these tests, he will decide if a spinal tap (I think this
is the same as lumbar puncture) is necessary.
Any comments on these above?
3X! | l*h
发帖数: 4124 | 9 Overall, I agree it is a reasonable approach.
"1) The sub-centimeter focus is too small to cause the symptoms (she has
some
腿麻, 胳膊麻 etc lately. Her numbness is sometimes on the left or right leg
, arm, toes, fingers, and even face, but never on all these places at the
same time). He thought her numbness was caused by other factors, but not by
the brain focus."
I agree.
"2) If the focus is some kind of tumor, her symptoms will stay and will not
go away. Now my wife's numbness is better than 2 weeks ago, i.e. less
duration/degree of numbness. BTW, her numbness has been on and off since the
beginning."
I agree.
"3) He simply said her symptoms do not look like multiple sclerosis, but did
not provide any reasons/explanations."
From the tests he ordered, he didn't rule MS out. Her symptoms don't look
like a typical severe MS. For mild onset MS, it may take a long time to
establish the diagnosis.
"4) Biopsy is not necessary for now. But if MRI shows the focus grows in
size
after several months, biopsy may be needed."
I agree.
"5) He mentioned the brain focus might simply be some kind of inflamation,
but this again needs to be confirmed by future brain MRI (to see if the
focus diappears)."
Inflammation includes many things. MS is also an inflammation.
"He ordered several tests for my wife, including some blood tests, MRI
Cervical Spine (W/ and W/O Contrast), EMG/NCT (2 Extremities Left upper ext
Left lower ext), and VERS (Visual Evoked Potential Test). He said depending
on the results of these tests, he will decide if a spinal tap (I think this
is the same as lumbar puncture) is necessary."
I agree. cervical spine should be looked at, not very likely, but possible.
From the tests he ordered, he is focusing on degeneration and demyelinating
disorders.
Demyelinating disorders, especially MS, often cause symptoms that cannot be
explained by local findings on MRI. The reason is that demyelination can be
repaired at one location and then occur at another location.
some
leg
by
the
【在 d********1 的大作中提到】
: Just came back from the neurologist. His major opinions:
: 1) The sub-centimeter focus is too small to cause the symptoms (she has some
: 腿麻, 胳膊麻 etc lately. Her numbness is sometimes on the left or right leg
: , arm, toes, fingers, and even face, but never on all these places at the
: same time). He thought her numbness was caused by other factors, but not by
: the brain focus.
: 2) If the focus is some kind of tumor, her symptoms will stay and will not
: go away. Now my wife's numbness is better than 2 weeks ago, i.e. less
: duration/degree of numbness. BTW, her numbness has been on and off since the
: beginning.
| l*h
发帖数: 4124 | 10 there are also MS patients who have only one attack in the life and a
diagnosis is only established many years later retrospectively.
some
leg
by
the
【在 d********1 的大作中提到】
: Just came back from the neurologist. His major opinions:
: 1) The sub-centimeter focus is too small to cause the symptoms (she has some
: 腿麻, 胳膊麻 etc lately. Her numbness is sometimes on the left or right leg
: , arm, toes, fingers, and even face, but never on all these places at the
: same time). He thought her numbness was caused by other factors, but not by
: the brain focus.
: 2) If the focus is some kind of tumor, her symptoms will stay and will not
: go away. Now my wife's numbness is better than 2 weeks ago, i.e. less
: duration/degree of numbness. BTW, her numbness has been on and off since the
: beginning.
| d********1
发帖数: 77 | 11 3X again for your comments!
I will update here when her new tests are completed. Hopefully good news
will come!
leg
by
not
【在 l*h 的大作中提到】
: Overall, I agree it is a reasonable approach.
: "1) The sub-centimeter focus is too small to cause the symptoms (she has
: some
: 腿麻, 胳膊麻 etc lately. Her numbness is sometimes on the left or right leg
: , arm, toes, fingers, and even face, but never on all these places at the
: same time). He thought her numbness was caused by other factors, but not by
: the brain focus."
: I agree.
: "2) If the focus is some kind of tumor, her symptoms will stay and will not
: go away. Now my wife's numbness is better than 2 weeks ago, i.e. less
|
|
