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A brief beginner's guide to the brain and MRI

As some of you know, I often answer posts on here asking for help to understand what a neurologist’s letter or radiologist’s report means. What you probably don’t know is that it is a pretty time-consuming task and, every time I find myself typing the same stuff, I say to myself, “I absolutely must put something together that I can copy and paste from!”

Well, I have finally done it :-)

It occurred to me that some of you might be interested in reading the whole thing and that you might use it as a “starter for 10”, to give you more confidence to go and do some research on your own when you come across something in a letter or report that doesn’t make any sense.

I’ll still be happy to help, especially as the stuff I’m posting here only really scratches the surface, so don’t take this as me telling everyone to start doing it on their own :-)

I think the whole document is too long to post in one go, so I’m going to do a reply below this about the brain and a reply after that about MRI. My apologies – the spinal cord is noticeable by its absence. Maybe I’ll add something about that at a later date.

A couple of caveats. I have made this as easy as I could. That means that an expert would no doubt shake their head at bits and laugh their heads off at other bits, but on the whole I think it’s an acceptable explanation. However, I am not a neurologist or a radiologist; my knowledge comes from a background of neuroscience research using MRI followed by a lot of self teaching. In other words, please don’t assume that this is fault-free!

I hope you find it helpful.

Karen x

PS This would never make a best seller list - prepare to be rather bored!!!

Topics Not MS Symptoms

The brain

The brain has three main parts: the cerebrum, the cerebellum and the brain stem. The cerebrum is the big part on the top which most people think of as the brain. The cerebellum is the smaller, roundish part that lies underneath the back of the cerebrum. The brain stem is the part that joins the brain to the spinal cord. It lies underneath the cerebrum, in front of the cerebellum and is at the top of the spinal cord.

The brain has three main types of “matter”, i.e. stuff. Gray matter is the stuff that does all the processing, encoding and storage – basically the “thinking”. White matter is the stuff that carries the signals between different parts of gray matter. If you imagine your phone connected to your computer via a USB cable, the phone and the computer are different parts of gray matter and the USB cable is the white matter allowing them to communicate with each other. Gray and white matter are made up of billions of neurons, or nerves: gray matter contains the main bodies of the nerves and white matter contains the tails of the nerves, called axons. Nerves that need to transmit fast signals have a myelin coating on their axons.

The third type of matter is CSF (cerebrospinal fluid). It bathes the brain, cushioning it and providing nourishment. There are reservoirs of CSF in the brain, the contents of which are continually refreshed by our bodies. These reservoirs are called ventricles. The biggest of these are called the lateral ventricles. If you slice the head from the eyes to the back of the skull and look down at it, you will see the lateral ventricles, one on either side of the line down the middle of the cerebrum, looking a bit like a butterfly.

Humans have evolved to have a lot of brain matter, so the only way to fit it all into the skull is to squeeze it together, like squishing up a piece of cloth to fit it into a tight space. This means that the cerebrum has lots of folds in it. The bits that go in are called sulci (a single sulci is called a sulcus) and the bits that go out are called gyri (a single gyri is called a gyrus) and they all have names. [Mammals that aren’t as intelligent as humans have smoother cerebrums, with fewer sulci and gyri, if any.]

The cerebrum has two halves, or hemispheres, which are approximate mirror images of each other. They are joined only by some tracts of white matter (like a bunch of USB cables instead of just one), so the two halves can work together. The main tract of white matter joining the two hemispheres is called the corpus callosum. It is in the middle of the cerebrum, next to the lateral ventricles. If you cut the corpus callosum, the left side and right side of the cerebrum cannot communicate properly. It is quite common for people with MS to have lesions on the corpus callosum. (A lesion is an area of damage or abnormality.)

The cerebrum is split into four “lobes” (areas): frontal, parietal, temporal and occipital. Because the cerebrum has two halves, there are right and left frontal lobes, right and left parietal lobes, etc. The frontal lobe is more or less the front half of the cerebrum. It stops at the “central sulcus”. The parietal and temporal lobes lie behind the frontal lobe with the parietal lobe at the top of the head and the temporal lobes at the sides, more or less behind your ears. The occipital lobe is right at the back. The frontal lobe is important for personality, working memory, decision making, controlling inhibition, movement, etc.  The parietal lobe is important for sensation, maths, music, humour, spatial tasks, etc. The temporal lobe is important for hearing, memory, language, emotions, object recognition, etc. The occipital lobe is dedicated to vision.

The outer layers of the cerebrum are made up of gray matter. Together, these layers are called the cortex or cerebral cortex. Anything to do with the cortex is referred to as cortical. (Anything to do with the cerebrum is called cerebral and anything to do with the cerebellum is called cerebellar.) White matter lying close to the cortex is called subcortical (or superficial). White matter lying deeper into the brain is called deep white matter. There is also deep gray matter, found in the centre of the brain and the brain stem as well as white and gray matter in the spinal cord.

Amongst other things, the cerebellum is important for making all kinds of movement smooth, for balance and for learning new motor skills. The brain stem is important for many fundamental functions like sleeping, breathing and heart rate. Many of the “cranial nerves” come from the brain stem, controlling things like eye movements, sensation and movement of the face, mouth and tongue, and swallowing.

In general, the left side of the cerebrum controls the right side of the body and vice versa. This is not the case in the cerebellum where the right side controls the right side of the body and the left, the left. All the nerves from the cerebrum and the cerebellum go through the brain stem to get to the spinal cord. The cerebral nerves cross in the brain stem so that the right side of the spinal cord controls the right side of the body and the left, the left. This means that a problem with the right side of the body might come from a left hemisphere cerebral lesion, a right hemisphere cerebellar lesion, the left or right side of the brain stem (depending on whether it is above or below where the nerves cross) or a lesion on the right hand side of the spinal cord.

The McDonald criteria stipulate that, to be diagnosed with relapsing remitting MS, patients need to have at least two attacks and at least one lesion in at least two of four specified areas of the central nervous system: three in the brain and one in the spinal cord. (You can download the full paper for free: it’s Polman et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. ANN NEUROL 2011; 69:292-302.) The criteria for primary progressive MS are a gradual progression of symptoms (normally of at least a year’s duration) and two of the following: a positive lumbar puncture, at least two spinal cord lesions, at least one lesion in at least one of the three specified brain areas.  

The three brain areas in the McDonald criteria are juxtacortical, periventricular and infratentorial. Juxtacortical means next to / into the cortex, i.e. a lesion that lies right at the border of the gray and white matter close to the outer edge of the cerebrum. Periventricular means next to the ventricles. Lesions next to the lateral ventricles are very common in MS. They often form at right angles to the ventricles which, when looked at side on, look a bit like fingers poking up over a wall. These are called Dawson’s fingers and are a classic sign of MS. Infratentorial means the brain stem and cerebellum; the areas under the cerebrum.

There are some parts of the cortex that are named after what they do. The most obvious of these are the visual cortex, the motor cortex and the somatosensory cortex. The visual cortex is the cortex in the occipital lobe; the gray matter that makes sense of all the information that your eyes gather. The motor cortex is the last gyri of the frontal lobe, the precentral gyrus. It is in charge of movement. The somatosensory cortex is the first gyri of the parietal lobe, the postcentral gyrus. It is on the other side of the central sulcus to the motor cortex and it controls sensation in your body. If you put your hands loosely on both ears, your thumbs are pointing towards your visual cortex, your left and right ring fingers are pointing roughly towards your left and right motor cortices and your middle fingers are pointing roughly towards your somatosensory cortices.

Finally, a few terms that you might come across:

- Anterior: in front; towards the front of the brain

- Posterior: behind; towards the back of the brain

- Superior: above; towards the top of the brain

Inferior: below; towards the spinal cord

- Horn/tip: refers to the ends of the lateral ventricles; the “wing tips” of the butterfly shape.

Thank you .really interesting I like all the detail ...explained everything in a way that could be understood excellent
 
sue

Will attend neurologist at end of this month .. my MRI showed “ some white patches “ said my doctor when he phoned me .. this article has helped me be prepared to ask informed questions then 

MRI: Magnetic Resonance Imaging

When you have an MRI scanning session, they run a number of different scans. The standard ones, that are run for pretty much all medical conditions, are called T1 and T2. Scan types are constantly being developed, but the most commonly used additional scan type for MS investigations is FLAIR. You will also hear of PD, FSE, STIR, DWI and others, but I’m not covering them here.

The way MRI works is that different types of matter give off different levels of energy when they are placed in a magnetic field. The computer slices the thing being scanned and collects the energy signal from one slice at a time. Because of some of the loud banging noises the scanner makes, it can also work out the signal from small cubes of each slice. These cubes are called voxels (short for volume pixels).

Each slice provides the information for one image and each voxel provides the information for one pixel in that image. The whole process uses some very advanced mathematics, but ultimately, the higher the overall signal from a voxel, the brighter the pixel is on the final image (and the lower the signal, the darker the pixel). This is where the terminology gray and white matter is less than helpful so bear with me!

 In a T1 scan, gray matter gives off a low signal and looks darker in the images than white matter which gives off a higher signal and looks pale gray. CSF meanwhile gives off the lowest signal and looks black. Everything is reversed in a T2 scan: gray matter looks pale gray, white matter looks darker gray and CSF looks white. FLAIR is a clever adjustment of a T2 scan which suppresses the signal from CSF. This means that we end up with gray matter looking pale gray, white matter looking darker gray and CSF looking black.

Different lesions give off different signals too. In general, a white matter MS lesion gives off a high signal in T2 and FLAIR scans, leading to it looking like a “white spot” against the white matter which looks relatively dark in these scan types. T1 is usually rubbish for spotting MS lesions unless the lesion has caused the area to die, or “atrophy”, in which case it is called a “black hole” – because it is a wee black hole on a T1 image. The terms “hyperintensity”, “hyperintense”, “high signal”, etc, all refer to the fact that somewhere is brighter / whiter than it should be.  “Hypointensity”, “hypointense area”, etc, refers to somewhere that is darker than it should be. Exactly what relevance these have depends on their size, shape, location and the type of scan though.

Remember that I mentioned CSF bathes the brain? That means that all the sulci of the brain are full of CSF and so there is a lot of white on T2 images. Spotting a lesion in amongst lots of perfectly normal white stuff can be tricky, however it is really quite easy in FLAIR images – because there shouldn’t be very much white; all the CSF is black. (Please note that some small white spots can be perfectly normal – they are usually blood vessels.)

Sometimes, neuros ask for a scan with contrast. This is a T1 scan taken after the patient has been injected with a “contrast agent”. This is usually gadolinium which looks bright white on a T1 scan. The central nervous system, i.e. the brain and spinal cord, is protected by the blood brain barrier (bbb) which stops things that might harm it from getting in; gadolinium normally can’t get through the bbb.

In MS, cells from the immune system get through the bbb and attack the myelin coating of nerves in that area, causing inflammation and damage: a lesion. While this is happening, the lesion is called “active”, “enhancing” or “contrast enhancing”. The gap the immune system has caused in the bbb allows gadolinium to get in. If there are no breaches in the bbb, there should be no bright white signs of gadolinium inside the brain or spinal cord. If there are, these show where there are breaches, in other words, where the immune system is actively causing new damage.

Contrast is used for two main reasons: to show up very new lesions (typically lesions newer than about six weeks) because these can be difficult to see on normal MRI and to help show which lesions are active and which are not as this can be important for deciding on meds. Newer types of scans, e.g. DWI (diffusion weighted imaging) which measures water flow, can be used to do this too so contrast is being used less often these days.

Some terms you might come across:

- Sagittal: images taken from ear to ear, parallel to the nose

Axial: images taken from front to back, at right angles to the nose

- Coronal: images taken from the front to back, parallel to the nose and so that one slice goes through both ears

- Artefact/artifact: a computer error, nothing to worry about

- 1.5T (and other numbers followed by a T): This is scanner strength, i.e. how strong the magnetic field is that the scanner produces. The T is short for Tesla, but has nothing to do with the T in T1 and T2 scans.

Most NHS scanners are 1.5T. There are a few 3T (and stronger) scanners that are much more powerful than 1.5T scanners, but these are usually run by Universities. Do not assume that private MRI scanners (or scans) are better than NHS scanners (or scans) – they are mostly the same, but can be worse.

For those of you who aren’t quite brain dead yet(!)...

“Partial volume effects” are an important factor in how good a scan is and are particularly relevant if you are told your MRI is clear or you have no new lesions when you are having new symptoms. Remember that the computer slices up whatever’s being scanned and then splits the slices into little cubes, the signal from these determining how dark or light a pixel will be in the image? Well, the size of those cubes has a major effect. Imagine a voxel that only contains white matter.

In a T2 scan, that voxel will give a low signal and the resultant pixel will look dark gray. Now imagine a voxel that is mostly white matter, but also has a bit of a lesion in it. In a T2 scan, lesions give high signals, so the pixel will now look brighter than the last one. But by how much? If it’s a small voxel and the lesion provides a decent proportion of the signal, the pixel will be obviously brighter than its neighbour and a radiologist should spot it easily.

However, if it’s a big voxel, the extra signal from the lesion might only make the pixel a wee bit paler than its neighbour and make it very easy to miss. So, the moral of the story: it’s important to have thin slices and small voxels! 3mm slices are fine. Less than that is great, more than that and you are losing a lot of definition and increasing the chances of missing small lesions.

By the time you get to 6mm and thicker, you could miss average and even bigger than average lesions too. (The average MS lesion is 7mm.) The slice thickness is not usually written in reports or on images, but the number of images is the same as the number of slices so the greater the number of images in one scan, the thinner the slices.

The best images generally come from thin slices with small voxels on a stronger scanner, but small voxels on a 1.5T scanner will be better than big voxels on a 3T scanner every time.

rizzo wrote:

Sometimes, neuros ask for a scan with contrast.

 

If I had a non-contrast plain MRI done, and it shows no white patches and thus does not show any lesions, does it mean I'm cleared of MS? Or does it mean the chances of me having MS is low? Would some lesions require contrast MRI to be detected? 

zoe

Thank you so much xxx

Amazing......am in awe !!

Xx

Wow, thats my evening's reading sorted!  Thank you Karen

 

I take my hat off to you Karen......thanks.

 

Pam x

This is wonderful Karen. You have done a great job. I can just about understand it which is great for a non-scientist like me!

Thank you so much!

Teresa xx

Thank you so much Karen, it's fascinating stuff, made even more so by being written by someone who wants people to be able to understand what's going . You've helped pass the wee small hours for a newbie with steroid induced insomnia!!

Cathy

x

I did brain and brief neuro-anatomy over 10years ago in my first year at uni. If only they'd explained it as simply as this! Great stuff!

Made it sticky. Thanks for the post Karen. The functionality for bullet points is a little wanting. Well, it doesn't work, to be honest, so emboldened dashes was the best I could manage. 

 

 

 

Stewart (admin)

Gokr wrote:

I did brain and brief neuro-anatomy over 10years ago in my first year at uni. If only they'd explained it as simply as this! Great stuff!

 

Me too, only this was 30 years ago. I was told this week that I'd had a small stroke in the white matter and this has clarified things for me. Brilliant explanations, Karen. Thanks!

Stewart Cumiskey wrote:

Made it sticky. Thanks for the post Karen. The functionality for bullet points is a little wanting. Well, it doesn't work, to be honest, so emboldened dashes was the best I could manage. 

 

 

 

Stewart (admin)

Thanks Stewart. Could you do the bullet points in the MRI post too please? (The last one starts with 1.5T...)

Thanks everyone else too - I'm glad it's proving helpful :-)

Kx

pip

Well done Karen,and a big thank you for finding the time and energy to word it so well.

I bet I am one of many to get their letters out and go through them to translate them into normal speak.

Pip

Absolutely superb.

Thank you taking the time and effort to do this.

It gives us, less likely to know people, a better knowledge.

Fantastic, Thanks.

loverly jubbly Karen just what l needed.
F.xx

I read this on the train last week, a few times.  Just collected a copy of my MRI, and using your brilliant explanation, I think I have found two of my three lesions!

Thank you again Karen

Thank you so much Karen, I will print it off and laminate for reference. We are so lucky to have you here to help.

Well done Karen! 

Also means that the rest of us can reply to others "Read the sticky post by Rizzo for more info". 

A huge help,

Pat x thumbsup

Brilliant - thank you Karen.  :)

H x

I have MS

 I have now read about 6 times and it seems to have stuck!

I will now be ready going into my Neuro appointment!

Thank you Karen x

LOL :-) The sixth time is a charm :-)

I have absolutely no idea why though!!!

For those of you who think we are mad, I told Laura that I used to tell my students, "If you don't get it, read it six times, out loud if necessary." It always seems to work :-)

Kx

Fabulous post! Brought back all the stuff I used to know when I did my Medical Science degree 9 years ago but then never pursued further. Thank you for the refresher! It's all becoming relevant again now I'm personally having problems. 
 

Thank you!

Nat x

Thank you for taking the time to do this, much appreciated!

Could u help me... My mri said this .... mri brain shows cerebral spinal fluid flow artifacts are present with increased signal in the occipital lobes adjacent to the occipital horns ... what does this mean? Thank u so very much

KrisNchris wrote:

Could u help me... My mri said this .... mri brain shows cerebral spinal fluid flow artifacts are present with increased signal in the occipital lobes adjacent to the occipital horns ... what does this mean? Thank u so very much

I've replied on your thread :-)

Kx

Thank you Karen, will be interested to see what or if or how they can diagnose on the Old Mac scale as I can't be MRI'd. PS my doc said when you give birth you lose brain cells with the placenta, as I've had 6 children I'm guessing I don't have a lot of brain cells left! tounge

Whoops don't know why I sent a blank one. It was really useful thanks [will have to read it several more times though] 

Helen 

hello

Just new to this Forum, was diagnosed last September and I think I have finally taken my head out of the sand and accepted that I really do have MS.  Especially after yet another bad fall yesterday!

Think I'll go read the post from Karen now as it looks really interesting and I might learn something - Hopefully that everything might not be as bad as I've been thinking.

TC

 

This is great Karen. When it says high spots or elisions in two or more areas of the brain for MS diagnosis is this peri ventricular plus one of the other two or can it be two areas of peri ventricular? My MRI report says 'one or two small high signal abnormalities seen in the peri ventricular white matter tracts this is particularly the case anterior lot on the left. Sagital imaging suggests these are perpendicular to the corpus callosum raising pissibility of demylenation. No florid signal changes elsewhere, no lesions on brain stem, cerebellar lesions, cervical spine unremarkable except disc bulge with stenosis at C5/6.'

I am not sure how there can be 1 or 2 high signals and then 'mainly' anteriorly on left. If there are only 1 or 2 they are either there or in that area and another or there must be more than 2 - sorry picking apart English

By the way is migraine visible on MRI I had a headache that day on left hand side which got worse in the machine.

This is great Karen. When it says high spots or lesions in two or more areas of the brain for MS diagnosis is this peri ventricular plus one of the other two or can it be two areas of peri ventricular? My MRI report says 'one or two small high signal abnormalities seen in the peri ventricular white matter tracts this is particularly the case anteriorly on the left. Sagital imaging suggests these are perpendicular to the corpus callosum raising possibility of demylenation. No florid signal changes elsewhere, no lesions on brain stem, cerebellar lesions, cervical spine unremarkable except disc bulge with stenosis at C5/6.'

I am not sure how there can be 1 or 2 high signals and then 'mainly' anteriorly on left. If there are only 1 or 2 they are either there or in that area and another or there must be more than 2 - sorry picking apart English

By the way is migraine visible on MRI I had a headache that day on left hand side which got worse in the machine.

Hi Karen

I am newly diagnosed 20th Aug 2013,  and have felt myself swimming though a sea of previously unknown names, words, abbreviations and acronyms, your post will become my first port of call to deciphering them.

Many thanks for your route map on this new and daunting journey.

Sara

 

Hi Karen I have been recently diagnoised July of this year.  My consultant told me face to face and let me see my images from the mri scan.  He showed me a couple of bright marks on my scan and on my spine.  While we were looking at the scan he did show me some marks which were darker in colour he did not fully explain what these were but he did go on to say I have had ms for quite some time without displaying any outward symptons.  My query really is do you think these particular slightly darker marks are older marks to do with the ms for him to stay I have had it for some time?  Many thanks for your help x

Thank you.  Very useful reading!  It's very much appreciated

Thanks a lot that makes its a bit clearer

hiya

please note the date when this thread was started!

however i note alot of new folk around that may find this info useful. karen is not currently posting/around and i ask u to respect this and dont ask her questions.  i can tell you that she is fine and i trust she wont mind me pointing out this info to others.

ellie x

Is the amount of lesions relative to how bad, maybe your ms has become?

Yes

Thanks for posting all this information, its great and I understand the criteria. However I do not understand what "enhanced" means. Here is what it said:

 

There are multiple punctate areas of peripheral white matter hyperintenity.

there is a posterior focal area of periventricular high signal with two similar areas on the right that appear to be inferior callosal. There are several juxta cortical lesions particularly in the right frontal and right parietal regions.

there does not appear to be any associated cavitation.

these lesions do not appear to enhance.

no other abnormality is seen intracranially. The intracranial arterial vasculature remains normal in appearance.

Comment: The study was compared to that performed on 1/06/13. Periventricular/Pericallosal lesions.

: There is no evidence to suggest any involvement of the temporal or occipital regions nor the posterior fossa structures.

: There is no cavitation or enhancement

0verall, there appears to be some relative increase in size of at least 2 lesions within the frontal lobe and a possible periventricular pattern that also appears to have increased in prominence. Although not conclusive , these changes make the possiblity of underlying demyelination a little more likely. Does this corrolate with other clinical tests?

My Neurologist still thinks the findings are nothing to worry about however obviously the Radiologist does suggest the possibilities of MS.

Whats enhacement mean? and why are the lecions getting bigger?

I am very worried.

 

Thanks in advance x

Hi anon,

Not sure about the lesions getting bigger, but I think ( don't quote me on this) that the fact they are not enhanced means they are not active? :-/

J x

ive tried reading this over 5 times,,abit hard with brain fog angry try again to tomorrow

can anyone help ive been fobbed of for 2 to 3 years now i have had quit literely thousands of appointments i do mean thousands i have an great amount of the symptoms which can get realy bad its destroyed me marrage weve bean seperated for about 3 or 4 months now i rise my kids by myself so ive always needed to look after myself bean health freak for years so far ive bean diagnosed with r.l.s restless leg syndrom thats wat stop me and my partner sleaping in the same bed touretts ptsd after i had a long term miss diagnoses for schizophrena removed insomnia and reignal pain syndrome and i need corective shoe where becuase of my giat i never had any real test apart from lots of bloods and examination i always get fobbed of i dont think i actualy have any of them conditions im in an absurd amount of pian opiats dont work my legs randomly give way at the knee or knees and i have to catch myself before hitting the ground im not always the winner lol lately my vision is gone its gone realy bad lot of time i cant watch tv i have a constant stiff and sore neck like its bean in the same place for ages i need to stretch  every min of the day constant dead arms and legs and pins and needles and the left leg is constantly freezing and numb i mean dead i could turn away and you could stab it i wouldnt no my hands are badly swollen with my feet twitches all over the main ones are eyes and chest and legs when i am speaking i get like a nerv pull on my face feals like its trying to tear itself of stops me speaking realy realy bad bad fatigue and head aches and one day ile b not to bad then for two days i feal like im about to die and alot of the time it seems like a option couple of mounths ago at a diff hospital i had a steriod injection for my hands for 1 weak i was brand new ive got to wait mounths to see if i can have it again and have evan thought of buying some of the streats im fed up with fealing like this with a box of tramadol which do more harm than good i have to change things some how also 2 more soz lol last couple of weaks ive started having fits stoped tramadol just incase that was to blame still getting them and i grew up in the 80s lol caring for my dad who ultumatly died from m.s there wernt alot of help back then or alot known no one will listen to me give me a new syndrome new piankillers and im suposed to be happy its making me so down my left leg is lit dead ive evan sat there trying to get docs to punch it to try and get them to see thats were i get more spasms to there quit scary to see like a alien under the skin my boy loves it lol anyway any advise PLEASE soz spelling

i was in the hospital recently and had a lot of MRI scans done with and without contrast and was told in the MRI they cannot say for certain if it's just an artefact or its a definite lesion they are seeing on the scans i also had what was called EMG(Electromyography) and some type of lesion showed up on the test and they where questioning if i had MS one doctor told me i showed all the symptoms for it and my GP had put me on cyclopenzaprine which they thought  will aid if i was suffering with MS. I think the uncertainty of not knowing is worst than knowing for certain at least if i knew for certain it would give me and my family peace of mind can anyone help me in giving me advice to what should my next step be PLEASE!crying

Have you spoken to an MS nurse thats my next move?

 

I have been waiting a month so far since referral from my doctor to a neurologist.  My appointment is not until 17th November.  I continue to get tingling hand, fingers, tongue, toes, crawly feeling up bottom and back of legs, sharp pains in my eyes which make me jump, neuralgia  on one side of my face I had previously dismissed as sinuses when sinuses not blocked, (this has been going on for years), and various other symptoms. odd pains here and there which I put down to rheumatism, cognitive impairment which I put down to getting on a bit (I'm a few months off 62), varying problems with bladder, bowels etc.  I don't get wobbly legs, but I can trip over nothing, and frequently do.  One knee collapsed last year, but it was a few months after a knee injury when I fell at the bottom of a hill so assumed it just just injury from that fall, and loads of other symptoms which I could explain away.  It was not until I went to the optician with the sharp stabbing needle pains in my eyes that she told me there's nothing wrong with my eyes, and that it sounded like a nerve problem and I should go the doctor that I got concerned.   Well, I did and when I told him about the tingly sensations as well and all the other things I'd explained away, he didn't hesitate and referred me immediately to a neurologist.  Shame a referral doesn't mean immediately!  I feel very alone.  My husband says he understands, but I think he thinks I am imagining it all.  I just need to know I'm not alone.

Your not alone please contact me via my email if you wish to talk I have simple symptoms Reguards Lotusflower12345...

Hi Karen, I have only joined this web site today & therefore this is my first reply to a post, The reason for joining is that I have been diagnosed with Fibromyalgia since 2008, however, I believe that I have had a miss diagnosis due to some of the symptoms that I have developed over the years. I have also been recently diagnosed as having Epilepsy due to having had two huge seizures over the last few weeks. I originally had a seizure back in December 2012, I then had an MRI scan to see if this showed any reason as to why I had had the seizure, which it didn't. However, it did show that I had had two minor strokes, this was reported as " a couple of lesions to the left thalamus & left lentiform nucleus which are probably small lacunar infarcts. I was then prescribed to take 75mg Aspirin a day. I then went right up to August of this year before I had another seizure, I then had to have another MRI scan. The day before I was due to have the scan I had another seizure. The MRI scan did not show any changes from the first scan that I had in 2013 so I was diagnosed with having Epilepsy, for which I am now taking Lamotrigine. However, I have recently received another letter from the neurologist to say that the areas that showed damage & had been reported in 2013 as having been the two small strokes was now being reported as "The previously identified T2 hyperintense foci in the left thalamus & basal ganglia do not show any peripheral flare hyperintensity. These appearances are suggestive of perivascular spaces rather than lacunar infarcts. My question to you is would the neurologist have to ask for a specific type of MRI to be able to diagnose MS or would the neurologist be able to pick up on MS no matter what the scan was for?  

I hope you can answer my question if not would you recommend that I go back to my GP with the information & list of symptoms that I have & insist on having further tests.

Kind regards

Bev 

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