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Stroke

Question re: MRI results

01/03/2006

Question:

Hello and thank you for your time. I am not sure which topic I should have this question in, but hopefully I am close. Last year I had an MRI w/o contrast with Impression: Multiple foci of white matter signal abnormality in left cerebrum. I was examined for MS and all was normal (evoked response, lumbar puncture, etc). MD said was not MS, but he couldn`t say what it was, that he saw no other abnormals other than the MRI; stated small possibility of very early MS. I am 42 yo. This year I had MRI w/ and w/o contrast with Findings: focal areas of nonenhancing T@ signal abnormality in the periventricular, deep, and subcortical white matter of the cerebral hemispheres, bilaterally. There is mild prominence of a left occipital sulcus, which may represent a variant of normal. CSF spaces otherwise of normal size and configuration. Impression: Multiple foci of white matter signal abnormality, which likely represents a chronic ischemic change. Demyelinating disease, though somewhat less likely, cannot be excluded. The MD`s nurse called and said "results were normal". This MD did not have the results of the first MRI as I had moved several states away. Later I obtained the MRI reports on my own to get the actual findings but I have not seen my nuerologist here about them and comparing results. Also report did say: no evidence of mass lesions, small or large vessel infarctions, abnormal contrast enhancement,or of intracranial hemorrhage. I am a nurse so you don`t have to explain the terminology of this part, but I don`t understand the findings and the impression. Just incase, my diagnosed condtions are Chronic pain we believe r/t to failed surgery s/p discectomy with anterior fusion, C6-7 in March 2004, followed by C2-3 in May 2004. Also, hyperthyroidism (or whichever one that requires taking syntroid-I get them confused), and a history of depression and anxiety for which I continue to take maintenance meds for. I was also dxed this year with a "severe" sleep d/o and use the autopap at night, which doesn`t help very much. My 2-night O2 sats were pretty good with a few "88`s`. I always feel awful and want to sleep constantly. I am not depressed, rather I am very happy when awake and alert as long as I don`t think about the sleep problem. this started well after I started my meds below that are sedating, so I don`t feel like these are the cause of the sleep problem. Meds are: Avinza 90mg HS, Neurontin 600mg tid, Effexor XR 150mg bid, Wellbutrin XR 150mg 2 AM and 1 noon, Klonopin 0.5mg tid and 1 prn but I don`t take these tid, only most HS`s and occasional daytime, Lamictal 100mg bid (once on stable dose on this my MD hopes to gradually decrease the other antidepressants), ASA 1 qd, Synthroid 0.25mcg qd, occasionally Motrin 800mg tid for a few days and/or Tylenol ES prn. My questions are (and are probably dumb from and RN but I don`t understand them anyway). - I understand you have not examined me, but what can the MRI results mean? Are they just alot of medical terminology that is basically normal? If a test is normal I have always noted that the Impression reads `normal MRI` or CT scan or whatever the test is, but it always says normal; it doesn`t have all of this stuff written there. -What does it mean that the results were on the left side and now they are bilateral? I know that means `both sides`, but it went from the left side the 1st year to `bilateral` the 2nd year? Isn`t that a progression of something? If so, then what? -What are "focal areas of nonenhancing T2 signal abnormalities"? What symtoms would these cause based on their location? also symptoms that would come from the white matter vs. the cerebrum. -Could any of this stuff be the source of my sleep problem? If so, what are some possible tx options either with my autopap, or without it? -Anything else you can think of tht I might need to know will be very helpful. My family and I am just very concerned and afraid I might stroke out or acutally have MS or something else. (note, this concern of MD`s has been the reason for the MRI`s). -My neurologist is handling this and my sleep problem. She has told me I can NEVER drive again. Why would she make this determination? Should I get a 2nd opinion? I think so as I`m only 42, NEVER again is a long time. I hope. Again thank you for your time and evaluation of this situation`s possibilites. Sincerely, Vikki P Adams vikki@openmyeyes.com

Answer:

This question has been answered previously (to some extent--see "Help explaining MRI results in 9/05). In this answer, I discussed some of the reasons why we see periventricular white matter disease.  Such findings are common with age and risk factors such as hypertension and diabetes.  Sleep apnea, with the episodes of hypoxia, is another cause of these findings.  They are not exactly "normal" findings, as they are associated with increased risk for stroke and cognitive decline in the long term, but are not always indicative of a stroke. 

As to the driving restriction, it would be best to discuss this with your neurologist.  From the information provided, it is difficult to see why you would be formally restricted, but you do have sleep apnea AND you are taking pain medications that are potentially sedating.  It is likely that she is worried about the possibility of a sleep attack while you are driving, and thus thinks it is safest for you not to drive any longer.

I hope this helps.

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati