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What Causes Imbalance Issues And Mood Swings Despite Being On Antidepressants?
Question: I am a 42 year old female . I had a standard Brain MRI no contrast and the report / findings say :
There are scattered areas of increased T2 & FLAIR signal in the periventricular and subcortial white matter . There is a minimal amount of signal in the pond . Some of the foci demonstrate intrinsic low T1 signal . No periventricular increased signal seen to suggest transependymal flow. The corpus callousness is relatively thin , likely due to hydrocephalus ( which I do have ) no diffusion abnormalities are identified to suggest an acute or sub acute infarc .Brainstem & cerebellum are normal. It states to : consider sequelae of vasculitis , migraine or in correct clinical setting demyelination.....
I questioned over 5 years ago the possibility of myself having MS . I was diagnosed with Chronic Epstein Barr when I was in my early 20's & Fibromyagia 8 yrs ago . I am now 42
The only meds I am on are for acid reflux , muscle relaxers & antidepressants.
Reading what my findings state do you think MS is a valid concern ?? I hate to seem like a hypochondriac, and I tend not to say half my symptoms so I don't seem like one . It is a while before I go back to see my Neuro.
I have episodes of extreme light headedness, heavy legs ( I only wear slippers ) significant loss of strength over the years . I am also colorblind which is apparently rare in woman & do not recall being that way until highschool . I have had visual difficulties yet pass eye exams .My bladder is weak and even episodes of urinary incontinence even if small amounts . I am a nurse and had to change jobs ...Im even finding this job very difficult to maintain.
I forgot to say that I have memory issues . So much so that my 10 yr old asked if I have Alzheimer's because he was concerned . My daughters gets annoyed I forfet so much.
I have balance issues, mood changes despite being on 2 antidepressants .
There are scattered areas of increased T2 & FLAIR signal in the periventricular and subcortial white matter . There is a minimal amount of signal in the pond . Some of the foci demonstrate intrinsic low T1 signal . No periventricular increased signal seen to suggest transependymal flow. The corpus callousness is relatively thin , likely due to hydrocephalus ( which I do have ) no diffusion abnormalities are identified to suggest an acute or sub acute infarc .Brainstem & cerebellum are normal. It states to : consider sequelae of vasculitis , migraine or in correct clinical setting demyelination.....
I questioned over 5 years ago the possibility of myself having MS . I was diagnosed with Chronic Epstein Barr when I was in my early 20's & Fibromyagia 8 yrs ago . I am now 42
The only meds I am on are for acid reflux , muscle relaxers & antidepressants.
Reading what my findings state do you think MS is a valid concern ?? I hate to seem like a hypochondriac, and I tend not to say half my symptoms so I don't seem like one . It is a while before I go back to see my Neuro.
I have episodes of extreme light headedness, heavy legs ( I only wear slippers ) significant loss of strength over the years . I am also colorblind which is apparently rare in woman & do not recall being that way until highschool . I have had visual difficulties yet pass eye exams .My bladder is weak and even episodes of urinary incontinence even if small amounts . I am a nurse and had to change jobs ...Im even finding this job very difficult to maintain.
I forgot to say that I have memory issues . So much so that my 10 yr old asked if I have Alzheimer's because he was concerned . My daughters gets annoyed I forfet so much.
I have balance issues, mood changes despite being on 2 antidepressants .
Brief Answer:
MS not likely, neuroexam important, lumbar puncture if in doubt
Detailed Answer:
I read your query carefully and I understand your concern.
The report finds some changes but not typical ones for MS, more likely a remnant of an old vasculitis or migraine changes (migraine can cause brain changes which are not found to be related to any functional decline).
Since the findings are not specific then for the diagnosis they must be correlated with your signs and symptoms. If you don't suffer from migraine that possibility is removed.
In considering MS looking at your description, it seems more like generalized fatigue rather then focal symptoms related to MS plaques. Usually MS in its most common form (relapsing remitting) manifests with relapses of focal neurologic symptoms. Gradually fatigue and depression can become a part of the clinical picture as well but not as a first presentation. Color blindness is not part of the disease as well. So I don't think it's a likely diagnosis. However if the neurologist finds abnormal manifestations in his clinical exam suggesting MS lumbar puncture for oligoclonal bands might be performed to make the diagnosis.
As for the possibility of vasculitis, it speaks of sequelae meaning not active process just remains of a past one, so no treatment is necessary. If you haven't been tested though that invites for evaluation for autoimmune disease like connective tissue diseases such as lupus.
I remain at your disposal for further questions.
MS not likely, neuroexam important, lumbar puncture if in doubt
Detailed Answer:
I read your query carefully and I understand your concern.
The report finds some changes but not typical ones for MS, more likely a remnant of an old vasculitis or migraine changes (migraine can cause brain changes which are not found to be related to any functional decline).
Since the findings are not specific then for the diagnosis they must be correlated with your signs and symptoms. If you don't suffer from migraine that possibility is removed.
In considering MS looking at your description, it seems more like generalized fatigue rather then focal symptoms related to MS plaques. Usually MS in its most common form (relapsing remitting) manifests with relapses of focal neurologic symptoms. Gradually fatigue and depression can become a part of the clinical picture as well but not as a first presentation. Color blindness is not part of the disease as well. So I don't think it's a likely diagnosis. However if the neurologist finds abnormal manifestations in his clinical exam suggesting MS lumbar puncture for oligoclonal bands might be performed to make the diagnosis.
As for the possibility of vasculitis, it speaks of sequelae meaning not active process just remains of a past one, so no treatment is necessary. If you haven't been tested though that invites for evaluation for autoimmune disease like connective tissue diseases such as lupus.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you very much for your interpretation . I never considered an auto-immune or connective tissue issue . I'm hoping to have more tests and a better exam when I return .
Having Hydrocephelus my primary ordered the MRI just to see if there were changes with that or something else that could be causing some of my issues and referred me to the Neuro .
Having Hydrocephelus my primary ordered the MRI just to see if there were changes with that or something else that could be causing some of my issues and referred me to the Neuro .
Brief Answer:
Hydrocephalus not active. Tests only if deemed necessary.
Detailed Answer:
MRI confirms hydrocephalus is chronic not active for the moment which is suggested by the part where it says there's no transependimal flow.
As for the vasculitis and autoimmune connective tissue conditions, they are to be tested for when vasculitis is confirmed, but in your case remember it's just a hypothesis. Also the possibility of their presence must have been thought of when you were evaluated for fibromyalgia, so if your clinician is confident there aren't any signs indicating their possibility tests are not a must. Tests for antinuclear antibodies or rheumatoid factor are positive in a percentage of the normal general population so the diagnosis is made only in combination with clinical signs.
I hope to have been of help.
Hydrocephalus not active. Tests only if deemed necessary.
Detailed Answer:
MRI confirms hydrocephalus is chronic not active for the moment which is suggested by the part where it says there's no transependimal flow.
As for the vasculitis and autoimmune connective tissue conditions, they are to be tested for when vasculitis is confirmed, but in your case remember it's just a hypothesis. Also the possibility of their presence must have been thought of when you were evaluated for fibromyalgia, so if your clinician is confident there aren't any signs indicating their possibility tests are not a must. Tests for antinuclear antibodies or rheumatoid factor are positive in a percentage of the normal general population so the diagnosis is made only in combination with clinical signs.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Yes , thank you for all your insight :-),
Brief Answer:
Thank you and good luck!
Detailed Answer:
Thank you, I am pleased you have found my answer helpful.
I remain at your disposal for any other question. If or when you have no more questions I would kindly ask you to close the query.
Wishing you good health!
Thank you and good luck!
Detailed Answer:
Thank you, I am pleased you have found my answer helpful.
I remain at your disposal for any other question. If or when you have no more questions I would kindly ask you to close the query.
Wishing you good health!
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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