What Does Scattered Subcortical Areas Of High Signal In Frontal And Parietal Lobes Means?

Posted on Tue, 26 Mar 2013

Question: MRI of brain. Was dx with both lupus and MS in 2004.
I've been falling a lot but have not in last few months.]
MRI showed "scattered subcortical areas of high signal in frontal and parietal lobes left more than right" and 2 areas of high signal at the pericallosal white matter XXXXXXX
What the heck does this mean??

Answered by Dr. Gopal Krishna Dash (1 hour later)

Hello,

Before I do respond your query, I would like to discuss certain things noted as follows:

Multiple sclerosis is a diagnosis that is entertained when a patient meets the clinical criteria and other laboratory findings to support it and no other neurological disease/condition can explain that clinical situation in a given patient. As a principle of neurology practice, one should try to explain the patient’s profile with a single disease rather than multiple. Though, several diseases can coexist in a given patient. Other neurological conditions that can mimic Multiple Sclerosis are lupus, brain infections, HIV infections, autoimmune disorders. These conditions need to be ruled out since management and outcome can differ in each of them.

The MRI data that (I am sorry that you have not mentioned if these lesions are enhancing in contrast or not) you have posted are seen in Multiple Sclerosis, lupus, vitamin B12 deficiency, other infections and so on. If you are diagnosed as having Multiple Sclerosis, this can simply mean demyelination which is seen in MS. If your lesions are bright with contrast injection, it could mean that the lesions are active.

As the management of lupus and MS are different and the presence of lupus can explain the clinical findings that you have, with due respect to your physician, I will request you to get a second opinion from an expert in multiple sclerosis in your area. The management of these conditions are different.

I hope I have answered your query
Please get back to me if you have any concern
Best wishes

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Gopal Krishna Dash (22 hours later)

I have an MS specialist, who ordered the 3 Tesla MRIs of brain and thoracic spine. He is with the university and it is difficult to reach him. I assumed because I had not heard of the MRIs, they were ok. My rheumatologist told me that the MS Doc had sent her notes that he wanted to see me b/c MRI labs are abnormal. Tell me about the difficulty differentiating MS and SLE! In 2004, I went to multiple specialists and the consensus was that I had both. I was a pincushion, had a spinal tap (positive for MS) and multiple MRIs then, all of which were consistent with MS. The first MS symptoms were in 1991. I had had numbness, extreme fatigue, depression but no optical issue. Same in 2004 but i also had vertigo which lasted a couple of months. Several months ago I was falling - I am an attorney and have the dubious distinction of having fallen in every courthouse in a 4 county area. The falling and depression worsened and I ended up drinking again 4 months ago in a suicidal state of mind. I have since sought help for the latter two. Some of the falls caused serious pain - falling down concrete steps is not a pleasant experience. In addition, I had classic lupus clinical signs. I do not have HIV or B12 deficiency. I also do not have migraines. The rheumatologist said it could be SLE related since the location of these would suggest significant cognitive dysfunction - which I do not have. Thus, she thought it was probably MS related.

The high signals were with contrast. I was able to obtain this MRI but not that of the thoracic spine which was done at same time. I was unaware that the high signals with contrast show active lesions. If it is MS, which is what I presume, would lesions in this area cause stumbling/falling - my legs just not working. I also have severe muscle pain.

I chose to not continue taking Avonex in 2004-2005 because the side effects seem worse than the potential benefits. Now I need to make an appt with the neuro and see if I can get in sometime this year.

Finally, I appreciate the follow up on this. I won't ask another. I participated in a similar $35 "expert opinion" website for questions for attorneys in certain fields. I gave it up. Getting old is a bitch.

Answered by Dr. Gopal Krishna Dash (12 hours later)

Hello,

Thanks for the query and the feed back

I have noted your medical history.
The symptoms and the MRI data that you have described are suggestive of MS. I also agree with your physicians that you could have both, a rare clinical situation.

Yes, the thoracic spine lesions can explain problem in the legs.

There are so many options apart from Avonex. Your doctor will help you select one.
Please do not worry and keep cool.

Please get back to me in case you have any concern. It’s my pleasure to help you as long as it is possible.

Best wishes

Above answer was peer-reviewed by : Dr. Raju A.T