MRI and Steroids

[Nellie23]

Hello! This is my first post - long story short, I am a young female and my whole adventure started a year ago. I have been diagnosed with trigeminal neuralgia, but it is atypical in presentation and due to my age, I am seen by a MS Neuro who suspects this could be MS. I had an MRI no contrast from my GP in Jan 15 which showed a few periventricular lesions, which led me to the neurologist's, obviously. CSF has been negative (I was told 15-20% of people never have positive results, or this could just be too early), but I have had a couple "relapses" between then and now, with a few weeks ago having a relapse with ptosis and hearing loss along with my TN issues. My neuro immediately gave me 500mg IV Solumedrol, just one day. It helped the ptosis which was the biggest concern at that time.

I was supposed to get my follow up MRI with contrast in July, but she wanted me to move it up to this month instead. So, I have my MRI this week - 3 weeks after the IV steroids. My question is, will that single, 1/2 dose of IV steroids affect lesion enhancement on the MRI? I am assuming she wouldn't have ordered the MRI if she thought I should wait any longer after the steroids, just curious if anyone knew? I can call the office, I just don't want her nurse thinking i'm questioning my doctor in anyway, because that's not my intention - I completely trust my Neuro, it's just she wasn't the one who scheduled the MRI, the imaging center did.

[jreagan70]

Hi Nellie:

There steroids might or might not make a difference on your MRI. What you had isn't a lot of steroids, so more likely not. Inflamed lesions typically enhance for about 6 weeks. In theory, since you're having your MRI 3 weeks after the start of your new symptoms, new lesions should still enhance.

But this is important to bear in mind.

1) Your relapse and onset of new symptoms already tell you neurologist that you had new inflammation. Your neuro doesn't need to see enhancement on your MRI to know that it exists. It's just that enhancement showing active inflammation makes a much nicer piece of supporting information than an MRI that doesn't show it.

2) Even if, for sake of discussion, the steroids knocked out enough inflammation that the lesions don't enhance on MRI, the new lesions will still be visible on MRI. The mere presence of new lesions (compared to your January MRI) is enough to meet the diagnostic criteria of separation of lesions in time and space.

3) In the rare (and really frustrating) event that new lesions don't show up on your MRI (it happens sometimes), go back to #1 above. The signs and symptoms of your ptosis and hearing loss are enough to show that new lesions have to be there even if they can't be seen on MRI. It's just a whole lot nicer when there's other supporting information to confirm the lesions.

This is a great question to ask your neuro at your next appointment. Beyond that, what's done is done. It isn't worth fretting over something you don't have any control over. It sounds like you're doing your part in the process just fine.

[Nellie23]

Hi Nellie:

There steroids might or might not make a difference on your MRI. What you had isn't a lot of steroids, so more likely not. Inflamed lesions typically enhance for about 6 weeks. In theory, since you're having your MRI 3 weeks after the start of your new symptoms, new lesions should still enhance.

But this is important to bear in mind.

1) Your relapse and onset of new symptoms already tell you neurologist that you had new inflammation. Your neuro doesn't need to see enhancement on your MRI to know that it exists. It's just that enhancement showing active inflammation makes a much nicer piece of supporting information than an MRI that doesn't show it.

2) Even if, for sake of discussion, the steroids knocked out enough inflammation that the lesions don't enhance on MRI, the new lesions will still be visible on MRI. The mere presence of new lesions (compared to your January MRI) is enough to meet the diagnostic criteria of separation of lesions in time and space.

3) In the rare (and really frustrating) event that new lesions don't show up on your MRI (it happens sometimes), go back to #1 above. The signs and symptoms of your ptosis and hearing loss are enough to show that new lesions have to be there even if they can't be seen on MRI. It's just a whole lot nicer when there's other supporting information to confirm the lesions.

This is a great question to ask your neuro at your next appointment. Beyond that, what's done is done. It isn't worth fretting over something you don't have any control over. It sounds like you're doing your part in the process just fine.

Thank you for your response, helps put me at ease!

[rdmc]

Hi Nellie,

I've posted this link many times, especially for those just learning about MS, lesions, relapses, etc.

This is a link to an research paper called More than Meets the Eye. It shows 26 consecutive MRIs, of a man who would "shoot the tube" ever 2 weeks for a year. The man reported no increase in symptoms or signs of relapse during this year, but as you'll see from the MRI time lapse, there was a lot going on. That is the reason that we need to think of 1 MRI as a "snapshot" in time. What is or isn't happening on the MRI is not a definitive picture of what's happening in your brain. This is one of the reasons that some neuros say, "I rely on the signs and symptoms, not the Mri." I've had neuros over the years that saw MRIs both ways. Most have required yearly MRIs, and I've had 2 who only did an MRI if symptoms were raging and not remitting over time.

Here's the link:

http://www.msdiscovery.org/news/news...more-meets-eye