Originally posted by Brittan
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So the radiology report should explain why the abnormalities on your MRI look too specific to be infarcts. And in that case, the radiologist should have an idea of what the not-nonspecific lesions look like. MS lesions tend to look a particular way -- generally more oval than round. So what did the radiologist say they do more specifically look like, with enough confidence that infarction can be ruled out? if they're not nonspecific, what are they specific enough to look like?
Without a description of the lesions, what's left are some possibilities of low likelihood -- so it will probably take more than one medical opinion to come to a conclusion.
1. Chiari malformations aren't known to cause brain lesions. However, if there has been enough vascular trauma, there is a physiological explanation for infarcts, so the possibility can't be entirely thrown out.
2. It's highly unlikely that it would take almost 20 years for MS lesions to show up. That possibility is even less likely than the possibility of vascular damage and infarcts from 20 years of the traumatic effects of a Chiari malformation, so 20 years of MS has to, physilogically, go to the bottom of the list. You might think it's possible if you assume that your symptoms going back 20 years are from MS. But because the symptoms of a Chiari malformation can be the same, it doesn't make sense to assume that the symptoms would be from something that hasn't been showing the characteristic signs rather that something that is.
3. The MRI abnormalities might be from something that hasn't been considered yet. But since that's a wild card so far, it also goes to the bottom of the list.
4. It's possible that the lesions are MS lesions. But since there's no relationship between Chiari malformation and MS, the possibility of MS means that everyone, including you, must abandon any inkling of an idea that the Chiari malformation somehow "caused" MS. That's physiologically not possible. And from what you have said about the location of the brain abnormalities on MRI, none of them are in places that would contribute to your heart rate and blood pressure symptoms.
5. Allowing, for sake of argument, that the abnormalities are MS lesions, the characteristic behavior of MS is that it has probably been in existence for no more than 10 years, and possibly less than 5 years. It would be be an unusual coincidence to have a Chiari malformation and then develop MS many years later, but that is physiologically possible.
AND other tests should support MS, such as an LP and evoked potentials -- something that's specifically characteristic of demyelination, not just nerve trauma.
Again, it may -- and should -- take more than one medical opinion to figure out a complicated case like yours. Your research into Chiari, including talking with other people who have a Chiari malformation, isn't enough to crack the case on its own. So I hope you can get an opinion from one or more neurologists at a top-notch neurology clinic who can do all of the pertinent tests and interpret the results properly.
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