MRI thoracic-"syrinx", years prior ENT test(s), abnormal, CNS involvement...help!!!!

[Britbrat]

Hi,
Long story, but I am getting absolutely no where with my doctors.
In 2016, I had a posterior lumbar decompression partial laminectomy, L5 S1, for "sciatica", right leg pain, numbness, tingling, etc. I did well for about 1 month, and now, I am having the continued, back,lumbar pain, leg numb/tingling/pins/needles, foot/toes.

I was referred to Pain Management, I had 3 lumbar epidural lumbar injections, with no relief, I then did a trial for a spinal stimulator, which I wore for 7 days. I wanted it out when I got home, went in the office every few days, changes settings a few times, I was able to turn it on and off as I wanted, which I did, it was soo uncomfortable the whole time I wore it. I had muscle spasms, and that is when the pain started going up my back! (I stuck the trial out to see if this is something that could/would really help me, and to see if I could take the muscle spasms/pain, for the relief and the feeling of my leg and foot and toes again) I continued seeing pain management, and they ordered a MRI of my thoracic spine, because I was hurting so bad with the muscle spasms.

MRI results: 3/15/17, Thoracic Spine W/O CONTRAST: Conclusion-Small caliber right paracentral spinal cord syrinx extending from the T6 level through conus medullaris. This measures 1mm in maximal diameter behind the T8 vertebral body. This is of questionable clinical significance, however consider adding postcontrast T1 weighted images to the exam to exclude the presence of a causative lesion. If previous contrasted scans from outside institutions are available for comparison, these would be helpful and may eliminate the need for additional imaging.

In 2013, I was diagnosed with "vestibular neuritis", I was dizzy, off balance, it felt like my "brain" was literally being shaken, for a year.
I went through numerous test(s), and some were abnormal, saying, abnormal saccades, results is insolation and abnormality is bilateral.

My last c-spine and Brain MRI/MRA, was 2015.

Normal, MRI/MRA, Brain.

MRI: Spine Cervical with out contrast:

Opinion: There is mild multilevel non-compressive degenerative disk disease. The most significant abnormality is at C2-3. There is a mild degenerative spondylolisthesis and severe facet arthrosis on the left side at this level.

Advice? What to do now? Should I have the MRI with contrast? Pain Management, was just ordering thoracic contrast MRI. Shouldn't I be getting a brain and c-spine, MRI?

I have numerous symptoms, loss of memory, trying to get the right words out, cant remember anything, foggy, blurry vision, always tired, hip pains, frequency, feels like a rubberband is around my ankle/toe. Any advice?? anything will help!!

[22cyclist]

Hi and welcome to MS world Britbrat: Contrast is not really needed to diagnose MS, however if that is what they are looking for they should probably refer you to an MS specialist, or at least a neurologist. It sounds like they are simply looking for an origin of the anomaly in your thoracic spine. MS MRIs use contrast to see if any of the lesions they might see are "active" or light up. This is what tells them if the disease is active. It is not needed to see MS lesions as they are seen on FLAIR sequences of a regular MRI.

So since your anomaly was seen on Mri, you may want to take it to a neurologist to have them look at it and either refer you to a nearosurgeon or help you depending on what the MRI impression was.

Only a doctor can give you advice about your MRI results so a good neurologist is a great place to start. If the impression part of the MRI said nothing about consistent with MS, or differential diagnoses MS, then you should cross that off of your worry list.

Take care and let us know how it goes, OK?
Lisa

[jreagan70]

Hi Britbrat:

Since you're posting in an MS forum, I'm assuming it's because you think you may have MS.

Nothing you posted indicates that you have MS. You've had neurological workups and MRIs of your brain and spinal cord. At least one brain MRI (2015) was done after your vestibular symptoms, and it was normal. How many other brain MRIs have you had, and were they also normal? Normal MRIs point away from MS.

Your cervical MRI indicates degenerative disc disease, arthritis and mechanical issues, but doesn't say anything about spinal cord issues there. Your thoracic MRI doesn't indicate the presence of lesions that could be associated with MS.

MS lesions are visible without contrast, so you don't need contrast for them to show up on MRI. In MS, contrast only differentiates older, noninflamed lesions from actively inflamed lesions. If the pain management doctors want an MRI with contrast to look for some kind of lesion, it definitely isn't MS lesions they're looking for. If an MS lesion were present, it would already have been visible on your MRIs.

What to do now? Should I have the MRI with contrast?

That's up to you. You should consider doing it if it will help your doctors get a better idea of what's going on with your thoracic spinal cord and the pain and spasms you're having. Don't do it if you think it will uncover some kind of "hidden" MS lesion, because it won't.

Pain Management, was just ordering thoracic contrast MRI.

A thoracic MRI is all the pain management clinic would be ordering because your leg pain and thoracic issues are all they're treating you for. They wouldn't be ordering a cervical MRI because apparently your signs and symptoms aren't the kind that are caused by issues in the cervical region.

Shouldn't I be getting a brain and c-spine, MRI? I have numerous symptoms, loss of memory, trying to get the right words out, cant remember anything, foggy, blurry vision, always tired

Possibly you should be, but not from the pain management clinic. They're investigating your leg pain and spasms. They're not general neurologists who are going to work up or treat your memory, vision or fatigue issues.

For your blurry vision, have you been examined by an optometrist or ophthalmologist? A visual exam by an eye doctor of either profession is needed. Neurologists and primary care doctors aren't eye doctors and aren't trained or equipped to evaluate your blurry vision.

It sounds like somewhere along the line you've seen at least one general neurologist who ordered your brain and cervical MRIs. Since it's been a couple of years since your last brain and cervical MRIs, the next step would be to go back to your general neurologist and have a new MRI series done.

It's important to know that many different conditions can cause the symptoms you're having. MS is only one of many. And it sounds like you've already had MRIs that would indicate MS lesions and there have been no MS lesions on any MRI.

So it sounds like the two next things to do are to get a proper eye exam from an eye doctor and follow up with a general neurologist to continue looking for what's causing your symptoms. You may need to see a rheumatologist and orthopedist.

Multiple sclerosis got its name from the characteristic multiple lesions in the central nervous system. So far, your MRIs haven't shown any. So unless your next brain or cervical MRI shows those specific, characteristic lesions, you can take MS off the table.

Good luck on your journey to finding answers.