What I Did When I Thought I Was Sliding into Secondary-Progressive MS, Part II
In my previous article WHAT I DID WHEN I THOUGHT I MIGHT BE SLIDING INTO SECONDARY-PROGRESSIVE MS, I described some worsened symptoms on the right side during this past year, the side that has been the stronger of the two ever since the onset of my RRMS in 1998.
During a May neurology appointment, I noted that my pattern of relapses had changed. I’ve averaged one flare every five years, but it’s been six years now since my last flare. This change could mean:
- Tecfidera is doing its job, or
- The disease might be settling down as I enter my senior years, or
- Some other reason.
Put that together with the right-sided worsening limb weakness and foot drop in the absence of a flare, and it could mean:
- The waxing and waning pattern is being caused by non-demyelinating factors such as temperature changes and bladder infections, or
- Stenosis caused by degenerative spine/disc disease has worsened lately, or
- I’m sliding into secondary-progressive MS (SPMS).
On July 14, 2017, I underwent a brain MRIw/wo contrast. Below is my simpler translation of the original report. The descriptions might look a lot like your own MRI results.
The existing brain lesions have not multiplied compared to a 2012 MRI and remain most densely populated in the periventricular white matter (but are they symptomatic?). No blockages in blood vessels so no ischemia, a subtype of stroke that blocks blood flow to the brain. No brain shrinkage. (This last item relieved me since atrophy can indicate disease progression.) The radiologist methodically touched on each part of the brain in descending order towards the spinal cord. Sulci, cisterns and ventricles are spaces in the brain that hold cerebrospinal fluid or blood, and they all appear normal. Going on down the line, the pituitary gland, midline, posterior fossa and cerebellar tonsils are normal. That takes us to the top of the cervical spine.
Cervical spine MRI
I had a cervical spine MRI also on July 14, 2017. There’s a lot more going on in my spinal cord than in my brain. Here’s an abbreviated version. Again, you might find things that are similar to your own MRI results.
What hasn’t changed
Compared to a 2012 MRI, areas of abnormal signal in the spinal cord at C2 and C3 and in C5-6 remain unchanged. Most pronounced abnormality is at the C5-6 region involving much of the central cord but also of the left.
What has changed
Disc herniation at C5-6 now has severe loss of disc height. Endplate bone spurs are now present. (Endplates are the bony end parts of each vertebra that make contact with the discs. They can become deformed and dysfunctional from the pressure of collapsing discs.)
Bone spurs at C5-6 are now present and also compressing the ventral thecal sac and ventral spinal cord. (The thecal sac is the sheath that contains the spinal cord and cerebrospinal fluid.)
Central stenosis at C5-6 has worsened. (Central stenosis is a narrowing of the main central canal that protects the spinal cord. This narrowing makes it more likely for nerve compression to occur on the spinal cord, which can result in chronic and painful symptoms for those affected. See reference below.)
Moderate left- and right-sided foramen stenosis is now present. (Foramen stenosis reduces the size of the space between each vertebra. A foramen is a space located to the right and left of the vertebrae. A herniated disc can cause those spaces to narrow and produce pinched nerves, pain, and other symptoms. See reference below.)
Multiple sclerosis-related demyelination in brain and cervical spine has not advanced despite worsened motor function and increased neuropathic discomfort. Disc/spine deterioration has worsened.
Thoracic spine MRI scheduled for July 5. Looking for demyelination and disc disease in the mid-spine as possible causes for worsened motor function and muscle weakness.
My thoughts on the findings thus far
I hope the culprit is spinal stenosis rather than MS. Back problems are easier to treat with physical therapy alone. Medication often isn’t necessary. The little experience I’ve had using medication for back pain proved to me that it is much less effective than self-massage, activity and heating pads.
A question I want to research
Do periventricular white matter lesions cause symptoms? My first neuro said it’s a “no man’s land” and contains no vital functions. I’m skeptical. Internet research has not yet addressed this question. Next I’ll ask my present neuro.
Folks, always read your radiology reports. Your neuro might not tell you everything they contain. MRIs pick up other problems you need to know about. For example, if I hadn’t read the reports myself, I would never have known I had gallstones and an enlarged thyroid lobe. Time and again, I’ve learned that it pays to be thorough.See my next installment (Part III) for results of the thoracic spine MRI. The plot thickens!
How many specialists did you see before finding "The One"?