I was hospitalized for fainting in a restaurant (May 2002), and on my brain MRI there were “white spots” suspected as Multiple Sclerosis demyelination. I also had a positive Babinski sign, but I am sure I have always raised my toes upward if anybody touches my foot in anyway. I had a positive tilt table test, and I now have to wear TED hose to keep my blood pressure up, and to my head. Without them I feel my blood pooling, sort of in my stomach… and I get nauseous, and feel faint. Well, they did do the spinal tap and I do not have banding in my CSF. I understand this. But, I ask, “So what are the white spots?” I get told things like,” They can just be areas of more intense signals..” and “Could be from migraines…lots of things…” but no doctors give it any other explanation, or act like it is odd. I do feel like my left limbs are much weaker than my right, and a neurologist then did an EMG of the left limbs. The EMG was fine. I can tell you this: I did have severe migraines when I was in my teens. I am a 44 year-old female. After I started taking antidepressants, I never had another migraine, but I do continue to have the visual auras (that look like psychedelic lights dancing around in front of my eyes) and I am always very thirsty then. I associate it with dehydration, actually…dehydration brought on by drinking caffeine. So, I drink a large amount of water and the aura goes away in about fifteen minutes. When I was young my left hand and left side of face would go numb, then I would vomit for 12 hours. I also want to say that I had shingles on my eyeball, in the conjunctiva, and on my face, nose, and head. I understand this is chickenpox, revisited, on the cranial nerve. Would that have anything to do with the white spots on the MRI?
I also have hypothyroidism, anxiety/depression, and had a hysterectomy for a large fibroid in 2002, but I still have ovaries. I also have disc degeneration and a bulging discs in my lower back, and in my neck. So, I guess I am wondering if I named anything that could have caused the white spots on my brain MRI, since I don’t have MS. I had another brain MRI lately, so they were about 18 months apart, and the white signals seemed to be about the same. I wish you would know why I keep having these visual flickeries, too. It happens anywhere from once week to about five times in a week. I drink Gatorade, now, to try to keep from dehydrating since my low blood pressure ( about 85/55 without TED hose; 98/60 with TED hose) has been said to also be improved with water retention. There’s a lot of info for you, but no doctor seems to care, as long as I don’t have MS. I care, though! Thanks.

?

Dr. Joshua’s Answer:

?

It’s really hard for me to say what the white spots on the brain MRI are without actually seeing the pictures. White signal lesions on T2 MRI occur in multiple sclerosis, but such a finding can occur in various other conditions, and are sometimes seen as an incidental finding with no significance. The fact that the white spots did not change between the two brain MRI speaks against multiple sclerosis, because multiple sclerosis is a dynamic disease and usually the lesions change over time.

Positive Babinski sign alone without other signs of spinal cord or brain injury could be just a misinterpretation, just as you suggested.

Heart and blood pressure symptoms are sometimes seen with multiple sclerosis because of the involvement of the autonomic nervous system, which is the system that controls heart, blood vessel, lung, and gut function. However, the fact that you have these symptoms does not indicate that you have multiple sclerosis.

Cerebrospinal fluid (spinal tap) is examined for Immunoglobulin G index. This is elevated in >85% of multiple sclerosis patients. This means that negative finding (normal IgG index) does not exclude multiple sclerosis - in about 15% of multiple sclerosis cases, the CSF IgG index is not elevated.

If you have had severe migraine with hemiplegic (motor weakness on one side) symptoms and features, it is possible that these migraines have caused sufficient circulation disturbance in the brain to produce visible findings in brain MRI in that specific region but this is rare.

As for the bulging disc, shingles, hypothyroidism and hysterectomy: They do not explain the brain MRI findings.

Up to 30-40% of healthy adults have some high-intensity T2 findings (white spots) in brain MRI. Therefore these findings are not specific to any disease and are often incidental (no significance).

Sometimes these findings may be a sign of cerebrovascular disease (small strokes), so I recommend that you have your stroke risk factors checked (blood lipids, smoking, diabetes, obesity etc) and evaluated by a neurologist until we are satisfied that every measure has been taken to protect your brain.

I cannot say for sure that you do not have multiple sclerosis, and I can’t make a diagnosis of your symptoms over the internet, but I realize that these findings and symptoms cause a lot of distress for you, and I hope I have managed to answer some of your questions.

If you wish, you can e-mail me a scan of the brain MRI, and I’ll have a look.

Discuss this topic on the Health Forum

   More answers in Family Doctor, Multiple Sclerosis, Neurology, Radiology