View Full Version : MRI next step, Rheumatologist?

08-22-2016, 10:34 PM
I recently saw a MS specialist just for screening since my sister was just diagnosed and I do have some symptoms, such as a strong intolerance to heat, odd feelings in my legs, such as cold running down them, weakness in my legs (everything is worse on the right), I can't remember things, tremors of head and hands, numbness, tingling, burning, etc.

Anyhow, I just got my report back and the Dr. suggests that I see a Rheumatologist. I'm not sure that is the right place to go next after reading the results of my MRI, which is as follows.

MRI did not indicate MS. The testing for lupus and sjogrens was negative. However you might want to see a rheumatologist as some of the conditions they treat are negative in terms of labs. There is no evidence for MS at this point.
DATE OF EXAM: Aug 5 2016 5:46PM


PROCEDURE REASON: Paresthesia of skin

* * * * Physician Interpretation * * * *



Paresthesias. Clinical suspicion for demyelination, but no firmly
established diagnosis.


Imaging of brain and cervical spine. Demyelinating disease protocol.
Imaging without and with gadolinium.

MR Contrast: Dotarem
Contrast Dose: 15 cc
Route of Administration: Intravenous

Prior MRI of the brain, IAC protocol for indication of left-sided hearing
loss. This demonstrated no evidence for schwannoma.



There is no restricted diffusion on this examination to suggest focal
acute ischemia or pathologic brain parenchymal cellularity. Brain
parenchyma demonstrates normal signal and morphology. No abnormal
extraaxial collections, acute or remote blood byproducts, or
hydrocephalus. Hypothalamic and pituitary region normal.
Craniovertebral junction normal. Cerebellar tonsils are normally
positioned relative to the foramen magnum.

Major intracranial arterial structures and dural venous sinuses show
typical flow void consistent with patency by spin echo criteria.

Minimal fluid in both maxillary sinus chambers, minimal anterior ethmoid
inflammatory mucosal thickening.

After gadolinium administration, there is no abnormal brain parenchymal
or meningeal enhancement. Grossly normal enhancement pattern of the
major cortical draining veins and dural venous sinuses. Right transverse
sinus is dominant.

Cervical spine:

Counting reference: Craniocervical junction.

Straightening of the usual lordotic curvature may be positional. Mild
multilevel disc bulging C3-C4, C4-C5, C5-C6 with loss of disc height and
C6-C7. Ventral CORD contact at these levels, but no myelomalacia. There
is limited CSF space surrounding the cord which is related to these
degenerative changes, superimposed upon low normal AP diameter of the
spinal canal on a developmental basis.

Canal and foramina are normally patent at C2-C3, C3-C4, mild right and
moderate left foraminal narrowing at C4-C5, moderate bilateral foraminal
narrowing at C5-C6, and mild to moderate foraminal narrowing bilaterally
at C6-C7. Normal patency of remaining neural foramina at the C7-T1
through the T5-T6 levels.

No subtle cord changes on the sagittal 3-D FLAIR through the mid C6 level.

After gadolinium administration, no abnormal enhancement.


Grossly normal appearance of the brain.

Based on the axial T2 flow void pattern, proximal intracranial arterial
vasculature, major cortical draining veins, and dural venous sinuses are

Cervical spondylosis as noted. Multilevel ventral cord contact related
to chronic disc and bony degenerative change. Foraminal narrowing is
detailed above.

No evidence for prior demyelination involving the brain or visualized
cord through the T5-T6 level.

08-23-2016, 02:59 PM
Welcome to the board. I'm not sure why a rheumatologist is suggested. I would suggest a visit to a spine specialist as the cord compression could be responsible for your symptoms. This could be a fellowship-trained orthopedic spine surgeon or a neurosurgeon. Just be sure that whoever you see specializes in issues of the neck and back only.

It looks like you have degenerative disc disease throughout the cervical spine. You can find tons of information on DDD online...just look for a reputable site for best information....

Compounding the issues caused by DDD, you were born with a central spinal canal that is smaller in diameter than normal/average. This means you have even less space than the average person so when anything develops that occupies some of that same space needed for the spinal nerves to function normally, symptoms develop.

There is nothing causing cord disease and the other issues are not severe, but the foraminal stenosis, rated mild to moderate, could be enough to cause some of your symptoms.

I think I would start out with the spine specialist for an accurate diagnosis and plan of treatment, if needed. If it turns out the stenosis is not causing your symptoms, you can check spine related issues off the list and move on.