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Date of last update: 10/20/2017.

Forum Name: Ischemic Heart Disease

Question: MRI shows possible ischemic vs. multiple sclerosis

 mpic - Sun Apr 05, 2009 10:32 am

HISTORY: Elevated blood pressure and heart rate accompanied with dizziness and tremors in hands with numbness in finger tips on Christmas Eve 2008. PCP sent me to a heart doctor who did an ultrasound, heart monitor (24 hours), EKG, nuclear stress test accompanied by scans of my heart. Results came back normal with no blockages.

Feb. 13, 2009 I experienced high blood pressure (142/85 with a heart rate of 104), dizziness so intense that I was dizzy even laying down with me eyes closed. Taken by ambulance to emergency room, ct scan of brain (normal), EKG, given fluid intravenous for dehydration and dismissed 8 hours later feeling fine again. I also reported tinnitus and a feeling of fullness in my ear that has been ongoing for some time. No history of headaches.

Heart doctor sent me to an ENT who did a hearing test that indicated loss of hearing in the left affected ear and sent me to a neurologist who ordered an MRI with and w/o contrast and an MRA of my brain and neck on March 28, 2009.

MRI results: Scattered T2 hyperdensities are present in the bilateral frontal white matter. Diagnostic considerations include ischemic vs. multiple sclerosis plaque. There is no MRI evidence of 'enhancing lesion' in the brainstem to suggest acute process.

MRA results: No MR angiogram evidence of aneurysm.

The neurologist (who did not look at the films, only the report) had his office call and say the results came back normal and to follow up as needed.

So don't know what to do now as the doctor says nothing is wrong, but symptoms persist. My blood pressure is back down to normal (116/75) but still have the ear problems and bouts of milder dizziness. I am the type of person who rarely goes to the doctor and this is making me not want to see a doctor ever again because I have now spent about 6 months of my paychecks with no results. I don't know what to do.
 John Kenyon, CNA - Thu Apr 23, 2009 9:19 pm

User avatar Hello --

I am so sorry you've had this experience with no satisfactory medical outcome. It seems the MRI first confused everyone then led them off the track of the real problem, which is the symptoms.

The symptoms you describe, prolonged, severe vertigo, tinnitus and loss of hearing in one ear, are all typical of Menier's disease. This can be associated with MS and also with ischemic brain changes, but the radiology report really does describe a relatively normal brain with some nonspecific artifact which could be unrelated to the symptoms, and even if it is related, they would be treated the same way: symptomatically.

There are several considerations involving Menier's syndrome, including avoidance of aspirin, treatment with meclizine or other anti-vertigo medications (meclizine can be had over the counter and is often very effective; stronger ones require a prescription), and exercises to help adapt to and ultimately "short circuit" the dizziness. The fact that you're dizzy when lying down strongly suggests vertigo and when it goes this long, with hearing loss and tinnitus, it is extremely likely to be Menier's. A repeat MRI of the brain later might yield some further insight into the possibility of MS, but right now it seems to be at best a marginal possibility (and is often difficult to diagnose for long periods of time). Meanwhile you need the troublesome symptoms to be treated, and I can't understand why that hasn't been done. It should be noted that the initial episode may have featured numbness and tremors because vertigo (and especially Menier's) often trigger an acute anxiety response that includes hyperventilation (often unrealized by the patient) with subsequent tremor, numbness and even severe carpal spasm and faintness.

This is not meant to imply anxiety is at the bottom of this, only that it can be a prominent complication of it and will often blur the issue. The MRI information is virtually meaningless at this point, but it should be repeated within six months of the first one, for purposes of comparison. Frequently, odd as it may seem, doctors will only read the imaging report and not actually see the films. They have this much faith in the radiologist's readings, for better or worse, and sometimes this is actually an advantage because they are not always nearly as good at reading the films. Strange, but true.

I do hope this is helpful. I'm glad to learn the problem has improved and may be resolving. I still believe at least meclazineshould be tried to help resolve most of the remaining symptoms. If you can't find generic, at least you should be able to find either Dramamine Less Drowsy formula or Bonine, both being brand names of meclazine.

Please follow up with us here as needed and again, I hope this is helpful. Goood luck to you.

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