Dr. Hitesh Kumar
Neurology
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Patient's Query
Hello doctor,
I recently had an MRI with no contrast for migraine presenting with an aura consisting of visual disturbance and aphasia. I have had them for a while, and they run in my family. When I got the results of my MRI, it started something that did not make sense. A differential diagnosis between MS and migraine or microvascular disease is common, I know. But what they put in does not make sense. It said they found lesions consistent with Dawson's fingers. It could be a possible demyelinating disease or could also possibly be a relatively advanced microvascular disease, given a history of high blood pressure and chronic migraine. The reason I say that does not make sense is because Dawson's fingers are precise to MS, and I am asymptomatic of it, and they do not show up in the same places in the brain. My question is, how could this possibly be a differential diagnosis when it seems so clear that they are separate, possibly comorbid problems?
Kindly help.
Hello,
Welcome to icliniq.com.
I just read your query. I can understand your concern.
I have not seen your magnetic resonance imaging films. But as you have mentioned, they found lesions consistent with Dawson's fingers. Dawson finger lesions are present in the corpus callosum and surrounding areas. These are demyelinating lesions of multiple sclerosis. These are somewhat perpendicularly located ischemic microvascular lesions situated very near the corpus callosum, in the periventricular region. Sometimes, it is not so easy to differentiate between these two types of lesions in the initial phase of illness. A differential diagnosis means possibilities. So, it might be they are talking about radiological possibilities. If there are only radiological lesions (without clinical symptoms) mimicking multiple sclerosis. That is labeled as RIS(Radiological isolated syndrome). As you mentioned that you are asymptomatic for multiple sclerosis, then you should not be thinking of starting any medication for multiple sclerosis. But continue treatment for other ailments and can get a serial MRI Brain with contrast scans every year, if you get some symptoms in between, then get an MRI brain early.
Thank you.
Regards.
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Neurology
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