What Are Brain Lesions
Nerve fibers in your brain and spinal cord are wrapped in a protective membrane known as the myelin sheath. This coating helps increase the speed at which signals travel along your nerves.
If you have multiple sclerosis , overactive immune cells in your body trigger inflammation that damages myelin. When that happens, damaged areas known as plaques or lesions form on the brain or spinal cord.
Carefully managing and monitoring the condition can help you and your doctor understand if its progressing. In turn, sticking with an effective treatment plan may limit or slow the development of lesions.
When lesions develop on your brain or spinal cord, they can disrupt the movement of signals along your nerves. This can cause a variety of symptoms.
For example, lesions may cause:
- vision problems
- muscle weakness, stiffness, and spasms
- numbness or tingling in your face, trunk, arms, or legs
- loss of coordination and balance
- trouble controlling your bladder
- persistent dizziness
Over time, MS can cause new lesions to form. Existing lesions may also grow larger, which might cause a relapse or an acute flare-up of symptoms. This happens when your symptoms get worse or new symptoms develop.
Its also possible to develop lesions without noticeable symptoms. Only 1 in 10 lesions causes outward effects according to the National Institute of Neurological Disorders and Stroke .
What Are Treatments For Ms Brain Lesions
The goal of is to stop relapses from occurring: We prevent new relapses by preventing new lesions from forming, explains Dr. Bhargava.
Disease-modifying MS therapies, such as beta interferon drugs, infusion treatments, and oral medications, have been shown to be powerfully effective when it comes to preventing new lesions. These treatments can reduce existing inflammation, too.
Sometimes, lesions can be stalled. We can slow down the inflammation of some lesions when theyre actively inflamed by starting therapy so the lesion itself might not be as drastic, Dr. Hua says.
What Causes Brain Lesions
Brain lesions can have many different causes. Age, a family history of brain lesions, trauma, and viral or bacterial infections are just a few things that can cause brain lesions. Autoimmune diseases, such as lupus and MS, are another. In the case of MS, brain lesions are the result of inflammation and damage caused by a misfiring immune response and the formation of scar tissue.
Symptoms of MS vary from person to person and are largely dependent on where MS lesions develop in the central nervous system. The severity, size, and location of lesions all influence what functions of the central nervous system are impacted.
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How Will I Know If I Have A Lesion
If a healthcare provider suspects that someone may have MS, he or she will typically conduct an MRI screening. MRI scans are used to check for new or changing lesions on the brain. Its important to schedule regular appointments and MRI exams to monitor this.
The Effects Of Nerve Damage
When MS is in its early stages, the myelin sheaths are damaged, but the axons of the neurons are not immediately injured. Numbness, weakness or other transient symptoms may occur.
However, the symptoms often come and go as the neuroglial cells regenerate and heal. Periods of disease remission occur.
As the illness worsens, the myelin sheath no longer regenerates. Scar tissue and lesions develop in the place of the myelin sheath. The unprotected neurons become permanently damaged. Messages between nerves and tissues of the body slow and may become completely disrupted. Permanent symptoms and loss of function may result.
The process is intensified if there are multiple lesions in many parts of the nervous system. The intensity of the disease and the rapidity of its progress varies greatly between different people with MS.
Lesions may be visible with an MRI. Plaques may be forming even when the illness appears to be in remission. Research has shown that 5 to 10 new brain lesions form for everyone that causes symptoms. Symptoms occur due to damage within the brain, spinal cord or optic nerves.
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Why Do Lesions Cause Ms Symptoms
The CNS controls everything in your body. So, wherever the lesions are, they disrupt that signaling pathway, says Le Hua, M.D., director of the Mellen Program for Multiple Sclerosis at Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, NV.
If a lesion forms on one of your optic nerves, it affects your vision. If it develops on your spinal cord, you might experience numbness or difficulty moving your arms or legs. If it attacks your brainstem, this can impact your eyes and facial movements, speech, and even swallowing. Lesions can also cause fatigue and brain fog, Dr. Hua says.
MS is a relapsing-remitting disease, which means you have periods of disease activity , followed by periods where inflammation decreases and disease activity stops . All the symptoms that we typically associate with MS relapses can be caused by lesions, depending on where they are, says Dr. Bhargava. As the inflammation dies down in those lesions, the symptoms can then improve.
T1 Weighted Imaging With Gadolinium Enhancement
A gadolinium chelate administered intravenously five minutes before T1 weighted imaging detects bloodbrain barrier breakdown in association with active inflammation. New lesions appear enhanced and usually persist for a month on average, making them a useful marker for monitoring disease activity. Such lesions play an important role in indicating dissemination in time within the new diagnostic criteria. Triple dose gadolinium or combination with magnetisation transfer imaging can both increase active lesion detection further but are not required in clinical practice.
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Do Any Other Diseases Look Like Ms
When neurologists evaluate MS they are also considering other diagnoses. While MS is the most likely cause of typical white matter changes and symptoms in an otherwise healthy young person, there are some other diseases that we consider and occasionally diagnose. These include a vitamin B12 deficiency that can cause an MS-like illness, and rarely, lupus, which may have symptoms that suggest MS. The MRI is very useful in ruling out many other disorders that could be confused with MS, and the blood tests and spinal fluid may also be helpful in diagnosing other diseases.
Why Are Mri Scans Important For An Ms Diagnosis
In MS your immune system attacks the myelin coating surrounding nerves. MRI scans can pick up these areas of damage, called lesions, in different parts of your central nervous system.
MRI has shaped how we monitor and treat MS too. Its used to build a picture of how someones MS is changing over time. This can help to decide if a treatment is working.
Theres ongoing debate about how often to have a scan. Research has highlighted the benefits of yearly MRI scans to monitor MS and inform treatment decisions.
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Symptoms Of Ms Brain Lesions
MS causes a wide range of symptoms because the areas it can affect in the brain and spinal cord control so many bodily functions.
Many of the sensory and motor symptoms of MS brainstem lesions are similar to symptoms of lesions of the spine and other parts of the brain because those in the brainstem often interrupt nerve pathways that connect to these regions.
Symptoms that result from brainstem lesions include:
- Impaired strength or control of movements
- Diminished balance
- Trouble sleeping
Additionally, brainstem involvement in MS affects cranial nerve functions, which causes symptoms that are not produced by MS lesions in other locations, including:
- Diplopia or jerky eye movements
- Hearing impairment, including deafness, tinnitus , or noise intolerance
- Diminished sense of taste
- Dysphagiaswallowing problems, including choking, coughing, or gagging
- Facial pain or altered facial sensation
- Problems with blood pressure, heart rate, or breathing
The Structure Of Nerves
The nervous system is comprised of two parts. The brain and spinal cord make up the central nervous system. Nerves that go to and from the rest of the body comprise the peripheral nervous system.
The nervous system contains two types of cells. They are called neurons and neuroglia. Both have a role in the formation of lesions.
A neuron is composed of three main parts: the axon, dendrites and cell body. It is believed that damaged neurons cannot regenerate. If they are damaged, the injury is permanent.
Axons are the portions of nerves that are directly damaged by lesions. The axon portion of a neuron may be microscopic or over a yard long it depends on the specific nerve. Neurons carry messages between nerves or organs.
Neuroglial cells provide nourishment and protection to neurons. These cells are sometimes referred to as glial cells. They support the neurons and indirectly aid the transmission of messages.
Specialized kinds of neuroglia protect the nerves of the peripheral nervous system. The fatty myelin sheath contains the neuroglia, which can regenerate. They may be repaired however, the tissue regeneration process may be slow, impeded by scar formation in the peripheral nervous system.
When MS occurs, the myelin sheath is weak and scarred by lesions, and its protective effects do not function adequately. Damage to neurons result and symptoms of MS appear.
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What Is The Prognosis For Ms
Most people think that MS is a rapidly disabling disorder. This is not true for most people with MS. A recent study of people with MS in the Olmstead county area near the Mayo clinic showed that most people did well even without treatment. An older study showed that after 25 years without treatment most people were still able to walk. However, only a small percentage of people followed for years do not show some measurable signs of MS on examination.
How Does Mri Work
MRI measures how much water there is in the body. Because different parts of the brain have different amounts of water, we can use MRI to distinguish them and build up pictures of the central nervous system.
The protective myelin coating is a fatty substance, so it repels water. This means we can measure how much myelin is present because it looks different to nerves and other cells in the brain on a scan.
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What Is The Lumbar Puncture For
The lumbar puncture helps to show signs of inflammation and immune system activity in and around the brain and spinal cord. The test is really the only direct measure of immune activity that we can use clinically. In people with MS, there may be an increase in white blood cells and antibody formation in the spinal fluid. There may be ‘oligoclonal’ bands, which are a measure of immune activity found in MS but also in other immune disorders. Spinal fluid helps to diagnose other diseases such as Lyme disease and lymphomas of the nervous system. Not everyone needs a lumbar puncture, but it can be very useful.
Are There Different Types Of Mri Scans
There are a number of different images that can be taken during a single MRI session.
A common type of MRI for MS is a T2-weighted scan, which detects all areas of myelin damage in the brain and spinal cord. We can now use a technique called FLAIR to make it easier to spot the lesions.
Doctors will also use a contrast agent called gadolinium with a T1-weighted scan to focus on newer, active lesions. Gadolinium only highlights active damage because it cant enter the brain unless theres inflammation.
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Is Fatigue Part Of Ms
Fatigue, a sensation of being tired all the time, is very common in MS. Most patients with MS feel tired more than they used to, despite getting sleep at night. While fatigue in MS can be due to a lack of sleep or poor sleep, it is often just one of the symptoms of MS. It may be due to activation of the immune system, like fighting off an infection. It may be due to having to work harder to re-route information in the brain because of the MS. In any case, it can be treated. Taking naps helps with afternoon fatigue.
Regular exercise actually improves fatigue symptoms. Avoiding very heavy meals may help. Making sure that night-time sleep is good is also useful. There are medications that have been shown to be helpful in MS-related fatigue.
Did I Do Anything To Bring On The Ms Or Make It Worse
As far as we know there are no activities that specifically cause MS or make it worse. People with MS may not tolerate heat as well as they used to and may need to avoid particularly hot or humid situations. There is evidence that having infections makes having an exacerbation of MS more likely. There does not appear to be a link to trauma. However, emotional stress has been linked to a worsening of MS symptoms. Having MS is not the fault of people who have it it can happen to anyone.
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What Is The Prognosis Of Ms
The prognosis of people with MS has increased considerably over the past 25 years. According to the National MS Society, people with MS can expect to live approximately seven years fewer than people who do not suffer from MS. However, they typically pass away from complications of their disease rather than as a direct result of their disease. For example, they may die from cardiovascular disease. It is rare that someone has MS that progresses so rapidly that it is fatal.
That being said, the progression of MS is highly variable, meaning that it affects each person differently. One person may progress much more rapidly through their disease state compared to another person.
Other factors affect life expectancy to consider. Having a family history of MS, smoking cigarettes and lacking vitamin D exposure all can make MS progress more rapidly. People who have progressive forms of MS also tend to progress more quickly than those with relapsing-remitting MS, as do African Americans with MS.
So, what has improved the life expectancy over the past 20 to 25 years? Well, there have been two large factors that contribute to the improved life expectancy: better availability of treatments and people making lifestyle changes.
There are now more disease-modifying therapies on the market, meaning that people with MS have options when it comes to their treatment. If one medication does not work, there is more than likely another one that will.
What Is A Demyelinating Plaque
In MS, demyelination occurs in the white matter of the brain and in the spinal cord. Lesions or plaques then form where myelin is under attack by the immune system. Many of these plaques, or scar tissue, occur throughout the brain over the course of years.
What could cause demyelination?
Triggers. Demyelination is often caused by inflammation that attacks and destroys myelin. Inflammation can occur in response to an infection, or it can attack the body as part of an autoimmune process. Toxins or infections can also harm myelin or may interfere with its production.
Is demyelinating disease serious?
Drugs that fight inflammation can stop the damage to the nerves in your brain and spinal cord. A doctor also can prescribe other medicine to ease some ADEM symptoms. Most people recover fully within 6 months, though in very rare cases, ADEM can be deadly.
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How Do Lesions Correlate With Ms Symptoms
A lesion can interfere with the normal function of nerve cells, blocking or slowing normal electrical communication or nerve impulses in the brain and spinal cord. This can directly contribute to MS symptoms, with the specific effect depending on the location of the lesion.
However, not all lesions cause obvious symptoms. Sometimes patients can develop new lesions without associated disease manifestations these lesions are referred to as clinically silent. Conversely, patients may also have symptoms in the absence of a clearly detectable lesion in a corresponding part of the central nervous system.
Furthermore, it is not always possible to make a direct correlation between the location and number of lesions and the clinical signs and symptoms a patient experiences as part of disease progression.
Generally, according to the National MS Society, lesions in areas such as the spinal cord or optic nerve are likely to result in disease manifestations.
What Does Demyelinating Disease Of The Optic Nerve Mean
Optic neuritis inflammation of the optic nerve in one or both eyes. Neuromyelitis optica inflammation and demyelination of the central nervous system, especially of the optic nerve and spinal cord.
What are the different types of demyelination in the body?
There are different types of demyelination. These include inflammatory demyelination and viral demyelination. Inflammatory demyelination happens when the bodys immune system attacks myelin. Types of demyelination like MS, optic neuritis, and acute-disseminated encephalomyelitis are caused by inflammation in the brain and spinal cord.
Why do demyelinating disorders cause scar tissue to form?
It helps messages from your brain move quickly and smoothly through your body, the way electricity flows from a power source. Demyelinating disorders are any conditions that damage myelin. When this happens, scar tissue forms in its place.
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Extreme Pain And Numbness
I went to bed and was woken with extreme pain. It felt like someone with large hands had wrapped them around my body and was squeezing my ribs. This repeated itself for 5 nights, lasting for 4 hours easing off the last 2.
Woke up one morning. My left side was numb. Numb like when the dentist freezes you, but the freezing is almost out, but not. My entire face, tongue, neck, arm, hand, torso, leg, and foot. I waited for 5 days to see the doctor.
I was not wanting to be a burden on the doctor when it seemed like anytime I had any sort of symptoms, it came up as nothing.
