Question: FLAIR Signal on MRI

[keane]

I'm in the process of getting all of my records together for an umcoming referral to the Mayo clinic. On my last Nerologist visit, he indicated that he was basically stumped and only time will tell. He really thought I should go to the Mayo for 2nd opinion. He briefly discussed my MRI, but stated that it was not significant. My wife and I got the impression that he was uncomfortable with his lack of diagnosis and wanted us to go elsewhere.
In reviewing my MRI report, there was a mention of two foci of increased FLAIR signal, likely secondary to inflammation or demylination. Frankly, I'm annoyed that this was not mentioned. 5 years ago I had an MRI that was completely normal (related to hypertension).

My wife also asked me to note in the 1st visit that I've recently developed an embarrasing laugh that pops up even when I only feel mild humor. It usually pops up in the most embarrasing situations. Also, I can't seem to eat a meal without powerful hiccups, which is totally new to me. The doctor said nothing, but his report said these were significant. EMG was also mildly abnormal. The complaint that initially took me to the neuro was left hand weakness. Reflexes were hyper in one arm and leg, but absent in the left ankle, which is severely atrophied due to a partial joint fusion years ago from a football injury.

Does anyone know if FLAIR signals are common?

 

[ptich]

As far as I understand, FLAIR is an MRI technique to discover those brain lesions that happen to be located close to the liquid surrounding the brain, with higher sensitivity than a normal MRI.

So the question should be - what a couple of brain lesions mean ? Apparently, it is very non-specific. As far as I understand, a high number of leasions would make MS diagnosed more likely. It is possible that lesions in, or close to, the motor complex make ALS diagnosed more likely - for example, "brainhell" in his blog described that he was found to have a few lesions in the motor complex and in the speech area, which correlated with his early ALS symptoms.

So, overall, it seems, a couple of increased FLAIR signals, taken alone, do not mean much.

But I really did not understand this one: "He really thought I should go to the Mayo for 2nd opinion". Did you get the 1st ?

 

[keane]

At the time I was referred to the Mayo clinic, my only clinical weakness was in the left arm. It was hard for him to make an opinion on atrophy when my bicep was 18 1/2 inches on my weak arm 6 months ago, and the forearm was 16 inches. Now, both have shrunck over an inch and a half, so they are still larger than normal. Basically, we were told that if my clinical symptoms move to additional limbs over the course of a year, with documented atrophy, it is ALS. If not, he feels that he has ruled out everything else.

He ordered twice weekly physical therapy to measure strengh in all extremeties, because he felt that this is the only way to document because even in my weakened state, I could still lift him off the floor with my good arm (on scales, I remember pinching over 200 lbs with each hand just a few years ago).

In the last month, my grip strenght on the original weakened hand has dropped to 22 lbs, and over the course of four weeks, the right dropped dramatically down to 50. The therapist is dumbfounded. (on scales, I remember pinching over 200 lbs with each hand just a few years ago in a contest with work friends).