Natalie, the Black Holes are seen in the T1-weighted images. They are the accumulation of areas of direct axonal (nerve fiber) degeneration. These correlate very well with both the accumulation of disability and with brain atrophy. Interesting enough, they are not so much the product of the inflammatory demyelinating and remyelinating lesions. So the Black Holes are NOT just the progression of the T2 lesions that the neuros talk about.

Quix

Thanks Quix. So if the black holes are not the progression of T2 lesions (which would show change over time) is this a separate process? How can I be told I have a bunch of black holes with my diagnosis 9 months ago but I have absolutely no disability at all and just the one incident of mild optic neuritis (where I still had 20/20 vision)?? Or is this just another example of how the MRI doesn't necessarily correlate with what is going clinically?

Natalie, this is exactly where the MRI doesn't necessarily correlate. The best way I can answer this is an excerpt from my blurb on "Lesions vs. Symptoms"



"First, lets talk about the BRAIN. Remember that about 90% or so of our brains are "unused." That means that we don't know what those areas do when they are healthy or might do if they are damaged. ALL of the scientific articles are clear that the majority of MS lesions in the brain are not "eloquent", that is, they don't "speak up" with actions or sensations in the body. The same is true that those areas don't show symptoms if they are damaged. No good MS Specialist is going to try to map all the lesions with the symptoms that are showing up in the patient. It is almost impossible and it is a waste of time. It is well documented that some people with many, severe symptoms may have very few visible lesions. And some people who are diagnosed when they have just one symptom may have a whole brain full of lesions on their first MRI which had never before "spoken up."

This is the best way I have to explain your situation.

Quix