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Accidentally slipped and struck head in the sink. Done with CT scan of head. What are the findings from the report?

DOCTOR OF THE MONTH - Apr 2014
Apr 2014
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My husband who is 56 years old had a non-contrast CT scan of the head last week. He accidently slipped in the bathroom struck his head on the sink and passed out momentarily and was therefore advised a scan to rule out an XXXXXXX injury.
The CT scan did not show any XXXXXXX injury. However, the following findings appearing in the report are of concern to me and I would like to know whether further investigation is required, what treatment to follow and whether the anomalies reported can worsen with the passage of time.
i. Minimal cerebellar atrophy on the superior aspect reported in the scan. Are there future negative (serious or otherwise) consequences of this? Will this worsen with the passage of time?
ii. There is age related prominent sulcal spaces in bilateral cerebral hemispheres. There is a prominence of cerebellar folia on the superior aspect. Are these two findings significant.
iii. PNS- there is a subtle deflection of the nasal septum to the right. No mucosal thickening is seen in the para nasal sinuses.

My husband suffers from chronic lower back ache, chronic cervical spondylitis and takes the following medicines. He also drinks somewhat heavily 1-2 times a week and has been doing so for the last 15 years.
a. Amlodipine 5 mg for mild hypertension (last 7 years).
b. Lorazepam 2 mg every night (last 10 years).
c. Doxophylinne 400 mg every morning for mild asthma.
iv. Omeprazole 20 mg once a day (since 1996 for chronic gastritis).
d. NSAID – Nimuleside once or twice a week on SOS basis for his neck and back ache (last 8-10 years). No other NSAID suits him in view of his gastritis and asthma.
Would you need to review the reports or images as well.
Posted Mon, 28 Oct 2013 in X-ray, Lab tests and Scans
 
 
Answered by Dr. Indu Kumar 53 minutes later
Brief Answer:
CT scan report shows age related changes.

Detailed Answer:
Hello
Thanks for writing to XXXXXXX

According to CT scan report
1. Minimal cerebellar atrophy on the superior aspect reported in the scan

There is minimal cerebellar atrophy on superior aspect and this finding is acceptable according to age. This finding will not cause any problem if it does not progress any further.

2. There is age related prominent sulcal spaces in bilateral cerebral hemispheres. There is a prominence of cerebellar folia on the superior aspect.

This finding is due to shrinking of brain tissue with age. Due to shrinkage, sulcal spaces become prominent. Cerebellar foliae also become prominent due to shrinkage. These findings are acceptable according to age.

3. PNS- there is a subtle deflection of the nasal septum to the right. No mucosal thickening is seen in the para nasal sinuses.

There is deviated nasal septum towards right side. It is very commonly found in population and in most of the cases it doesn't cause any problem.

Chronic back ache and cervical spondylosis are also due to age related changes. Best treatment is physiotherapy. There are many other treatment options available but they have their advantages and disadvantages.

The medications mentioned in your query should be continued under supervision of your doctor. He should take anti hypertensive medicines regularly as hypertension has many systemic effects.

Your husband should also quit drinking completely. Consuming alcohol hastens the progression of brain atrophy. Though he is an occasional drinker, by proper counseling and strong determination, he can quit drinking completely.

There is no need to review reports and images as your query is clear and CT scan findings are comprehendible as stated by you. However, if you still wish to show me the images/ report, please feel free to upload the same.

If his condition worsens, then MRI scan brain can be done after consultation with neurosurgeon, if felt necessary.

Hope I have answered your query.
Get well soon.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Accidentally slipped and struck head in the sink. Done with CT scan of head. What are the findings from the report? 2 days later
Hello Doctor,
Thank you for your advice. You have mentioned that the minimal cerebellar atrophy on superior aspect is acceptable according to age and will not cause a problem if it does not progress any further.

I would like to know what the possibility of further progression of atrophy is and what will cause it. Is it normal to expect further atrophy and if your answer is yes that what can be done to arrest or slow down the progression of atrophy.

You have said that if his condition worsens then MRI brain scan can be done. But his condition is completely normal. So it is not quite clear as to what inference I should draw this from this advice. I am uploading a scanned copy of the NCCT and would be grateful if you could take a look at the various images and give me your learned opinion.

I would also like to know how long would it take for the ill effect of the heavy dose of radiation from the scan to wear off. Are there any precautions to be taken and for what length of time. You will be glad to know to know that my husband has stopped drinking since the fall on the 25 Sept. and I am confident that he will give it up completely as he is determined to do so.

Thank you
 
 
Answered by Dr. Indu Kumar 33 minutes later
Brief Answer:
If stop alcohol then it will follow natural course

Detailed Answer:
Hello
Thanks for your query

Your husband has minimal cerebellar atrophy and this is expected finding considering his age. Like other organs, it is expected that atrophy will become more prominent with age advancement. Various diseases and alcohol hasten the process of atrophy. Only condition relevant to your husband is alcohol history, if he quit it completely then it is expected that atrophy process will not be hastened and follow its natural course.

Sorry, I couldn't find the uploaded images/ scanned report. Please upload it again. Any way, if he is fine, then MRI can be skipped. I was just sighted a condition.

Don't worry about radiation exposure .Total dose delivered during CT Scan of brain is much less than the safety limit.So,No need to take any extra precautions.

Hope I have answered your query.
Get well soon.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Accidentally slipped and struck head in the sink. Done with CT scan of head. What are the findings from the report? 17 hours later
Hello Doctor,
Somehow I missed uploading the scanned images after attaching them and I am sending them to you now for your professional opinion and any further advice, if any.

Thank you for your time and reassuring advice.
 
 
Answered by Dr. Indu Kumar 1 hour later
Brief Answer:
There is minimal cerebellar and cerebral atrophy.

Detailed Answer:
Hello
Thanks for your query

Findings are same as described by you earlier. You shouldn't worry at all.
There is only minimal atrophy on superior aspect of cerebellar hemispheres.It can be considered as normal finding considering his age. This wouldn't cause any problem to him.
Also,There is mild atrophy of cerebral hemispheres and it is also normal.

Hope I have answered your query.
Get well soon.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Accidentally slipped and struck head in the sink. Done with CT scan of head. What are the findings from the report? 27 hours later
Hello Doctor,

Before closing the discussion I have the following questions.

i. After reviewing the scan you have indicated that there is mild atrophy of the cerebral hemispheres. This was not reported under IMPRESSION by the Radiologist who examined the CT Scan. But under general observations the radiologist did say that there was age related prominent sulcal spaces in bilateral cerebral hemispheres which probably suggest atrophy (scanned copy of report uploaded). I would like to know if the atrophy is widespread/generalised or only isolated and concentrated only in a particular region and therefore of much less concern. If it is isolated, then in which region?

ii. Would you recommend that as a follow-up an MRI scan be done at a later date say after one or two years – or is this not necessary is he remains asymptomatic.

iii. Is there any need to consult a neurologist? Though the contusion/bruise on the back of my husband’s skull was very bad it has almost healed completely now, there is hardly any pain left, he has regained his vitality and resumed his regular daily 10 hour work schedule a week ago.

I am very grateful to you for all you advice. Thank you very much once again.
 
 
Answered by Dr. Indu Kumar 29 minutes later
Brief Answer:
Atrophy is generalised.No need of MRI.

Detailed Answer:
Hello
Thanks for your query

1. Age related prominent sulcal spaces in bilateral cerebral hemispheres implies mild cerebral cortical atrophy.Sulcal spaces becomes prominent due to atrophy. It is such a normal phenomenon that it is needless to mention in last impression, though it was mentioned in detailed description.
Mild atrophy is generalized and you shouldn't be worried about this.

2.There is no need of follow up MRI(Brain) if he is asymptomatic.

3.I think it is not necessary to consult neurologist at present if he is alright.
Neurologist will also give same information that you have received.
If any problem, then you should certainly seek neurologist opinion.

Hope I have answered your query.
Get well soon.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX
Above answer was peer-reviewed by
 
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