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Diagnosed with transient memory loss. EEG normal. Should I go for second opinion? Worried about small vessel ischemic disease?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Hello. I am a 47 year old women, normal weight, blood pressure, do not smoke, and generally healthy. On May 6th, I woke up in my bedroom at my home and did not recognize where I was and I had trouble speaking and following conversation. I could not recall the days before or specifics from the past week and could only recall some images. I also could not recall other major events from the past year. I went to the ER and had an MRI completed Below are the MRI results:

FINDINGS: There is no evidence of acute intracranial hemorrhage, infarction, mass effect or midline shift. No abnormal extra cranial fluid collection is identified. The ventricles, sulci and basilar cisterns are normal. There are a few tiny scattered areas of subcortical and periventricular white matter T2 hyperintensity, particularly in the parietal lobes, consistent with chronic small vessel ischemic disease. The flow voids of the skull base are unremarkable. The visualized paranasal sinuses, mastoid air cells and orbits are normal. The skull base and calvarium are intact. IMPRESSION: 1. No acute intracranial pathology.
2. A few scatted white matter lesions in both parietal lobes most consistent with chronic small vessel ischemic disease. Vasculitis and demyelinating disease could have a similar appearance, and these are clinical possibilities.

The ER doctor diagnosed me with transient memory loss and referred to a neurologist. Neurologist order an EEG for fragmented memory loss and partial seizure vs psychogenic phenomna. The Neurologist reported that the EEG was normal.

The neurologist said that I am physically fine and did not have a seizure or brain stroke. and the symptoms that from from mood disease and significant life stressors.

Since going to the ER, I have been able to recall some of my memory which required a lot of focus and tired me. I am also having trouble focusing and following and do not feel that my cognitive abilities are normal. For example, I am not able to multi-task anymore. I have also experienced additional memory loss since the initial incident.


MY QUESTION: SHOULD I SEEK A SECOND OPINION? I AM CONCERNED THAT THE NEUROLOGIST DID NOT ADDRESS THE MRI REPORT CONCERNING THE FINDINGS RELATED TO SMALL VESSEL ISCHEMIC DISEASE. HE DISMISSED MY CONCERNS ON THIS TOPIC AND SAID EVERYONE HAS IT. I KNOW THAT I AM NOT 100% AND HAVE A HARD TIME BELIEVING THAT MY DEPRESSION AND LIFE STRESS IS THE REASON FOR ON-GOING ISSUES. PLEASE COMMENT ON WHAT THE NEUROLOGIST IS SAYING AND WHAT YOU RECOMMEND FOR ME TO DO?
Posted Wed, 19 Jun 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 4 hours later
Hi Ms XXXXXXX

Thank you for posting your query.

I have gone through all the attachments and our earlier discussion too.

I agree with you that your symptoms are not due to stress/depression, and are primarily related to ischemia of brain (due to lack of blood flow to brain). This is because your symptoms started all of a sudden, which is what happens in cases of brain stroke.

As of now, I would recommend that you continue medications such as aspirin and statins (rosuvaststin or atorvastatin) to prevent the chances of recurrence of stroke in future. In addition, please seek a second opinion from another neurologist.

Recovery may be slow in some cases, and may take a few months. So, there is no need to worry on that front.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
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