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MRI revealed tiny gliotic foci in both the fronto-parietal subcortical white matter. Meaning? And treatment?

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Hi! an MRI of Brain of my mother in law reveals few tiny gliotic foci in both the fronto-parietal subcortical white matter. What does it mean and how it can be treated? She was having severe vertigo during the last month and also previously, when she was asked with the MRI. Can anyone help with an answer?
Posted Tue, 22 May 2012 in Brain and Spine
 
 
Answered by Dr. Shiva Kumar R 3 hours later
Hello

Thanks for the query

From the details provided to me it looks to me like she is suffering from vertigo probably due to ear problems which is very common in this age group or could be due to high blood pressure.

Incidentally MRI probably done for vertigo shows few areas of gliosis in the white matter of the fronto-parietal areas.

To me the MRI changes look like areas of scars (gliosis) due to occlusion of the small vessels of the brain. Such changes are commonly seen in people suffering from high blood pressure and is termed as Leukoaraiosis.

Leukoaraiosis can also be seen normally in the elderly and in people suffering from cognitive problems like dementia. Rarely malignant malaria can cause these changes due to occlusion of the small blood vessels of the brain by the malaria parasites.

So I personally feel vertigo could be a manifestation of high blood pressure or inner ear problems. Leukoaraiosis is a well known MRI finding in elderly and people suffering from vascular risk factors. Strict control of blood pressure along with medications like antiplatelets (aspirin & clopidogrel) and statins (cholesterol lowering agents) to some extent prevent the progression of occlusion of small vessels of the brain.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
Follow-up: MRI revealed tiny gliotic foci in both the fronto-parietal subcortical white matter. Meaning? And treatment? 48 minutes later
In the primary stage 5 years ago when she first felt vertigo she was given Vertin 8 type of medicines besides she was already having Primodil-AT for her High BP Problems. She also underwent Cervical X-Ray AP/LAT and the finding revealed "a very common nature Spodiolysis" as the doctor commented. She was the referred to an ENT where she had hearing and incidental tests that too was at normal level. Thereafter everything was fine with continued dose of Primodil-AT, when during last month she had severe vertigo of greater intensity for a stretch of 3-4 days and during that time whenever she tried to turn her head right in sleeping posture she felt vertigo and the feeling was as if she was drowning/going down and down and then she was given Stemitil & Vertin16 thrice a day for 7 days when it subsided. It was a very hard time with rise of BP. Can you help me doctor with possible route of action besides the kind advise you have already given.
 
 
Answered by Dr. Shiva Kumar R 11 hours later
Hello

Thanks for the follow up query

From the information given to me about her vertigo I strongly feel she is suffering from Benign paroxysmal positional vertigo (BPPV) which is due to problems in the inner ear.

BPPV can be diagnosed only by a simple bedside test known as Dix-Hallpike maneuver. If positive, most effective treatment is a bedside procedure called "Epley's maneuver," which can move the small piece of bone-like calcium that is floating inside your inner ear.

So I request you to see a Neurologist or a Vertigo specialist to confirm BPPV. You need to stop both vertin and stemetil at least for 3-5 days before undergoing the diagnostic test. You need to take her to the cardiologist for good control of hypertension to avoid further brain damage due to high BP.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
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