HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

What Causes Dizziness And Double Vision?

default
Posted on Tue, 5 May 2015
Question: I have just had an MRI scan of my brain which shows a 'tiny linear 2mm hyperintensity in the left cerebellum which is non-specific but could potentially represent a small established ischaemic focus. The brain parenchyma is otherwise unremarkable. No focal structural abnormality is seen. Ventricles and extra axial CSF spaces are within normal limits. Arterial and venous flow voids are present as expected.

Intracranial MRA shows no significant vascular narrowing. The left P1 segment of the left posterior cerebral artery is hypoplastic. There is a small 2mm outpouching at the basilar tip, pointing to the left side which could potentially represent a small aneurysm.'

Can you explain????
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
No acute issues.

Detailed Answer:
I read your MRI report carefully and I understand it must look very worrying to you.

The first finding is a tiny change in the cerebellum, the small brain, on the left. It is an old change, a remnant of a past small damage and saying it's not specific means it is not possible to determine the origin, could have many causes such as small stroke, trauma, infection in the past, migraine.
If you have risk factors for stroke like high blood pressure, diabetes, smoking, high cholesterol preventive treatment with low dose aspirin may be considered.

It also shows on exam of blood vessels that the initial segment (P1) of one of your blood vessel, the left posterior cerebral artery is not well developed and narrowed. It'd a defect present since birth, a large percentage of people have such variations, it shouldn't worry you (you've lived with it just fine till now). The human brain circulation has many communications between it's vessels so the area this vessels supplies receives blood flow anyway because after the initial segment there is a communicating vessel which brings blood from the anterior arteries. I hope I am not confusing you, bottom line, it's an issue common in many people, you're born with it, shouldn't concern you.

The last finding is not given for certain, it is a suspicion of a small aneurysm, a dilation in the blood vessel wall, like a bulge. Now this as well is a born issue, 2-3 % of people have an aneurysm. Many live with it through their whole life without any issue. While the aneurysm itself doesn't cause any symptoms (unless a huge one, not your case), at times there is the risk of the aneurysm rupturing though, causing a hemorrhage which could be life threatening. So when an aneurysm is found surgery is taken into consideration to prevent a hemorrhage.
Now before you start to panic, that risk is related to the aneurysm size and in your case at 2mm it is very small, smaller than 7 mm risk is low and generally it is not intervened. So I wouldn't advise any surgery in your case, no treatment is needed. It is good that you are being consulted by a neurologist to confirm that though, at times we request another exam called angiography (inserting a catheter into the blood vessels and injecting contrast in the brain vessels and xray-ing the vessels) which is even more accurate then MRI in detecting aneurysm size and architecture.
It is not an urgent decision though, as I said it has been there since birth and has been found by coincidence, I don't think treatment necessary anyway, so it can wait for scheduled consult.

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Olsi Taka (53 minutes later)
Dear Dr Taka,
Many thanks for your swift and detailed response. It has really helped to set my mind at rest. However, I wonder if I could just ask a further question. My GP requested the scan because I have, in the last 2 or 3 months experienced blurred and double vision ( about 3 times) and have been quite dizzy and tired. I've also noticed a slight slurring of my speech on a few occasions and it sometimes feels like I struggle to express what I want to say clearly. I am not diabetic, I don't have high blood pressure, don't smoke, but there is a history of heart and stroke problems in my family. I also have a mild heart murmur which is monitored annually (I'm not on any medication for it) and is not of particular concern to my cardiologist at present. The only medication that I currently take is erythromycin daily as I don't have a spleen. Do you think that these recent symptoms could be linked to what's shown in the scan?
doctor
Answered by Dr. Olsi Taka (39 minutes later)
Brief Answer:
Read below

Detailed Answer:
Thank you for bringing some more info on your motives to have had the MRI.

I suppose your doctor has also had some routine blood tests to exclude anemia or other metabolic issues.

Assuming they were done and came back normal there is a chance (in the lack of another explanation - if I were to judge only by MRI I'd doubt it) dizziness and double vision could be related to transitory low perfusion in areas supplied by that posterior cerebral artery.
In that case the only treatment would be to stay hydrated not to let your blood pressure drop too low and aspirin.
An ultrasound of neck vessels is also recommended to check for possible narrowing of neck blood vessels leading to reduced blood flow in the brain (though not that likely at your age and without risk factors).

I hope to have been of help.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3673 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
What Causes Dizziness And Double Vision?

Brief Answer: No acute issues. Detailed Answer: I read your MRI report carefully and I understand it must look very worrying to you. The first finding is a tiny change in the cerebellum, the small brain, on the left. It is an old change, a remnant of a past small damage and saying it's not specific means it is not possible to determine the origin, could have many causes such as small stroke, trauma, infection in the past, migraine. If you have risk factors for stroke like high blood pressure, diabetes, smoking, high cholesterol preventive treatment with low dose aspirin may be considered. It also shows on exam of blood vessels that the initial segment (P1) of one of your blood vessel, the left posterior cerebral artery is not well developed and narrowed. It'd a defect present since birth, a large percentage of people have such variations, it shouldn't worry you (you've lived with it just fine till now). The human brain circulation has many communications between it's vessels so the area this vessels supplies receives blood flow anyway because after the initial segment there is a communicating vessel which brings blood from the anterior arteries. I hope I am not confusing you, bottom line, it's an issue common in many people, you're born with it, shouldn't concern you. The last finding is not given for certain, it is a suspicion of a small aneurysm, a dilation in the blood vessel wall, like a bulge. Now this as well is a born issue, 2-3 % of people have an aneurysm. Many live with it through their whole life without any issue. While the aneurysm itself doesn't cause any symptoms (unless a huge one, not your case), at times there is the risk of the aneurysm rupturing though, causing a hemorrhage which could be life threatening. So when an aneurysm is found surgery is taken into consideration to prevent a hemorrhage. Now before you start to panic, that risk is related to the aneurysm size and in your case at 2mm it is very small, smaller than 7 mm risk is low and generally it is not intervened. So I wouldn't advise any surgery in your case, no treatment is needed. It is good that you are being consulted by a neurologist to confirm that though, at times we request another exam called angiography (inserting a catheter into the blood vessels and injecting contrast in the brain vessels and xray-ing the vessels) which is even more accurate then MRI in detecting aneurysm size and architecture. It is not an urgent decision though, as I said it has been there since birth and has been found by coincidence, I don't think treatment necessary anyway, so it can wait for scheduled consult. I remain at your disposal for further questions.