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Dr. Andrew Rynne

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Brain MRI showed no evidence of any intracranial space occupying lesion. What does this mean?

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Dr. Sudhir Kumar

Neurologist

Practicing since :1994

Answered : 5579 Questions

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Posted on Wed, 16 Jan 2013 in Brain and Spine
Question: Hello Doctor,

I am looking for someone to translate these MRI results for me.

FINDINGS:
Diffusion weighted images reveal no definite abnormality.
The ventricular system is of normal size and remains in the midline.

Mid bilateral cerebellar atrophy is noted. There is no evidence of any edema or mass effect visualized.

Following intravenous administration of contrast normal enhancement of of pituitary gland and choroid plexus is noted. At the present time, no evidence Midbrain, brainstem and medullary spinal juction reveal no definite abnormally.

IMPRESSION

There is no evidence of any intracranial space occupying lesion or abnormal enchanging lesion.

Mild Cerebellar Atrophy is visualized.
==========================================================

That's the report I just received.

The last part of "Mild Cerebellar Atrophy is visualized XXXXXXX worries me.

Can you shed me your point of view of the report.
Do I have anything to be worried about.

Can Mild Cerebellar Atrophy turn into Servere if I don't do anything about it?

Thanks, XXXXXXX
doctor
Answered by Dr. Sudhir Kumar 5 hours later
Hi,

Thank you for your query.

I have gone through your MRI report of the brain. I would first like to reassure you that these findings do not suggest any serious abnormality.

Cerebellum is concerned with co-ordination of movements of arms and legs, movements of eyes and speech.

The finding of mild cerebellar atrophy is suggestive of mild shrinkage of cerebellum. This is a radiologist impression, and in isolation, it has no significance. However, if someone has inco-ordination of arms and legs, slurred speech, etc; then it is significant.

So, if you have no symptoms, then there is no need to worry.

The most common reason for progressive cerebellar atrophy is a genetic disease called as spinocerebellar ataxia. However, in your case, it does not seem so, and therefore, there are little chances of progression in your case.

I hope it clarifies. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 12 hours later
Doctor,

I have noticed that I have been feeling occasional numbness,
tingling sensations, muscle spams, tremors and random night sweats.

I have the atrophy eventually mean I will have MS or Parkinson's Diease?
XXXXXXX
doctor
Answered by Dr. Sudhir Kumar 22 minutes later
Thank you for getting back with more details.

1. First of all, cerebellar atrophy is not suggestive of predictive of white matter lesions on MRI of brain and spinal cord. In PD, MRI of brain is often normal.

2. PD is still a clinical diagnosis, characterised by tremors of hands at rest, rigidity of hands and legs, postural imbalance and slowness of all activities. It starts after the age of 40, and progressively worsens over time.

3. neurological disease.

I hope it clarifies. I would be pleased to answer any follow-up queries.

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 6 days later
Hi Doctor,

Question. If it's not MS, Parkinson's or "Atypical Parkinson's".

I do experience the following that seems to be linked to the cerebellar part of the brain.

1. Random "trunk" tremors. No one can really see this, but I can feel it when I am sitting down or laying down.

2. Random Muscle Spams.

3. Random Tingling and Pins and Needles all over the body.

4. Constant headache that feels like a tension headache.
This most occurs in the center of the head or lower back sides of the head.

5. Random cold chills on top of feet.

This stuff all started to happen to me after I smoked a pot product called "Kush".
It's been close to 3 months since I smoked it.

If my MRI says mild cerebellar atrophy and I have these random symptoms.
Doesn't that mean I have something that is serious going on?

Why would I have mild cerebellar atrophy and these symptoms as well?
Also, I did cold XXXXXXX .5mg of Xanax about 2.5 weeks ago.
I was taking it for about 3.5 weeks.

I do notice the trunk shaking much more after the Xanax stopping.

That was such as low dose though.
Doctor, in my previous post. Its not my trunk that random tremors. Its the back of my head that tremors from time to time. Especially when I do my breathing meditations.


doctor
Answered by Dr. Sudhir Kumar 9 hours later
Thank you for getting back with more details. I appreciate the fact that you have been very descriptive about your symptoms.

I know you are anxious about the MRI brain findings and want to exclude any possibility of a serious neurological disease.

Most of your symptoms are random (not present all the time). However, if you have any symptom due to cerebellar atrophy, we would expect it to be constant (present at all times).This is because the atrophy is there all the time. Also, you mentioned that the tremors can not be seen by others, but in tremors due to cerebellar diseae, they are easily noticeable to others.

Similarly, in PD too, symptoms are present all the time.

So, I think your MRI findings are incidental and your symptoms are not due to MS, PD or cerebellar disease.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 11 hours later
Hi Doctor,

Thank you for your response.

I think my biggest concern is this.

Are you symptoms a "starter" of something like PD or cerebellar disease.
I do believe these are "progressive" diseases which means they get worse over time.

I am ruling out MS because they found no brain legions.

But my concern is that even though my symptoms are really noticeable or that they same random.

Could this just be the "start" of something serious.

Or do those diseases like PD or cerebellar disease work different in the very early stages.

I hope what I am asking makes sense.

Take Care, XXXXXXX
doctor
Answered by Dr. Sudhir Kumar 3 hours later
Hi,

Thank you for asking more questions, and yes, your concerns and questions do make a lot of sense.

I agree with your last part that PD and cerebellar disease do have different types of symptoms at onset and in early stages of illness.

For example, in PD, the patient would either have tremors or slowness. If they have tremors, they are present in one hand and are present all the time (except while asleep). Similarly, those who have slowness, they are slow in all activities of living, such as walking, dressing, taking bath, etc, and all the time, everyday.

In cerebellar disease, the commonest symptom is imbalance while walking (they walk as if drunk). This is present always (whenever they walk). In some people, it may begin with inco-ordination of hands (poor handwriting, etc). This symptom is also present all the time.

In both PD and cerebellar disease, with progression, the severity of symptoms increase, and the other side of body also gets affected (in PD).

Other people would notice the abnormality in both these diseases, even in the early stage.

I hope it clarifies.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 27 hours later
Hi Doctor XXXXXXX

Thank you so much for your help.
You have been great!!!!!!

Since I do have Mild Cerebellar Atrophy.
Doesn't that mean something caused this?

I do know the brain shrinks I believe from the age of 30 - 90.

But if that was the case, wouldn't they not single out the Cerebellar part of the brain in my MRI report?

If it was just due to the normal aging process. Wouldn't that mean other parts of the brain would be shrinking as well. Wouldn't they note the other parts of the brain is shrinking in the MRI report?

Thank you so much for your help.
Also, in response to my last question.

My balance and movement seems to be ok.
I actually practice standing on one leg for 50 seconds a day.
I am pretty descent at it.

My family doctor did notice a slight difference in my walk.

But he is the only one that noticed that.

Besides the random muscle spams, tingling, numbness, XXXXXXX termors (not noticeable to others), random tension headaches. I feel like my movement and getting around is ok.
Take Care Friend, XXXXXXX
doctor
Answered by Dr. Sudhir Kumar 4 hours later
Hi,

Thank you for getting back.

First of all, I wish to tell you that the cerebellar "atrophy" in your case is not due to ageing, as this is not age for atrophy to begin, and atrophy does not start only in cerebellum, leaving rest of the brain unaffected. At 33, we do not see atrophy in MRI brain.

The description of cerebellar atrophy is an incidental finding, and a part of normal variation in your case.

None of your symptoms can be attributable to the so called cerebellar atrophy in your case.

I hope this clarifies.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 14 hours later
Hi, can you explain more of what you mean by "incidental finding"?
XXXXXXX
doctor
Answered by Dr. Sudhir Kumar 33 minutes later
Hi,

Thank you for getting back.

Incidental finding is something found on the MRI which is supposedly "abnormal" but it is not of any clinical significance or consequence. For example, your MRI showed cerebellar "atrophy" but you do not have any symptoms of cerebellar atrophy.

So, incidental finding is something that is reported by the radiologist, but the clinician does not take any action based on that, as the patient has no symptoms because of that.

I hope it clarifies.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 26 hours later
Hi Doctor,

I was taking .5/mg of Xanax. once a day for about 3.5 weeks.
My last dose was about 3 weeks ago.

I have noticed, ever since then.
I have been experiencing constant tension headaches that go from mild pain to medium pain.

I also have been experiencing random Myotonic Jerks.
They aren't really noticable to anyone but me.

Also, a couple of days ago.
I went to the gym and did a light workout.

I did 3 sets of 135 bench press 10 reps a piece.

After I finished my bench press.

I noticed both of my hands "tremoring/shaking".
I couldn't even text message.

Well, about 10 minutes later.
The tremoring/shaking went away.

What do you think this could be?

Random Myotonic Jerks. It seems to occur mostly when sitting down or laying down.
Tremoring/shaking hands after bench press that goes away in about 10 minutes?

I would love to hear your thoughts?
XXXXXXX
doctor
Answered by Dr. Sudhir Kumar 4 days later
Hi,

Thank you for getting back.

Sorry for the delay in reply, as I was on vacation.

Both tremors and myoclonic jerks in your case represent minor neurological symptoms without any serious underlying disease.

Tremors for a short duration after work out may be normal. They do not represent any disease.

Myoclonic jerks are also common in normal people especially when falling asleep or getting up. They are random and occur only a few times and for a short while only.

They are not connected to the medications you have used.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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