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Dr. Andrew Rynne

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Got seizure attack. MRI showed encephalomalacia. What are the complication?

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Dr. Michelle Gibson James

General & Family Physician

Practicing since :2001

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Posted on Thu, 7 Feb 2013 in Brain and Spine
Question: Hi, My Husband fell at work and had a SEIZURE
and was taken BY ambulance TO hosp Ital AND ON THE WAY HAD A ANOTHER SEIZURE. A MRI was done and it showed sighns of ENcephalomalacia with Scattered Foci reported.Some chronic ischemic changes. #3 days in Hospital and 20,000 dollars latter-We have no health Insurance! He was release with no restrictions and given a followup appointment to Neurology who would not see him because he could not pay. DMV has suspended his license because of seizure. We are on unemployment. Should we be concerned with this and what are the causes of this condition and its symptoms and treatment.My Husband did Have kidney Cancer 5 YEARS AGO-REMOVED kidney(STAGE 2 bOSNIAC Cyst-Has been in remission since. They put him on Kepra-for seizures-Will he always have to take this? He is a Union Painter for 30 years and is 52 years old. How can he work if his job is going from one job site to another with no Car. His job involves being up on Latters and lifts in high places Painting-Is he likely to have more seizures. I am concerned he may fall. What is his most likely short and long term Prognosis. Thank You-
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Answered by Dr. Michelle Gibson James 54 minutes later
Hi, thanks for using healthcare magic

Encephalomalacia means softening of the brain tissue following infarction. Infarction is death of an area of the body because the blood supply to that are has been significantly reduced.
The chronic ischemic changes mean that they suspect that there are areas that have been deprived of adequate amount of blood for a long time. Ishemia means reduced blood supply.
Scattered foci indicates that it involved multiple areas of the brain.
Ischemia would occur in conditions such as hypertension, diabetes, smoking or high cholesterol , all of these can affect blood vessels and therefore reduce supply.
Controlling any of these risk factors would be important to reduce the chances of other ischemic areas developing.

Because of the persistence of the areas in the brain (once there, they are not going to disappear, the key would reducing the chances of new lesions)- he would be at persistent risk for seizures so it would be best if he continues to take the medication.
In general it is thought that anti seizure medication is needed after 2 seizures because the risk of recurrence is high after 2 or more seizures. Your husband had 2 seizure so there is greater risk of recurrence.
Long terms prognosis is affected by control of any risk factors that are present (high pressure, blood sugar, cholesterol, smoking) and also by any changes that occur in the lesions that are already present.
It would be best to see a neurologist for assessment but you stated that this would be difficult.

If he has no or few repeat seizures then he may be able to continue to work.

hope this helps, feel free to ask any other questions

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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