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Is the attached report indicative of the causes of dysphagia?

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Posted on Wed, 11 Jul 2018
Question: I've been under investigation for dysphagia, lasting approximately one year. I had an MRI done, which noted a 3mm lesion in the pons. Another MRI was ordered, with contrast, and I got the results from my general practitioner. I haven't heard from my neurologist yet. This one says: "There are a few scattered nonspecific foci of increased T2 FLAIR signal within the supratentorial periventricular white matter. These may reflect mild chronic microangiopathic ischemic white matter changes. The previously documented 4mm focus of increased T2 FLAIR signal within the left side of the pons is not dramatically changed. On post gadolinium imaging, there is no enhancement in this region. In fact there is no abnormal intra or extra axial enhancement. Impressions: There are a few nonspecific foci of increased T2 FLAIR signal within the supratentorial periventricular white matter, and solitary focus within the pons. While the findings could reflect mild chronic microangiopathic ischemic white matter changes, other causes for demyelination are not reliably distinguished on imaging." The report recommends Clinical follow up and repeat MRI in six months. Could you please help me understand these findings, and tell me if they are at all likely to have anything to do with my dysphagia. Thank you.
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Answered by Dr. Neeraj Kumar (58 minutes later)
Brief Answer:
Get examined and evaluated by a neurologist

Detailed Answer:
Hello,
I have gone through your question and understand your concern.
The mri changes are due to small blood vessels block due to aging or other risk factirs like hypertension or diabetes.
The lesion in pons region is atypical but non uptake of contrast rules out any malignancy at present.
Follow up imaging is required to monitor the pons lesion.
There ia less likely chance of dysphagia due to this pons lesion.
Other possibilities may be achalsia or bulbar onset motor neuron disease.
Examination by a neurologist will be helpful.
EMG may Be required too.
Is there any wasting if tongue musculature?
Any muscle rippling or twitching movements?
Any muscle wasting in limb?
Any speech changes?
Hope you found the answer helpful.
Do get back to me for further information.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Neeraj Kumar (15 hours later)
Nothing unusual with the tongue. No muscular weakness.
Yes, some muscle twitching and vocal changes (vocal fry, loss of range in singing voice.)

Esophageal Manometry was done - I have not seen the report, but the technician said she saw strong evidence of the XXXXXXX failing to relax. Achalasia?
doctor
Answered by Dr. Neeraj Kumar (23 hours later)
Brief Answer:
please visit and consult a gastro medicine doctor

Detailed Answer:
Hello,

If investigations are suggesting achalasia, then you should consult a gastroenterologist doctor for further management.

Regards
Dr. N Kumar


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Neeraj Kumar

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Practicing since :2006

Answered : 2263 Questions

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Is the attached report indicative of the causes of dysphagia?

Brief Answer: Get examined and evaluated by a neurologist Detailed Answer: Hello, I have gone through your question and understand your concern. The mri changes are due to small blood vessels block due to aging or other risk factirs like hypertension or diabetes. The lesion in pons region is atypical but non uptake of contrast rules out any malignancy at present. Follow up imaging is required to monitor the pons lesion. There ia less likely chance of dysphagia due to this pons lesion. Other possibilities may be achalsia or bulbar onset motor neuron disease. Examination by a neurologist will be helpful. EMG may Be required too. Is there any wasting if tongue musculature? Any muscle rippling or twitching movements? Any muscle wasting in limb? Any speech changes? Hope you found the answer helpful. Do get back to me for further information. Regards Dr N Kumar Neurologist