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MRI showing encephalomalacia, artery occlusion. Have dizziness. Need treatment?

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Practicing since : 1974
Answered : 125 Questions
my neurologist report from an MRI stated encephalomalachic changes suspect ischemic disease? he also noted cerebral artery occlusion . I have just read this as I was applying for insurance. I had an epidermoid brain cyst removed 19 years ago. I have dizziness at times and have been on phenobard for the past 12 years as an AE.
What does this mean? Why would he think this? What are the dangers?
Posted Sun, 3 Jun 2012 in Brain and Spine
Answered by Dr. Pratap Sanchetee 5 hours later
Dear Friend

I have gone through your details and has following comments to offer:

1. I presume that you have no symptoms others than dizziness. Stenosis of cerebral artery, and encephalomalacia in that territory of brain in your case is asymptomatic. You need to be screened for atherosclerotic risk factor e.g. obesity, smoking, hypertension, diabetes, lipid problems and cardiac assessment. We must treat if one or more of them are present.

2. Removal of epidermoid cyst 19 years ago. I want to confirm weather it was inside brain or outside the skull (brain is present within bony skull). I also want to know if the cyst was on the same side of the encephalomalacia noted on the present MRI finding.

3. Continuation of phenobarbitone for 12 years need to be reviewed. The treating doctor may also look if this can be discontinued if felt unnecessary.

4. I will welcome details about your age, gender, present symptoms, past illnesses, report of clinical examination and investigation reports.


Pratap MD, DM
Above answer was peer-reviewed by
Follow-up: MRI showing encephalomalacia, artery occlusion. Have dizziness. Need treatment? 15 hours later
Thank you-- This is what is written on the report from the radiologist of my last MRI:
"There is suspected encephalomalacia change seen anterior to the left temporal lobe with associated fluid collection measuring 2.0 x 3.6 cm. There is associated suspected encephalomalacia surrounding this fluid area and this most likely is post-operative site, which could be confirmed clinically. There are however post-operative changes of craniotomy seen of the left temporal bone higher than this.
Scattered foci of abnormal high signal are seen predominantly in the left periventricular white matter and subcortal white matter. This does suggest small vessel ischemic disease. encephalomalacia in these regions would not be excluded. This is not eluded to in written report at time of previous study.
No other parenchymal abnormalities are noted."
I did smoke but quit 16 years ago. I am over weight by 25 pounds. My lipid level and triglyceride levels were high in my last CBC. My cholesterol was a bit high but nothing crazy.
The epidermoid was inside the brain. Part of my temporal lobe was removed as wa a bit of the hippocampus. The cyst was also near my occipital lobes and sylvian fissure.
it was a 10 hour micro surgery on my left side where all these issues are. I do have a dent in my temple and there has been partial inflamation since the surgery which has never gone away.
I was 28 at the time of surgery and am now 46. female. I battle anxieties, moodiness, dizziness. The neuros have questioned whether or not the anxiety attacks are partial seizures or not. I went on Phenobarb when I became pregnant 12 years ago as I was on depakote at the time. I do not think that it really does anything but have been told it is difficult to stop. I take 97 mg per night. I have no other illnesses other than my head. Thanks for your help so much.
Answered by Dr. Pratap Sanchetee 7 hours later

Thanks for writing back.

The situation is clearer now and here are some additional comments;

1. Encephalomalacia is related to possible effects of surgery done earlier

2. It is good that you have quit smoking. Lipid abnormalities needs to be treated with diet, exercises, weigh reduction and if needed, drugs. Avoid oil, saturated fat and excessive sugar. Have a balanced and nutritious diet. Exercise daily for atleast 30-40 minutes.

3. Consult your neurologist for consideration of tapering of phenobarbitone. Try to overcome anxiety symptoms with the help of friends or family, else consult a psychiatrist.


Dr. Pratap
Above answer was peer-reviewed by
Follow-up: MRI showing encephalomalacia, artery occlusion. Have dizziness. Need treatment? 15 hours later
My initial question was what does "suspect ischemic disease? and cerebral artery occlusion mean"??-- I get the anxiety and normal swelling post op.
Answered by Dr. Pratap Sanchetee 59 minutes later


I apologize if my initial answers were not clear. Let me try today to clarify your doubts.

Encephalomalacia in simple terms is localised softening of the brain. It occurs due to few conditions, commonly due to lack of blood supply or bleeding in that part of brain. Now to answer your query:

Cerebral artery occlusion means blockage of one or more blood vessels or its branches by any disease process. The commonest disease process is "atherosclerosis". Based on the severity of occlusion it can lead to partial or complete loss of blood supply to the portion of brain which had been receiving blood from the affected blood vessels. The lack of enough blood supply results in ischemic changes described medically as ischemic disease.

As your radiologist found occluded cerebral blood vessels, they believe the encephalomalachic changes are related to ischemic disease process.

However, as you've had surgery in that part of brain, it is likely that encephalomalachic changes may be related to surgery itself. You discuss about it with your neurologist.

Hope it is doubts are clarified. Let me know if you have any more queries.

Above answer was peer-reviewed by
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