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What Do The Following MRI Results Indicate?

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Posted on Thu, 11 Aug 2016
Question: 57 year old female. Brain MRI in 2006 after concussion was clear. MRI January 2016 for headaches. Migraine suffered for 40 years, but mature of headaches changed. MRI found 1 lesion. Impression: no evidence for active intracranial disease. Mild symmetrical frontal and parietal lobe volume loss. Small 9mm lesion in superior aspect of R cerebellar hemisphere. Diagnostic considerations are (1) small chronic infarct, (2) dilated sulcus, (3) small arachnoid cyst. Recommend repeat study in 6 months. in March i suffered a 2 week period of strange neurological symptoms, including complete brain fog, electrical shocks in left shoulder, dizzy spells, and, most concerning, 2 instances of my left leg collapsing underneath me with no warning symptoms or pain. Since that 2 week period i have experienced some form of odd neurological sensation almost every day, such as numb patches in my left calf, intense itching, needle stick sensations on my chest, lots of balance issues and occasional issues with reading comprehension. Repeat MRI in XXXXXXX 2016 impression: No significant intracranial findings. Minimal white matter disease on FLAIR images (1 or 2 tiny punctate foci), within the range of that often seen incidentally at this age. Please note that this follow up exam made NO MENTION OF PREVIOUS LESION, which does still appear on the MRI images. My family doctor says he doesn't think it's MS. Do you think it is worth a referral to an MS specialist or am i becoming one of those crazy women?
doctor
Answered by Dr. Neeraj Kumar (16 minutes later)
Brief Answer:
Upload images of Mri

Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
Multiple sclerosis is more common at an young to adult age and at this age it's possibility is less likely.
The location is also not specific for multiple sclerosis.
Other possibilities may be arachnoid cyst or infarct.
The imaging changes in infarct after some times.
You have other risk factors too which can lead to small vessel atherosclerotic changes in some region of brain.
Dizziness spell and balance issue may be related to the lesion location.
You can upload images or compiled pdf images of both Mri.
Continue rest treatment.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Neeraj Kumar (16 minutes later)
Ok, i get what you are saying but i have more questions. i have cysts all over my body. the fact that i may have one in my brain is not terribly concerning to me, if that is what it is. but with every other MRI i have had of other body parts, they were absolutely able to identify a lesion as a cyst. they didn't say might be this, might be that. why would they NOT be able to tell if this brain lesion is a cyst? and they only give 2 dimnesions on it (9mm x 5 mm). if it was a cyst, wouldn't there be a third dimension? Cysts aren't flat, are they?

Also, if the follow up study is done to monitor the original lesion, why would they NOT describe the status of that lesion? It is still there. I am concerned that the radiologist isn't doing his job.

2 new lesions in 5 months when there were none before, but my health status has been unchanged, except for the ongoing neurological symptoms. if this is normal, am i to expect my brain to just continue to deterioriate and just sit be and let it happen?

Finally, if all this is is normal aging BUT i am having balance deficits and dizziness because of the one lesion, shouldn't someone be talking to me about how to deal with that? my neurologist seems unconcerned, but he is NOT the one who is falling down!
doctor
Answered by Dr. Neeraj Kumar (11 hours later)
Brief Answer:
Take treatment and steps as advised

Detailed Answer:
Hello,
The cyst in brain are of many types and are different from body cyst.
Suspected arachnoid cyst is csf filled area only.
The measurements is given in only two dimensions because the Mri image is usually acquired and printed in two dimensions, but volume and 3 dimensions can be measured if required.
Some small findings may be missed by reporting radiologist. In case of follow up imaging, it is advisable to report the previous symptoms and Mri findings or deposit the previous Mri.
Even now you can ask for re-repoting by depositing both Mri if required by your treating neurologist.
Mild white matter changes in brain occurs due to age process, diabetes, hypertension, dyslipidemia too. Get investigated for any such risk factors.
As of now nothing seems to be serious and not a multiple sclerosis.
You can upload Mri for assessment.
Provide details of medications too.
Wishing you good health and early recovery.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
Answered by
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Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2259 Questions

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What Do The Following MRI Results Indicate?

Brief Answer: Upload images of Mri Detailed Answer: Hello, I have gone through your question and understand your concerns. Multiple sclerosis is more common at an young to adult age and at this age it's possibility is less likely. The location is also not specific for multiple sclerosis. Other possibilities may be arachnoid cyst or infarct. The imaging changes in infarct after some times. You have other risk factors too which can lead to small vessel atherosclerotic changes in some region of brain. Dizziness spell and balance issue may be related to the lesion location. You can upload images or compiled pdf images of both Mri. Continue rest treatment. Hope you found the answer helpful. Do get back to me for further queries. Regards Dr N Kumar Neurologist