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What do these brain imaging reports indicate?

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Posted on Wed, 25 May 2016
Question: need an advise from an international specialist. Details in the attached report. Have already taken opinion from an XXXXXXX specialist

I have uploaded the reports so please provide an opinion from an International specialist
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Answered by Dr. Olsi Taka (3 hours later)
Brief Answer:
As follows...

Detailed Answer:
Hello! My name is Olsi Taka. I am a medical doctor specialized in Neurology and after reading your reports carefully I will provide my opinion.

Regarding the brain imaging reports they more or less indicate the same thing, severe damage in the left part of the brain due to truck accident trauma. The most damaged part is the frontal lobe as well as the optic nerve which is responsible for vision input from the left eye. There are no new lesions on subsequent exams, only the remains of the old damage. Such damage justifies the loss of vision from the left eye, difficulty in using right limbs, possible epileptic seizures as well as some changes in behavior. Apart from prevention of seizures through antiepileptics I am afraid not much else can be done about those old lesions, the damage has already been done.

Now from what I understand your current concern is mostly neck pain. Judging from the only neurologist opinion, that of Dr Kothare, he notices also an abnormal position of the neck, a type of neck dystonia, called also torticollis. This prolonged abnormal positioning of the neck has lead to changes in the form of your cervical spine which is tilted to the right.
Dystonia can be due to a primary neurological cause, leading to painful abnormal contractions of some neck muscles. In that case often treatment with botulinum toxin injections may relieve the spasms.
Dr Kothare though thinks that it is not a primary neurological origin. He thinks that because of your left eye blindness you have developed the habit of tilting your head and over the years that has lead to the changes in the spine. In that case I am not sure that the botulinum toxin injections will help much. It would be a case of treatment with physical therapy, cervical collar in exacerbations of pain, anti-inflammatory pain killers for the pain like Ibuprofen, muscle relaxants. Application of heat might also help. Medication for chronic pain like Gabapentin or Pregabalin may also be tried, but since they are also antiseizure medications if you take antiepileptics their choice and dosage must be reconsidered.

Now since I am not able to examine you myself I can not ascertain the cause of the torticollis. Looking at the direction of the tilt of the spine on X-ray which would correspond to tilting to compensate for left eye blindness I believe there is a good chance Dr Kothare is right. However a second opinion from a neurologist with movement disorders as a subspecialty may be appropriate.
So, while I appreciate you asking for the opinion of a non-indian doctor, I guess at the end my opinion is along the same lines as my XXXXXXX colleague.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (50 minutes later)
Thanks for the opinion doctor. This was really helpful
doctor
Answered by Dr. Olsi Taka (3 minutes later)
Brief Answer:
You're welcome.

Detailed Answer:
I hope you will feel better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Practicing since :2004

Answered : 3669 Questions

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What do these brain imaging reports indicate?

Brief Answer: As follows... Detailed Answer: Hello! My name is Olsi Taka. I am a medical doctor specialized in Neurology and after reading your reports carefully I will provide my opinion. Regarding the brain imaging reports they more or less indicate the same thing, severe damage in the left part of the brain due to truck accident trauma. The most damaged part is the frontal lobe as well as the optic nerve which is responsible for vision input from the left eye. There are no new lesions on subsequent exams, only the remains of the old damage. Such damage justifies the loss of vision from the left eye, difficulty in using right limbs, possible epileptic seizures as well as some changes in behavior. Apart from prevention of seizures through antiepileptics I am afraid not much else can be done about those old lesions, the damage has already been done. Now from what I understand your current concern is mostly neck pain. Judging from the only neurologist opinion, that of Dr Kothare, he notices also an abnormal position of the neck, a type of neck dystonia, called also torticollis. This prolonged abnormal positioning of the neck has lead to changes in the form of your cervical spine which is tilted to the right. Dystonia can be due to a primary neurological cause, leading to painful abnormal contractions of some neck muscles. In that case often treatment with botulinum toxin injections may relieve the spasms. Dr Kothare though thinks that it is not a primary neurological origin. He thinks that because of your left eye blindness you have developed the habit of tilting your head and over the years that has lead to the changes in the spine. In that case I am not sure that the botulinum toxin injections will help much. It would be a case of treatment with physical therapy, cervical collar in exacerbations of pain, anti-inflammatory pain killers for the pain like Ibuprofen, muscle relaxants. Application of heat might also help. Medication for chronic pain like Gabapentin or Pregabalin may also be tried, but since they are also antiseizure medications if you take antiepileptics their choice and dosage must be reconsidered. Now since I am not able to examine you myself I can not ascertain the cause of the torticollis. Looking at the direction of the tilt of the spine on X-ray which would correspond to tilting to compensate for left eye blindness I believe there is a good chance Dr Kothare is right. However a second opinion from a neurologist with movement disorders as a subspecialty may be appropriate. So, while I appreciate you asking for the opinion of a non-indian doctor, I guess at the end my opinion is along the same lines as my XXXXXXX colleague. Let me know if I can further assist you.