What Does My MRI Scan Report Indicate?
1. The diffusion weighted images are normal. There is no evidence of acute or recent infarction. There is no abnormally restricted diffusion in either hippocampal formation
2. There are multiple (greater than 3 dozen) small (2 to 10 mm in diameter) gliotic foci in the subcortical white matter of both of the cerebral hemispheres. These findings are of uncertain etiology. These foci could be related to the sequela of systemic hypertension, chronic small vessel ischemic change, a demyelinating disease/disorder, a previous inflammatory process (i.e. prior vasculitis or prior infectious process), or other insult. These findings are more numerous and larger than typically described as the sequela of migraine headaches alone. The corpus callosum and the infratentorial white matter are normal.
3. There is a partially empty sella turcia. Please see the above discussion.
Nothing threatening, depending on symptoms other tests may be done
I read your question carefully and I understand your concern.
It might have been useful if you could have added something about why the MRI was prescribed, what were your symptoms and other medical conditions you might have.
Coming to the report: First paragraph is normal, it simply says there is no indication of any acute brain lesion. You should feel reassured that there is nothing threatening in this report.
The second paragraph describes scattered gliotic foci. These are not active, they are remnants of something old, sort of like minuscule scars in the brain. Unfortunately it is not possible to determine their origin, many causes can leave such remnants, that is why the report mentions several possibilities. The first two, hypertension and small vessel ischemic disease would be unlikely in someone your age, not unless you have some long standing condition involving blood vessels. A demyelinating process like multiple sclerosis is rendered somewhat unlikely by the location of these foci and the fact the corpus callosum is normal. Migraine may at times cause such findings but the radiologist thinks they are more than usually found in migraine. So that would leave a past infection or inflammation, something that may have happened many years ago as more likely. However as I said it is not possible to determine that with certainty only by those foci. If there are any symptoms pointing towards multiple sclerosis, or recent infection/inflammation a lumbar puncture may be considered. Otherwise nothing needs to be done apart from having another MRI in 6-12 months to make sure there are no new active lesions.
Regarding the third part the empty sella. That is a common finding, means that pituitary gland is flattened forming an empty space. Most often it is asymptomatic and needs no intervention. However at times it may be due to Intracranial hypertension, increased pressure in the brain which has other symptoms such as headaches, visual loss etc so if those are present an eye exam for signs of raised pressure as well as a lumbar puncture would be advised.
Another issue could be the possibility of deficiency of the hormones produced by pituitary gland. So I would also advise for testing of hormonal levels.
So to conclude, that report indicates no immediately threatening condition, most are chronic old findings. Perhaps no intervention of any kind might be needed at all. However depending on your symptoms some more tests might be required.
I remain at your disposal for other questions.
- Hypersomnia, treated by Ritalin
- Migraines, treated by Imitrex, as needed (usually 3-4 times a month)
- Barrette’s Esophagus, treated by Dexilant
- Irritable Bowel Syndrome-Diarrhea, treated by Viberzi
- Mood Disorder, treated by Lithium, Wellbutrin, Seroquel, Topamax
- Allergies, treated by Allegra
In the last 4 months, I have had problems with words when talking. I will try to say a word, but I will not always say the correct word. Some specific examples are I wanted to say “grateful,” but I said “graceful,” or I wanted to say “stuffed,” but I said “snuffed,” or I wanted to say “headset,” but I said “headspet,” or I wanted to say “cheap,” but I said “sheep.” All of them are in longer sentences – not in single words and it seems to happen more if I am stressed and even more if I am tired. As the course of the 4 months has gone on, it seems to be increasing.
My neurologist, who I see for hypersomnia, ordered a EEG, and I have attached the report here. My understanding was that the findings of the EEG were inconclusive, but he was concerned that some results of the tests were off and was not sure if it may be due to medication interactions or minor seizures. He ordered a Brain MRI – the findings of which I shared – and an extended EEG, which I will complete in a few weeks. I cannot get an appointment to discuss the results for over 6 weeks but it seems like something is not right, so I was hoping for some more info.
Thank you for that additional information.
I would say that the findings of the MRI do not justify those symptoms. I suppose the neurologist asked for a MRI to exclude lesions such as stroke, tumor etc affecting language areas or for brain shrinking in those indicating early onset dementia. But there is no indication of that sort. Those described foci as I said are old, it is not something which has developed in the last 4 months. So I do not see a cause for concern and would not suggest any measure based on that MRI.
Of course when it comes to language issues an MRI is not what makes the diagnosis. Evaluation of language and other higher mental functions is necessary by your neurologist. Often patients present with such symptoms such as yours but neuropsychological tests turn out normal, including the language part. If I were to judge by your last post, the precise and well organized manner in which you describe the issue, I wouldn't say language is impaired. The symptoms may be due to concentration issues commonly found in anxiety and depression. Looking at your list of medications at times medication side effects may contribute as well.
As for the EEG, I am afraid I do not see the report attached here. I wouldn't say seizures seem that likely, but anyway it seems your neurologist is being pretty thorough by asking for an extended EEG.
Let me know if I can further assist you.