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What Does My MRI Scan Test Report Indicate?
Question: My daughter gnana XXXXXXX found NCC on 22/06/2015 through MRI. Study : Multiple 4 - 8 mm ring enhancing lesions with peri lesional edema noted in bilateral cerebral & cerebrellar hemisperes, thalami and in left pons - S/o Granulomatous lesions more than 40 (Cysticercosis / ? Tuberculosis)
We underwent homeopathy treatment for paralysis on the same day. She don't have any symptoms before May, 2015, and from XXXXXXX 1st onwards she had fever cold and headache. She had treatment for synasitis upto 19th XXXXXXX From 23rd onwards she had homeo treatment for deworming as per mri scanning report. on 24th she had vomitting in the evening and at night had convultion in the presence of homeo doctor. he gave anti convulsion medicine as well as medicine for release of toxins due to deworming. as advised by homeo doctor, she was admitted in trust hospial, XXXXXXX on 25th for manitol and multi vitamanins thru iv. on 25th she was talking and responding well.trust hospital conducted ct scanning on 26th, shifted from micu to icu on 27th. despite opposition from homeo doctor, trust hospital on the advise of mr XXXXXXX XXXXXXX neuro physician conducted ct scanning on 26th and LP on 28th, homeo doctor advised neuro physician not to conduct ct scANNING and lp repeatedly but they have done without explaining he consequences etc to us. trust hospital never explained the nature other details of the problem to us. after lp she was restless and became very weak. 29th evening she became unconscious and trust hospital advised to think of alternatives and she is very serious. we have immdtly shifted to life line hospotal, kkd, headed by mr.k babji, neuro surgeon. she was taking breath on her own till 30th morning. at 7 am on 30th, she was put on ventilator and same day evening dr.babji informed us that she is brain dead. we have reqeusted him to continue ventilator till 4 july, but heart stopped at 1420 hours on 2nd july. we feel that ct scanning and lp were unnecessarily done by trust hosp and fight with them legally. kindly guide us in the matter medically.
We underwent homeopathy treatment for paralysis on the same day. She don't have any symptoms before May, 2015, and from XXXXXXX 1st onwards she had fever cold and headache. She had treatment for synasitis upto 19th XXXXXXX From 23rd onwards she had homeo treatment for deworming as per mri scanning report. on 24th she had vomitting in the evening and at night had convultion in the presence of homeo doctor. he gave anti convulsion medicine as well as medicine for release of toxins due to deworming. as advised by homeo doctor, she was admitted in trust hospial, XXXXXXX on 25th for manitol and multi vitamanins thru iv. on 25th she was talking and responding well.trust hospital conducted ct scanning on 26th, shifted from micu to icu on 27th. despite opposition from homeo doctor, trust hospital on the advise of mr XXXXXXX XXXXXXX neuro physician conducted ct scanning on 26th and LP on 28th, homeo doctor advised neuro physician not to conduct ct scANNING and lp repeatedly but they have done without explaining he consequences etc to us. trust hospital never explained the nature other details of the problem to us. after lp she was restless and became very weak. 29th evening she became unconscious and trust hospital advised to think of alternatives and she is very serious. we have immdtly shifted to life line hospotal, kkd, headed by mr.k babji, neuro surgeon. she was taking breath on her own till 30th morning. at 7 am on 30th, she was put on ventilator and same day evening dr.babji informed us that she is brain dead. we have reqeusted him to continue ventilator till 4 july, but heart stopped at 1420 hours on 2nd july. we feel that ct scanning and lp were unnecessarily done by trust hosp and fight with them legally. kindly guide us in the matter medically.
Brief Answer:
Please provide further vital information.
Detailed Answer:
Hi Sir/Madam,
I understand your concern.
This is an extremely unfortunate incident happened to your family.
My deepest condolences to your daughter Gnana XXXXXXX Garu.
Coming to your legal issue,Lumbar puncture has to be strictly avoided under certain diseased conditions in the brain.
I request you to provide me further info.
1.Before commenting on requirement of LP, I would like to know if such diseased conditions have ever existed in her case,that preclude her from getting an LP.
2.I need the uploaded reports/ scan impressions of both MRI(Dt:22/6) and CT(dt:26/6).This info is very important to voice out the opinion.
3.Who performed the LP procedure is it the Neurophysician or Anesthetist or someone else?
4.Upload Complete Report of LP( for any mention on opening pressure) if available.
5.What did your Homeopathic physician mean by "doing LP repeatedly".Was LP done earlier in her case?If yes ,when?
6.After what time span after LP,did she became restless?I mean when did the symptoms start after LP on 28/6?
7.Why did you ask Dr Babji on on 30th XXXXXXX to continue ventilator specifically till July 4th?Any significance with the date mentioned,I would like to know.(This is an out of context question,but I request you to provide me an answer if available).
I can guide you with definite accuracy,if you can provide me with vital information pertaining to the questions in your follow up.
Thank you.
Please provide further vital information.
Detailed Answer:
Hi Sir/Madam,
I understand your concern.
This is an extremely unfortunate incident happened to your family.
My deepest condolences to your daughter Gnana XXXXXXX Garu.
Coming to your legal issue,Lumbar puncture has to be strictly avoided under certain diseased conditions in the brain.
I request you to provide me further info.
1.Before commenting on requirement of LP, I would like to know if such diseased conditions have ever existed in her case,that preclude her from getting an LP.
2.I need the uploaded reports/ scan impressions of both MRI(Dt:22/6) and CT(dt:26/6).This info is very important to voice out the opinion.
3.Who performed the LP procedure is it the Neurophysician or Anesthetist or someone else?
4.Upload Complete Report of LP( for any mention on opening pressure) if available.
5.What did your Homeopathic physician mean by "doing LP repeatedly".Was LP done earlier in her case?If yes ,when?
6.After what time span after LP,did she became restless?I mean when did the symptoms start after LP on 28/6?
7.Why did you ask Dr Babji on on 30th XXXXXXX to continue ventilator specifically till July 4th?Any significance with the date mentioned,I would like to know.(This is an out of context question,but I request you to provide me an answer if available).
I can guide you with definite accuracy,if you can provide me with vital information pertaining to the questions in your follow up.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
homeo doctor requested physician, don't do lp such a serious condition (not repeated times, lp done once only). she got severe headache after ct scan. she became restless after lp (lp was done in the afternoon). tomorrow i will inform you about performance of lp (who performed lp). on 26th morning she is quite normal and next day onwards she had taken small quantities of solids and liquids.
we requested dr. babji for ventilator for three more days that any miracle may occur and her (XXXX) birthday falls on 5th july. she is very intelligent, friendly, helpful, multi talented, kind hearted and mother's kid. i treat my two daughters as my best friends. i miss her a lot
thanking you sirs XXXXXXX XXXXXXX (XXXX's mother)
LP test has been perfomed by anesthetist
we requested dr. babji for ventilator for three more days that any miracle may occur and her (XXXX) birthday falls on 5th july. she is very intelligent, friendly, helpful, multi talented, kind hearted and mother's kid. i treat my two daughters as my best friends. i miss her a lot
thanking you sirs XXXXXXX XXXXXXX (XXXX's mother)
LP test has been perfomed by anesthetist
Brief Answer:
Relevant medical facts provided.
Detailed Answer:
Hi Madam,
I understand your concern,
I have carefully gone through all your uploaded images.
In My Opinion,the possible diagnosis in your daughter's case is Neurocysticercosis,based on the findings of MRI and CT scan supported by CSF studies.
The cysts seem to show perilesional edema(which indicates parasite's larval degeneration form-Colloido-vesicular stage-->1 to2/4 stage of the NCC) on MRI scan alone.Their location is mainly in the brain parenchyma.
Colloidal stage is the stage,where parasite dies within 4-5 years untreated, or earlier with treatment and the cyst fluid becomes turbid.
As the membrane becomes leaky oedema surrounds the cyst.
This is the most symptomatic stage,ie this stage is most commonly responsible for clinical manifestations.
When parasites are located in the brain parenchyma, results of CSF analysis may be normal. The results are usually abnormal (50-80%) when parasites are present in the basal cisterns or in the ventricles.Basal cisterns and Ventricles are absolutely normal in case her ,both on MRI and CT scan.
Hence based on the MRI findings alone,the further need for LP is very minimal.
CT scan is done in her case with a view to do LP later(since all cases of LP must precede a CT scan to offer procedural clearance).
And once again,there is no need for CT scan in isolation since a much superior investigation (MRI) to this has been earlier performed just 4 days ago.
The probable reason to go for LP in her case might be to distinguish between Tuberculosis(tubercular meningitis/TBM) ,Neurocysticercosis and Bacterial infection of brain(encephalitis and meningitis).
But once again,this differentiation might be unnecessary ,since TBM strikingly involves and damages basal cisterns,which are absolutely clear in her case both on MRI as well as CT
Factors strongly favouring Neurocysticercosis(in my opinion).
1.Size of cysts in NCC is typically less than 20mm,whereas its more than 20 mm in Tuberculomas.
2.Midline shift of structures is rare in NCC,whereas its extremely common in TBM.
3.Features of raised ICT(intracranial tension) and constitutional symptoms are more marked with TBM,rather than NCC.The patient was very well prior to June(as earlier revealed in the query).
4.CT findings of NCC and early stages of TBM can be similar,requiring contrast study(as advised in your case,but not done).But MRI brain is an excellent tool which can reliably differentiate the two ,which was very clearly in favour of NCC from the beginning.
5.Even the CSF study reports in her case are highly against TBM.
6.Seizures,headaches and altered mental status in a young adult is a striking triad of NCC.
7.NCC can be treated with successful outcome in many cases based on the MRI findings alone.
8.Hence the need for further investigations like CT f/b LP remains unclear in my opinion.
Coming to LP-This procedure is certainly associated with risks.
Before this procedure ,all the risks will be clearly explained to the patient and or his/her relatives in their own language and the same is documented and a signature consent is taken by the doctor who performs the procedure.This protocol is universally/globally practiced.Any deviation in this goes in violation of medical ethics.
The complications/side effects after LP even though not common ,can still exist and can arise by combination of technical and procedural considerations.They include
1.Persistent headache.
2.Tingling and numbness in the legs.
3.Loss of hearing and double vision.
4.Bleeding in the brain and spinal cord(a very rare scenario).
Post your further queries if any,
Thank you
Relevant medical facts provided.
Detailed Answer:
Hi Madam,
I understand your concern,
I have carefully gone through all your uploaded images.
In My Opinion,the possible diagnosis in your daughter's case is Neurocysticercosis,based on the findings of MRI and CT scan supported by CSF studies.
The cysts seem to show perilesional edema(which indicates parasite's larval degeneration form-Colloido-vesicular stage-->1 to2/4 stage of the NCC) on MRI scan alone.Their location is mainly in the brain parenchyma.
Colloidal stage is the stage,where parasite dies within 4-5 years untreated, or earlier with treatment and the cyst fluid becomes turbid.
As the membrane becomes leaky oedema surrounds the cyst.
This is the most symptomatic stage,ie this stage is most commonly responsible for clinical manifestations.
When parasites are located in the brain parenchyma, results of CSF analysis may be normal. The results are usually abnormal (50-80%) when parasites are present in the basal cisterns or in the ventricles.Basal cisterns and Ventricles are absolutely normal in case her ,both on MRI and CT scan.
Hence based on the MRI findings alone,the further need for LP is very minimal.
CT scan is done in her case with a view to do LP later(since all cases of LP must precede a CT scan to offer procedural clearance).
And once again,there is no need for CT scan in isolation since a much superior investigation (MRI) to this has been earlier performed just 4 days ago.
The probable reason to go for LP in her case might be to distinguish between Tuberculosis(tubercular meningitis/TBM) ,Neurocysticercosis and Bacterial infection of brain(encephalitis and meningitis).
But once again,this differentiation might be unnecessary ,since TBM strikingly involves and damages basal cisterns,which are absolutely clear in her case both on MRI as well as CT
Factors strongly favouring Neurocysticercosis(in my opinion).
1.Size of cysts in NCC is typically less than 20mm,whereas its more than 20 mm in Tuberculomas.
2.Midline shift of structures is rare in NCC,whereas its extremely common in TBM.
3.Features of raised ICT(intracranial tension) and constitutional symptoms are more marked with TBM,rather than NCC.The patient was very well prior to June(as earlier revealed in the query).
4.CT findings of NCC and early stages of TBM can be similar,requiring contrast study(as advised in your case,but not done).But MRI brain is an excellent tool which can reliably differentiate the two ,which was very clearly in favour of NCC from the beginning.
5.Even the CSF study reports in her case are highly against TBM.
6.Seizures,headaches and altered mental status in a young adult is a striking triad of NCC.
7.NCC can be treated with successful outcome in many cases based on the MRI findings alone.
8.Hence the need for further investigations like CT f/b LP remains unclear in my opinion.
Coming to LP-This procedure is certainly associated with risks.
Before this procedure ,all the risks will be clearly explained to the patient and or his/her relatives in their own language and the same is documented and a signature consent is taken by the doctor who performs the procedure.This protocol is universally/globally practiced.Any deviation in this goes in violation of medical ethics.
The complications/side effects after LP even though not common ,can still exist and can arise by combination of technical and procedural considerations.They include
1.Persistent headache.
2.Tingling and numbness in the legs.
3.Loss of hearing and double vision.
4.Bleeding in the brain and spinal cord(a very rare scenario).
Post your further queries if any,
Thank you
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you Dr. Sureshji.
I asked you this information not to proceed legally neither on Trust Hospital nor on Dr Goutham. They are badly (Including Dr Babji) propaganda on me and on homeo doctor that wrong treatment done against XXXXXXX by homeo doctor. I am very much depressed on hearing this. So I approached you for clarifications. I am a heart patient since 2010. (had two times heart attack in 2010 and 2011) Two times I approached our homeo doctor only. While I had angiogram, the cordiologist was also advised to continue with homeo. When, in my daughter's case, our doctor explained about the case. I am a Reiki Master (III A Degree holder) and had the habit of meditating in the Pyramid. These universal powers passes through our body, while patient takes homeo / ayurvadic medicines only. So I preferred homeo. But trust doctor's had given my daughter's dead body. We had an old saying that "vaidyo narayano hari". But now some of our doctor's are behaving like yama kinkaras. Everybody including relatives and my daughter's friends were scolded me for approaching homeo doctor. Again on 2nd july, I had mild attack. Still I am getting pain but, I have to live for my another child.
Once again thank you for your valuable information which helped and saved me from the bad society.
I asked you this information not to proceed legally neither on Trust Hospital nor on Dr Goutham. They are badly (Including Dr Babji) propaganda on me and on homeo doctor that wrong treatment done against XXXXXXX by homeo doctor. I am very much depressed on hearing this. So I approached you for clarifications. I am a heart patient since 2010. (had two times heart attack in 2010 and 2011) Two times I approached our homeo doctor only. While I had angiogram, the cordiologist was also advised to continue with homeo. When, in my daughter's case, our doctor explained about the case. I am a Reiki Master (III A Degree holder) and had the habit of meditating in the Pyramid. These universal powers passes through our body, while patient takes homeo / ayurvadic medicines only. So I preferred homeo. But trust doctor's had given my daughter's dead body. We had an old saying that "vaidyo narayano hari". But now some of our doctor's are behaving like yama kinkaras. Everybody including relatives and my daughter's friends were scolded me for approaching homeo doctor. Again on 2nd july, I had mild attack. Still I am getting pain but, I have to live for my another child.
Once again thank you for your valuable information which helped and saved me from the bad society.
Brief Answer:
Move ahead Madam.
Detailed Answer:
Hi Madam,
I understand your concern.
I understand your pain.
But now its important that you take care of your own health.not just for you but also for your second daughter.
Your family needs your presence.
Have a regular cardiac follow up without fail.
Post your further queries if any.
Take care,
Thank you.
Move ahead Madam.
Detailed Answer:
Hi Madam,
I understand your concern.
I understand your pain.
But now its important that you take care of your own health.not just for you but also for your second daughter.
Your family needs your presence.
Have a regular cardiac follow up without fail.
Post your further queries if any.
Take care,
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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