What does the following MRI result indicate?

Posted on Mon, 19 Dec 2016 in Brain and Spine
Question: Results from MRI after visit and Parkinson's Diagnosis; What does this mean? She said a "cloud" from POSSIBLY smoking (a cigarette non-smoker) but probably from ..college (1971 to 1980) pot-smoking recreational use until 25 years ago, now 63 years old,
1. Small residual defect in the dorsolateral left thalamus is sequelae of a remote infarct or hypertensive bleed.
2. Moderate burden of nonspecific white matter disease, presumably sequelae of chronic microvascular ischemia.
3. No acute infarction, mass or acute hemorrhage.

Please plain language,..our telecom for results was quite short,..
Answered by Dr. Olsi Taka 18 minutes later
Brief Answer:
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Detailed Answer:
I read your question carefully and I understand your concern.

The first finding, the residual defect, means that there is a small area of missing tissue, sort of like a hole, a small empty space. That is a remnant of an old damage, like a scar so to say. It was a small damage which must have caused no noticeable symptoms. It is not possible to determine what was the cause now, it is not an active process. One can suppose there has been a small stroke as the report says, as it is the most common cause, but that can not be proven, only the most common hypothesis. But as I said it’s a remnant, no actve process, doesn’t need any treatment.

The second part, white matter disease, is a common finding the older one gets. It denotes diffuse narrowing of the small blood vessels, leading to the tiniest of them being closed and causing tiny areas of damage due to lack of blood supply. To a point it is part of aging, has happened over many years, as all our organs blood vessels undergo changes over the years as well, so over the age of 60 it is often noticeable, no cause for panic. It is in part genetically determined and nothing can be done, but it can be accelerated by factors damaging blood vessels such as high blood pressure, diabetes, smoking, high cholesterol, so the only means of slowing the progression is by controlling these factors when present. When mild or moderate it doesn’t usually manifest any symptoms, but when advanced it can cause mental and movement slowing.

As for the third part, it is not a finding, it simply says there is not any acute damage which is good.

So this report shouldn’t change your Parkinson’s management, MRI in Parkinson is done more than anything to exclude something else causing Parkinson’s symptoms like a tumor or stroke in the areas involved in movement control.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 41 hours later
Attached is collective thoughts to share with "Nuerologist Dr. prior to diagnosis,..

1)     Cannot walk with steady balance, fearful of falling or tripping,
2)     Right big toe awaits surgery to be broken, reset and shave arthritis from joint, Dr. Costeche
3)     Right knee replacement is still sore after 5 years, Dr Eckart April 2010
4)     Right thigh is extremely weak so drag right foot to walk, plus painful right toe and ball of foot, to apply weight, cannot do treadmill,..
5)     Cannot pivot right at hips, freeze in place unless right foot steps back then move left foot-Car accident rear-end collision Oct 2014, 1984-2% disability diagnosis lifting engine motor heads at Nuclear plant
6)     Loss of muscle control at right arm with
a)     partially torn rotator cuff-Dr. McCarty XXXXXXX 2016
b)     Avoided surgery due to work load, opted for PT which is not working
c)     Constant shoulder pain with house AC (both shoulders)
d)     Walk with constant “claw” looking hand even with wrist support,..
7)     Right hand/wrist cannot control PC mouse buttons-Dr. Brakke-Incorrect Carpal Tunnel diagnosis,..confirmed Spring 2016-Dr. XXXXXXX
8)     Need to use left hand for bathroom wiping
9)     Right hand/wrist trembles with bending to use fork/spoon to feed mouth or apply pressure on steak knife to cut food and avoiding public restaurants due to embarrassment,.. 2016-Dr. XXXXXXX
10)     Both right and left underarms cannot be bent back (scratching back) or stretched up 90˚, daily use of PT overhead pull ropes to relieve pain/tightness,
11)     In a sitting position with arm on arm rest, right hand forefinger and thumb trembles uncontrollably,..
12)     Neck constantly pops especially turning/looking to right,..
13)     Notice slight slur during speaking
14)     Left side of body seems normal other than left knee diagnosed for future replacement also, Dr. McCarty, pre 2010
15)     1988-Head-on car collision -Ripped scalp from forehead to crown with plastic cup and start of 5 (3 right/2 left) Arthroscopys to left and right knees,..before right knee replacement

So, here is the rest of the MRI report,..again please clarify,...
will send on last reply,..

here is the final bit to close out request for interpreaton...

Brain and intracranial structures: 7 mm defect in the left thalamus filled with CSF and surrounding by hemosiderin, likely to represent remote left thalamic infarct with hemorrhage. The size and configuration of the ventricles and sulci are normal for patient age. Moderate burden of nonspecific T2 hyperintensities in the periventricular, deep, and pericallosal white matter in the supratentorial compartment. There are no infratentorial lesions. Normal cerebral and callosal volume.

There is no mass lesion, hemorrhage or acute infarct.

Skull: Normal.

Scalp: Small right posterior auricular lipoma..

Orbits and face (included portions): Normal.

Paranasal sinuses and mastoid air cells (included portions): Left maxillary sinus is retention cyst versus polyp. Mild mucosal thickening in the ethmoid cells

for instance, like knocking on a front door,..
The skull are abehind my ear sond shollow the right side does not,..
now wearing eharing aids form Surround SOund

Thanks for the insight to what I have now termed XXXXXXX XXXXXXX Disease,..I am very scared!
Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
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Detailed Answer:
Thank you for the update.

Going through those points you have listed I would say that the majority of those is more likely due to rheumatological joint issues. There are some points though which make the hypothesis of Parkinson's disease possible which are the rest tremor of the right thumb and forefinger and the slurred speech. Of course that alone is not enough to make the diagnosis, MRI is not either. Parkinson's and the group of other similar disorders are the conditions where physical examination is more vital than any other neurological condition. The classical manifestations include rest tremor, rigidity of the limbs, bradykinesia (movement slowing), characteristic gait and posture changes. So in making the diagnosis testing limb movements and tonus, watching patient walk and perform fine movements etc is essential, only the examining neurologist can evaluate that.

As for the rest of the MRI report that doesn't add much to my previous interpretation, the sinus cyst or polyp doesn't represent any major danger, only a higher risk of having sinusitis episodes. That hollow sound feeling is not related to any pathology of the brain, may be due to your hearing issues or simply psychological.

I really do not think you have much to be scared really there is nothing threatening on that MRI. Only thing is you should pau attention to risk factors for stroke, in particular high blood pressure, since you have had one stroke in the past.
As for Parkinson's, even if that is confirmed by neurologist, while I understand is not good news it is not a life threatening condition either. Especially if followed regularly by a specialist patients can lead a good quality, active life for many years, shouldn't panic.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 19 hours later
Thank You,..major concerns are
1) loss of right forefinger/thumb control for PC Elec Eng work
2)imbalance dealing with Shaved bunion surgery re-hab
3)partially torn rotator cuff possible surgery decision to complicate physical degradation for overall movement
4) XXXXXXX J Fox and XXXXXXX William's tragic demise stand in my mind daily,..

Q-Should I continue re-hab exercise for shoulder and avoid surgery, I will be consulting with Dr for that exact Q?

Thanks again, this seems so debilitating,..I will stay in touch per the the account deadline,..Happy Holidays,......
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
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Detailed Answer:
Hello again!

I understand the difficulty the symptoms cause for your work. Hopefully now that you have started treatment with carbidopa/levodopa you will notice an improvement. Apart from levodopa for tremor an anticholinergic drug like Akineton may be added for tremor when levodopa is not enough.

As for rehab for rotator cuff, it is a little difficult to speak without knowing more details and reports. Generally speaking rehab is always the first step. If you have tried it for many months though, for at least 6 months without any success then rehab is not likely to achieve much more and surgery might be needed. Surgery is also needed for very large tears with significant loss of function.

I am not sure why you are thinking about XXXXXXX XXXXXXX his case had absolutely nothing to do with yours, there is no connection. As for XXXXXXX J Fox while it is true that he has Parkinson's his case should be an inspiration, he was diagnosed in 1991 and has been active working until recently. If anything he is an example that it is possible to lead an active life for many years even if you have Parkinson's.

I hope to have been of help. Happy Holidays to you as well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka


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