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What does this MRI report indicate?

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Posted on Tue, 19 Jul 2016
Question: Almost two years ago I was in a car accident. I lost my consciousness, but I don't know for how long. At the emergency room they performed an MRI; the MRI did not reveal anything. three weeks later, however I started to experience all kinds of strange symptoms: dizziness, vomiting, headaches, etc. A second MRI indicated that I might suffer of NP hydrocephalus. This is the official diagnosis now. My question is: could it be a concussion that lingers for too long?

thank you,
XXXXXXX
doctor
Answered by Dr. Olsi Taka (2 hours later)
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

It is true that sometimes concussion symptoms may linger for a long time, even for months, very rarely for years. However judging from that MRI report I am afraid that it is not your case, one can speak of a concussion lingering only if all other possible causes have been excluded.
If the MRI had resulted as normal it would have a possible hypothesis, but in your case the MRI has picked a cause such as the hydrocephalus. Hyprocephalus manifests on the MRI as an enlargement of the ventricles, so it is something which is objectively evaluated, by measurements performed by the software reading the MRI. It also justifies the symptoms that you mention. So since there is a cause which has been identified I do not think the symptoms are due to the concussion, in particular after two years.

I remain at your diposal for otherr questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (21 hours later)
Thank you for your prompt answer.

The problem is that there is no treatment for NPH except surgery. Two neurosurgeons so far told me that they don't think I need surgery. The symptoms however are the same.
XXXXXXX
doctor
Answered by Dr. Olsi Taka (13 hours later)
Brief Answer:
Read below.

Detailed Answer:
Hello again.

It is true that there is no medical treatment for NPH (but neither is there any medication for post concussion symptoms for that matter). I still do not think the issue is related to the concussion given the lack of findings on initial MRI, the beginning of symptoms only 3 weeks later and the fact that usually after such a long time symptoms should have subsided.
I must say that it is a little unclear what the neurosurgeons opinion was. Did they say they refused surgery because they didn't agree with the diagnosis suggested by the MRI? Also was there a lumbar puncture performed to try to remove some cerebrospinal fluid? It is a test which when accompanied by improvement after fluid removal indicates that surgery should help, but it also is a diagnostic test as when pressure is raised it would prompt to search for other causes of hydrocephalus.

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 (2 days later)
The neurosurgeon simply said that, in his opinion, I do not need surgery, without ever explaining why. Also, they performed a lumbar puncture during which they removed some fluid. Not only that there was no improvement, but I had a terrible reaction to the procedure: violent vomiting, headaches, nausea, lack of balance. Every person in the room said that this was the first time they witnessed such a reaction.

My neurologist said that he saw on the MRI some "white matter", but he is convinced it is NOT multiple sclerosis. Again he never explained why. The fact remains that at this point I don't feel I have a correct diagnostic and don't know what to do. My friends advised me to go to Mayo Clinic. It is however a complicated project for me. I am exhausted all the time, I walk very difficultly and I am profoundly depressed.

Thank you,
XXXXXXX

doctor
Answered by Dr. Olsi Taka (25 hours later)
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional information.

I am afraid that it changes my opinion, or rather it is hard to give an opinion with so many things which do not fit, at least not without having some medical reports - if you can provide them I would be glad to have a look. First the lumbar puncture leads to no improvement, then the neurologist speaks of some white matter issue and it is unclear whether they thought you had HPN as well or whether it was just the radiologist report.

So at this point I would say another opinion is certainly needed. Mayo is one of the most known clinics, famous not only in the US but also on this side of the Atlantic. If you have been feeling so bad for two years now I suggest that no matter how complicated it is you should try it, since it really is affecting your quality of life and doesn't seem likely to evaporate by itself anytime soon.

Wishing you good health.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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What does this MRI report indicate?

Brief Answer: Read below. Detailed Answer: I read your question carefully and I understand your concern. It is true that sometimes concussion symptoms may linger for a long time, even for months, very rarely for years. However judging from that MRI report I am afraid that it is not your case, one can speak of a concussion lingering only if all other possible causes have been excluded. If the MRI had resulted as normal it would have a possible hypothesis, but in your case the MRI has picked a cause such as the hydrocephalus. Hyprocephalus manifests on the MRI as an enlargement of the ventricles, so it is something which is objectively evaluated, by measurements performed by the software reading the MRI. It also justifies the symptoms that you mention. So since there is a cause which has been identified I do not think the symptoms are due to the concussion, in particular after two years. I remain at your diposal for otherr questions.