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What Does This MRI Report Showing Lesion In Brain Indicate?
Question: Brief history - I was married female lost my husband on 23rd Mar 2014 having 6 months daughter in an accident, husband died. Post which i came back to my parents and left the baby also as my husbands elder brother adopted my daughter. To recover from the trauma my family made me join a convent school as a teacher immediately. I was recovering well from the mental stress but than developed headaches often on and off. Took medicne for the same for around 3 to 4 months as advised by neurologist that may be Migrane, took medicine NAXODEM, TOPRAMADE, PROPANLOL, DULEXTEINE which i used to take and post taking 4 months headache went off.Later this year since XXXXXXX 15 i again had headaches which went severe but on off again, I referred to same neurologist who advised MRI where MRI findings suggested MENINGIOMA for which we went to another neurologist also and he confirmed the same and suggested CYBERKNIFE from XXXXXXX or XXXXXXX We went to MEDANTA on Mar 15 first week for the same, they intially went through the reports and said ok will go for the same treatment(3 SHOTS). They prepared for the same and also conducted MRI before the same where they had some doubts and then they repeated the same with MRS and gave us a conclusion that it is not MENINGIOMA but seems to be 90% BRAIN TB. They referred to there internal medicine specialist and put me on ADD for 6 weeks post which again they said to repeat MRI and MRS. I am on ADD now for 5 weeks but with ADD i used to have lot of vomit intially but the same settled down but from last 2 weeks i am having severe headache in the centre of the forehead for which i am taking NEUROBEN injection and the pain goes off. But again the same props up after 8 to 10 hours. I am planning to revist MEDANTA in next week for the referral with MRI and MRS. I have attached my MRI and MRS report conducted by MEDANTA please go through the same and help with the same. I would be obliged.
Brief Answer:
Your MRI and MRS reports points towards a diagnosis of TB in brain
Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. Sorry to hear about the problems you have been through in the past year and pray that things fall in place and you are back to normal.
2. Concerning your MRI, there is some area in and around the brain stem which appears to be about 1.6 x 2.1 x 1.9 cm and is showing appearance similar to multiple rings within. This is a small lesion but the location is surrounded by important structures.
3. I come across patients having similar problems and we routinely depend on MRS to make a better diagnosis. MRS is magnetic resonance spectroscopy and gives us an idea of the chemical composition of the lesion. In your report, there is mention of MRS findings showing that the lipid peak is much raised and the choline is slightly increased. The creatine and NAA (N-acetylaspartate) peaks are reduced. Therefor the chemical composition is most likely to be that of tuberculosis. Hence the doctor has given a possibility of brain TB and has started treatment.
4. The treatment of TB includes taking medicines for months. Initially many people have nausea and vomiting and later get used to the medicines. Since there is an infection that is in a complicated area of the brain, even slight changes due to the lesions (eg brain swelling or pressure changes) can cause pain and discomfort. Your other medicines are adequate. Some people also experience seizures due to brain TB in the initial stages of treatment and if you have any seizure then please talk to your doctor immediately.
5. The constant headaches might be due to the healing going on in your brain. Even slight changes in pressure inside the head can give rise to headaches which often recur. Doing another MRI and MRS might help to know the present status of the lesion and how much it is responding to the medicines you are taking. MRI scan is a safe method and does not cause any side effects.
6. It is important that you maintain a good intake of nutritious food including fruits and vegetables. Please take your medicines on time because missing even a single dose can cause delay in treatment.
7. The confusion in diagnosis in January MRI scan might be due to many reasons. It is possible that the lesions were too small and the appearance was much like that of a meningioma at that time. The main symptoms of TB are usually low grade fever in the evening and unexplained loss of weight for two months. You can recall if you ever had evening fever and weight loss around December 2014 January 2015 and if you had it then that is the time when the TB infection started.
8. In conclusion, please visit your hospital and get follow up done next week. Please maintain a weight chart and see for increase in your weight every 15 days. Keep mentally strong and always be optimistic that you will get well soon.
9. Since your diagnosis of brain TB is based on MRI and MRS scans, it is important to repeat the scans as required to know the improvement and healing of infection.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Your MRI and MRS reports points towards a diagnosis of TB in brain
Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. Sorry to hear about the problems you have been through in the past year and pray that things fall in place and you are back to normal.
2. Concerning your MRI, there is some area in and around the brain stem which appears to be about 1.6 x 2.1 x 1.9 cm and is showing appearance similar to multiple rings within. This is a small lesion but the location is surrounded by important structures.
3. I come across patients having similar problems and we routinely depend on MRS to make a better diagnosis. MRS is magnetic resonance spectroscopy and gives us an idea of the chemical composition of the lesion. In your report, there is mention of MRS findings showing that the lipid peak is much raised and the choline is slightly increased. The creatine and NAA (N-acetylaspartate) peaks are reduced. Therefor the chemical composition is most likely to be that of tuberculosis. Hence the doctor has given a possibility of brain TB and has started treatment.
4. The treatment of TB includes taking medicines for months. Initially many people have nausea and vomiting and later get used to the medicines. Since there is an infection that is in a complicated area of the brain, even slight changes due to the lesions (eg brain swelling or pressure changes) can cause pain and discomfort. Your other medicines are adequate. Some people also experience seizures due to brain TB in the initial stages of treatment and if you have any seizure then please talk to your doctor immediately.
5. The constant headaches might be due to the healing going on in your brain. Even slight changes in pressure inside the head can give rise to headaches which often recur. Doing another MRI and MRS might help to know the present status of the lesion and how much it is responding to the medicines you are taking. MRI scan is a safe method and does not cause any side effects.
6. It is important that you maintain a good intake of nutritious food including fruits and vegetables. Please take your medicines on time because missing even a single dose can cause delay in treatment.
7. The confusion in diagnosis in January MRI scan might be due to many reasons. It is possible that the lesions were too small and the appearance was much like that of a meningioma at that time. The main symptoms of TB are usually low grade fever in the evening and unexplained loss of weight for two months. You can recall if you ever had evening fever and weight loss around December 2014 January 2015 and if you had it then that is the time when the TB infection started.
8. In conclusion, please visit your hospital and get follow up done next week. Please maintain a weight chart and see for increase in your weight every 15 days. Keep mentally strong and always be optimistic that you will get well soon.
9. Since your diagnosis of brain TB is based on MRI and MRS scans, it is important to repeat the scans as required to know the improvement and healing of infection.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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