Posted on 05/17/2007 1:42:38 PM PDT by Miztiki
I have two easy questions for you. For some background, I had a brainstem tumor removed 6 years ago. In those first scans they also saw two "lesions", one in each frontal lobe. Those lesions never changed all these years until now.
(I'm 35 now by the way.)
I found out today that I have a new "lesion", this one also in one of my frontal lobes. The other two remain the same.
I have two questions - one asking for location and the other asking for your advice.
Firstly, where in the brain is the part highlighted in bold? The "anteriorly noted" part threw me. By that do they mean they are describing the location of the lesion when looking at it from the front? Is it there where the ventricle meets the surrounding tissue? If so, is it just inside or just outside of the ventricle? (I'm wondering if it could be a result of seeding since my tumor grew into my fourth ventricle.) [No size was noted for that lesion.]
"Oblong T2 signal hyperintensity is seen extending about 1.5 cm across the left frontal white matter from the periventricular to subcortical location. Adjacent oblong well defined T2 signal extending near the lateral margin of the body of the left lateral ventricle anteriorly noted. A 6 mm well-defined T2 signal hyperintensity is seen in the subcortical white matter of the inferior posterior right frontal lobe. The adjacent areas of T2 signal in the left frontal white matter demonstrate no mass effect and some decreased signal noted on T1 weighting."
For the other question, I saw a new neuro today cuz my last one dropped my insurance. He says finding a new lesion is no big deal and wants me to take a baby aspirin every day for a few months and see him again in a year. He says not enough blood circulation to the brain can cause these lesions (presumably ischemia, which was ruled out before).
They just got my head all wired up and ready for an EEG when the power went out. A power substation exploded here in Houston a couple hours ago and *none* of my doctors have power so I can ask them about this. The doc and everyone else where I was at literally disappeared so I just left. I'm sure you can understand my not wanting to be left hanging like this knowing that there's a new lesion in my brain and being told it's no big deal, take an aspirin!
I'm thinking I should see my family doc soon and have this looked into further. I'm thinking that taking this neuro's advice (when he didn't even ask about any tests I've ever had and knows basically nothing about my medical history) and treating this new lesion as "no big deal" would be a mistake. Would you agree? Or should I just start taking baby aspirin and not worry about it, and see him in a year?
So if you can tell me where this new lesion is and if I should disregard his advice and have it looked into further anyway, then I would really appreciate it.
If you have any questions or want to talk about brain stuff then I'm more than happy to give you details and get technical with you. The brain fascinates me and I've spent literally hundreds of hours learning and studying it. Learning as much as I possibly can has helped me accept and deal with all of this. Right now I feel the need to talk about this, so if anyone wants to do their good deed for the day... please.
I don’t know anything about this stuff but you have my prayers for good health and happiness.
Can he assure you that it is not neoplastic, and that it will not continue to grow. He may feel that it is some form of scaring. It seems odd that he would be so casual without a biopsy?
I would definitely suggest a second opinion, and not from your family doc.
I hope that the news you get when you have this long talk is good but I'd say that if you were told not to worry about it things will probably turn out OK.
Good luck!
Personally, I *always* go on political websites when looking for highly technical neurological information.
I don’t know if there are any neurologists who post here, but there are some on this site that could probably use the attention of one! Haha.
Best of luck to you.
Interesting. I’m no expert, and perhaps there are better medical forums for the specifics on this.
However, I would suggest the following for cerebral circulation:
Gingko Biloba is very good and very safe. Best brand sold is from Great Earth Vitamins. Go for the tablet in slow dissolve capsules. Expensive but worth it. 100mg 3x daily at least.
Also suggest omega 3 fish oils, ginger, and other herds tied to anti-inflamatory properties. Dr. Weil is a good source of sensible advice on this.
I’m bumping this because my husband is a neurologist and should be home from work around 5:30 (EST).
MRIs are referenced like you’re looking at the top of the person’s head. The lateral margin of the lateral ventricle means the area of tissue where the brain meets the ventricle (which is, after all, just an open space). Radiology reads aren’t designed to explain everything that’s in the MRI, they’re designed to draw your attention to certain things when you’re actually looking at it, so not all the information needed to say more is there.
It is entirely possible that the MRI looks benign. At some point the question becomes one of what knowledge is going to affect. If your blood pressure and cholesterol are under control, knowing there was a small infarct there isn’t going to change medical management at all.
But if not knowing is bothering you then make an appointment with your PCP and ask him to review the MRI or talk to the neurologist first. At the least they can give you an explanation of why they made their decisions.
Do you have a good neurologist? I have one, if you’d like the name and number. (He’s on the near west side - Hillcroft/Voss and San Felipe.)
I’m curious, on your radiologist report, did he give “impressions” of what he thought the lesion might be. I’m assuming he compared the old and new MRIs.
I have MS, so when I see the words, hyperintensity, periventricular and white matter together, I think MS...but you said that had been ruled out...how did they rule it out, an LP?
Why does your neuro assume it’s ischemia (which he obviously does since he wants you on a baby aspirin.) That seems weird to assume that. But what do I know, I’m not a doctor, and I don’t even play one on TV.
You need to get all the medical history from your old neuro doc and get it over to your new doc ASAP. If much of it is electronic, you need to be sure it all gets transferred to the new office and nothing gets lost along the way.
How did you get your new neuro doc anyway? It sound like your primary care doc is not in the loop, which can be a bad thing. He/she can give you some guidance on choosing a new neuro specialist (if you are unhappy with the new doc) rather than picking someone out of the phone book. The new doc needs to be fellowship trained and board certified or at least board eligible.
You should have been scheduled for a return office visit to discuss the results, but since the test was apparently cut short, you should have been rescheduled right away for a repeat test. Be sure you get the test rescheduled and also get the next office visit scheduled for later that same day or the next so you can go over the results item by item with the neuro doc.
I heard about this on the radio. It's amazing how many are without power. p.s. I hope you get well soon.
I’m not asking for a diagnosis or prognosis or treatment or anything. I’m just wondering if I understand correctly the location of this new lesion, and also if my gut instinct to have this looked into further is right (or if I’m just emotional over the new findings).
Clinkclink, thank you.
Rebelyell, I don’t have BP or cholesterol (or weight) issues. My headaches returned in the last couple weeks though, and that reminded me that I was overdue for my MRI, so I went and had one done. I never had headaches before the tumor and they went away after the surgery, so this new neuro telling me it’s nothing, take an aspirin, see me in a year doesn’t sound right to me.
I did call my family doctor’s office after seeing him, but they are out of power too and everyone is gone. I can’t even get a message through. So of course I sit here and worry! I don’t dare talk to my family or friends until I know something. I don’t want to worry them unnecessarily, but I can’t just put it out of my mind either. This is scary stuff!
I’m just blabbering, ignore me. I’m just a bit scared. I went through hell for so long and suffered so much. I’m not ready to have it happen again.
I just saw this neuro today for the first time. I've had the worst luck with doctors. For 2 years they said that thing in my head was nothing, and that my symptoms were B.S. basically. I literally suffered most of that time. It wasn't until I got copies of the MRI reports that I learned that the tumor had more than doubled in size. The neuro said oops, he must have overlooked that!!!
Then all the [new] docs said they couldn't do anything for me, too dangerous. I finally found one by chance who did the surgery and saved my life.
Then I was fine until I had an 8 week headache (among other things) that finally left right around the time hurricane Rita came around. My newer neuro at MD Anderson gave me the same B.S., nothing wrong with me. He was never available and even my family doc couldn't get in touch with him, so she found me another new neuro (Dr. Alpert).
But his office dropped my insurance plan, so last week after my headaches returned I was again left without a neuro until I saw this guy today who says it's no big effing deal, take an effing aspirin.
No, I don't seem to have a good neurologist. FReepmail me with info on yours please.
“Oblong T2 signal hyperintensity is seen extending about 1.5 cm across the left frontal white matter from the periventricular to subcortical location. Adjacent oblong well defined T2 signal extending near the lateral margin of the body of the left lateral ventricle anteriorly noted.
The way I read these two sentences is that #2 describes (to the minimal extent it “describes”) what came to the radiologists notice as being immediately forward of what is described in sentence #1. (adjacent and anterior = next to and forward).
These days, one MUST have a known and trusted family doctor/primary to act as quarterback - otherwise the specialists will toss you back and forth like a frisbee!
The lesion that you have highlighted is next to the one that is described immediately before it.
While it is true that the plaques of multiple sclerosis are bright on T2 weighted images and tend to be next to the ventricles, not everything with this appearance and location is MS. Frequently, MRI reports describe high signal smaller lesions on T2 and FLAIR sequences that are “nonspecific” in terms of pathological or clinical significance and are referred to as “microvascular ischemic change”. This can just be age related change of the white matter but can also be seen in people who have had migraines, high blood pressure or old head injuries among other things.
I agree that you will have to ask your neurologist or a different neurologist to review the study with you and explain the findings as well as the reasoning behind his advice.
I am not a Radiologist, however I am an mri tech for 13+yrs now. I have a question. Did they use gadolineum contrast and did the lesions enhance? As far as ms lesions, it the location of the lesion and the clinical findings as to whether or not they are ms lesions. Many people as they hit middle age will develop small vessel ischemic changes or have mini infarcts anywhere in the brain. they can be dozens of them or one or 2. They usually occur more in the top half of the brain. Also was your brainstem tumor a meningioma?-(benign) I am guessing you probably had an infarct or 2 which is probably why your Dr wants to thin your blood a little , but dont take my word for it as I am just a tech.
Admittedly, I have not seen the scan, but the description of the lesions does not sound like infarctions. Sometimes when the word “ischemic” is used, prescribing daily aspirin is a knee-jerk reaction.
Please e-mail his name and number to me, I am looking for one.
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