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Neurology (Expert Forum)
6 month Follow up craniotomy MRI questions
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6 month Follow up craniotomy MRI questions
by aireamdh, Dec 26, 2005 12:00AM
Thanks for taking this query. I am 48 yr old F, right convexity
meningioma abt.3 cm. DX 4/05. Craniotomy 5/12/05. Since, also finally diagnosed Hashimotos hypothyroid 10/05 after further odd neuro symptoms. Hope you can explain this MRI and what it might mean to me. Very happy no recurrence /no residual, but other sections of report have me worried. Particularly the mention of ischemia and encephalomalacia. Neither NS nor PC seem very concerned.
MRI with and w/o contrast. Compared to prior study 5/13/05. In
interval there has been an area of ischemia in the posterior left
frontal lobe with now a small area of residual encephalomalacia at
the frontoparietal boundary. This beneath a right parietal
craniotomy. No evidence of residual or recurrent tumor. Remainder of
brain is normal w/no additional mass or abnormal enhancement.
Ventricles are normal in size. No extra axial fluid collections. Flow voids are present in major arteries and dural sinuses.
meningioma abt.3 cm. DX 4/05. Craniotomy 5/12/05. Since, also finally diagnosed Hashimotos hypothyroid 10/05 after further odd neuro symptoms. Hope you can explain this MRI and what it might mean to me. Very happy no recurrence /no residual, but other sections of report have me worried. Particularly the mention of ischemia and encephalomalacia. Neither NS nor PC seem very concerned.
MRI with and w/o contrast. Compared to prior study 5/13/05. In
interval there has been an area of ischemia in the posterior left
frontal lobe with now a small area of residual encephalomalacia at
the frontoparietal boundary. This beneath a right parietal
craniotomy. No evidence of residual or recurrent tumor. Remainder of
brain is normal w/no additional mass or abnormal enhancement.
Ventricles are normal in size. No extra axial fluid collections. Flow voids are present in major arteries and dural sinuses.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Dec 29, 2005 12:00AM
I cannot give you a formal opinion without seeing teh MRI, so my comments are limited by the text of the report
Its not clear from teh report whether this is just an expected appearance due to the surgery done in this region (which may well be the case) or whether this is non-contiguous with the area of surgery and therefore may be a prior stroke. Encephalomalacia just means 'a hole' and there probaly is one ther from the surgery!. Ischemia is too specific a term, and it may mean that there is some 'high signal' in that area, which could also be from surgery. Icannot tell which from here. Have your doctors clarify this for you with the radiologist. The 'prior study' seems to have been done only one day after the surgey but further changes can occur as the brain recovers and settles down after surgery which may acount for the difference also. If it is a stroke though you should be evaluated further
Good luck
Its not clear from teh report whether this is just an expected appearance due to the surgery done in this region (which may well be the case) or whether this is non-contiguous with the area of surgery and therefore may be a prior stroke. Encephalomalacia just means 'a hole' and there probaly is one ther from the surgery!. Ischemia is too specific a term, and it may mean that there is some 'high signal' in that area, which could also be from surgery. Icannot tell which from here. Have your doctors clarify this for you with the radiologist. The 'prior study' seems to have been done only one day after the surgey but further changes can occur as the brain recovers and settles down after surgery which may acount for the difference also. If it is a stroke though you should be evaluated further
Good luck
Had "sensory seizure" in April which was thought to be a stroke at first.Entire left side went into a dead sort of numbness. ER workup and MRI determined the tumor. Had one more episode of this shortly after surgery. Similar but not same symptoms later were termed "episodes". Both NS and neurologist determined these were not seizures. Most of that has abated (numbness in parts left arm). Do continue to have mild numbness/weakness/pain. ongoing basis in left arm and hand. Had NO use of this arm directly after surgery. Rehab a tremendous help there. What I have now there is termed residual weakness from surgery. Began bilateral face/chin numbness in July, mentioned this in earlier query. Also pins/needles in feet. Bouts of terrible fatigue (worse than after surgery) began near the same time in July. Also mild twitching at night jsut before sleep. Then sudden weight gain more than 20 lb, other symptomslike memory problems. It was here I was advised request thyroid check in Augist.
Had GYN yearly scheduled, he initially refused to do any sort of work up, blaming all on brain surgery. I insisted he at least do
a basic TSH which was mildly elavated. Neurologist sent me to endo, TSH was up to nearly 57 by then. Anti bodies were over 8,000. So I thank you for initially giving me idea to have thyroid check. Seeking new GYN :)
Neuro told me hypothyroid can cause neurological symptoms, so its hard to tell sometimes which is from surgery/which from thyroid. Many of these are better from thyroid meds, but symptoms tend to return because the dose is being upped very slowly. Sorry to have gone on, but wanted to give a better picture. Looking forward to understanding more of what that MRI means. Thank you.