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Neurology (Expert Forum)
Need assistance on brain MRI interpretation
Answered by
CCFNeuroMD JT, MD - Neurology/Epilepsy, Neurology/General
Cleveland - OH
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Need assistance on brain MRI interpretation
by StrictlyTopSecret, Jul 06, 2007 12:00AM
Last week, I had a brain MRI (w/ and w/o contrast) for the purpose of shedding some light on some neurological manifestations of lyme disease as well as 2 seizures I had in the past year.
I had a 24-hr EEG a few months ago which showed some unusual activity in the left temporal lobe, but the neurologist said he was going to "technically read it as normal". The purpose for the neuro visit was to see if we could determine why I had a 2nd seizure (had it 10 mins after the initial infusion of Rocephin for the treatment of Lyme disease). An MRI performed after my first seizure (about a year ago) was unremarkable.
In addition, last week I had an ultrasound which revealed a 2.5 x 1.3 x 1.1 cm thyroid nodule with microcalcifications. I am scheduled for an US-guided thyroid nodule biopsy this Monday. I'm not sure whether or not this could relate to the brain MRI findings, but thought it could be significant.
Below, I have appended the three phrases from the MRI report for which I am requesting assistance in interpretation.
Thank you in advance for your input,
1. "There is a punctate focus of abnormal FLAIR and T2 hypersensitivity adjacent to the anterior horn of the left lateral ventricle, which is nonspecific in appearance"
2. "There is a tiny, presumed prominent Virchow-Robin space in the right parietal region"
3. "The cerebellar tonsils are low lying, but do not meet strict criteria for Chiari malformation"
I had a 24-hr EEG a few months ago which showed some unusual activity in the left temporal lobe, but the neurologist said he was going to "technically read it as normal". The purpose for the neuro visit was to see if we could determine why I had a 2nd seizure (had it 10 mins after the initial infusion of Rocephin for the treatment of Lyme disease). An MRI performed after my first seizure (about a year ago) was unremarkable.
In addition, last week I had an ultrasound which revealed a 2.5 x 1.3 x 1.1 cm thyroid nodule with microcalcifications. I am scheduled for an US-guided thyroid nodule biopsy this Monday. I'm not sure whether or not this could relate to the brain MRI findings, but thought it could be significant.
Below, I have appended the three phrases from the MRI report for which I am requesting assistance in interpretation.
Thank you in advance for your input,
1. "There is a punctate focus of abnormal FLAIR and T2 hypersensitivity adjacent to the anterior horn of the left lateral ventricle, which is nonspecific in appearance"
2. "There is a tiny, presumed prominent Virchow-Robin space in the right parietal region"
3. "The cerebellar tonsils are low lying, but do not meet strict criteria for Chiari malformation"
Doctor's Answer
by CCFNeuroMD JT, MD, Nov 11, 2007 08:05PM
, Nov 11, 2007 08:05PM
Dear StrictlyTopSecret-
Please allow me to elaborate on some of the answers provided to you by others. Understand that the following information should be used strictly for educational purposes and that I am unable to diagnose you without having had the ability to examine you and review your films.
To start off with, perhaps a brief explanation of FLAIR and T2 MRI sequences is warranted. Hyperintensity on a T2 sequence basically indicates that the characteristic of the brain tissue in that particular spot differs from the rest of the brain. A bright spot on T2 is rather non-specific and must be interpreted within clinical context. T2 hyperintensities may occur in demyelinating diseases such as multiple sclerosis, in vasculitis (inflammation of the arteries in the brain), in lyme disease- anything with a high water or protein content will tend to appear very bright. The FLAIR sequence is then used to suppress the hyperintense signal produced by water (or cerebrospinal fluid) in the brain. This is especially helpful when looking for lesions around the brain ventricles (which contain cerebrospinal fluid). An isolated T2/FLAIR hyperintensity is fairly nonspecific and of questionable diagnostic significance.
Viirchow-Robin spaces are normal anatomic findings which reflect areas around blood vessels in the brain which function as potential spaces for movement of fluid across the blood vessel walls into the brain. These are synonymous with perivascular spaces.
The cerebellar tonsils are found at the base of the cerebellum and when they lie particularly low, the diagnosis of a Chiari malformation is made. Patient's with Chiari malformation generally have severe intractable headaches.
Although I agree that an MRI can be useful in evaluating seizure, MRI is often unremarkable in patients with seizures. In your case, the MRI report you provided does not seem to indicate any obvious lesion causing your seizures. Please realize that not all MRI's are created equal. Sometimes, epileptogenic lesions may be so small/subtle that special epilepsy sequences using super-thin cuts through the temporal lobe and a stronger MRI magnet may be required to identify a lesion. Should you continue to have problems with seizures, you might benefit from evaluation at an epilepsy center such as the one at the Cleveland Clinic. Best of luck, and thank you for your question.
Please allow me to elaborate on some of the answers provided to you by others. Understand that the following information should be used strictly for educational purposes and that I am unable to diagnose you without having had the ability to examine you and review your films.
To start off with, perhaps a brief explanation of FLAIR and T2 MRI sequences is warranted. Hyperintensity on a T2 sequence basically indicates that the characteristic of the brain tissue in that particular spot differs from the rest of the brain. A bright spot on T2 is rather non-specific and must be interpreted within clinical context. T2 hyperintensities may occur in demyelinating diseases such as multiple sclerosis, in vasculitis (inflammation of the arteries in the brain), in lyme disease- anything with a high water or protein content will tend to appear very bright. The FLAIR sequence is then used to suppress the hyperintense signal produced by water (or cerebrospinal fluid) in the brain. This is especially helpful when looking for lesions around the brain ventricles (which contain cerebrospinal fluid). An isolated T2/FLAIR hyperintensity is fairly nonspecific and of questionable diagnostic significance.
Viirchow-Robin spaces are normal anatomic findings which reflect areas around blood vessels in the brain which function as potential spaces for movement of fluid across the blood vessel walls into the brain. These are synonymous with perivascular spaces.
The cerebellar tonsils are found at the base of the cerebellum and when they lie particularly low, the diagnosis of a Chiari malformation is made. Patient's with Chiari malformation generally have severe intractable headaches.
Although I agree that an MRI can be useful in evaluating seizure, MRI is often unremarkable in patients with seizures. In your case, the MRI report you provided does not seem to indicate any obvious lesion causing your seizures. Please realize that not all MRI's are created equal. Sometimes, epileptogenic lesions may be so small/subtle that special epilepsy sequences using super-thin cuts through the temporal lobe and a stronger MRI magnet may be required to identify a lesion. Should you continue to have problems with seizures, you might benefit from evaluation at an epilepsy center such as the one at the Cleveland Clinic. Best of luck, and thank you for your question.
Member Comments (3)
by StrictlyTopSecret, Jul 06, 2007 12:00AM
p.s. I am a 40 year old female. There is a family hx of thyroid disease (my US guided thyroid biopsy is scheduled for this Monday) as well as cancer.
by vega1318, Jul 08, 2007 12:00AM
Your MRI looks ok, nothing that would explain your seizures. It is common to get seizures after certain infusions, and Rocephin is not an exception. Thyroid cancer (not that you have it) can sometimes go to the brain but there is no evidence of it on the MRI.
