CAT scan report

[proudhockeymama]

My 16 yr. old daughter has been having migraines since she was about 13. There is a family history of migraines.  Most recently they have increased in frequency and intensity.  MOST disturbing, is that they have now been accompanied by SEVERE nose bleeds that can take up to 45 minutes to stop.  During one of these episodes I rushed her to the emergency dept. They did a CAT scan and referred us to a pediatrician within the hospital I took her to, (she does have a family doctor but they suggested we see this pediatrician).  We have recently received the results of the CAT scan they did in the emerg. dept. and yesterday the pediatrician referred her to a pediatric neurologist.  She is scheduled for an MRI based on the results of the CAT scan.  The MRI is scheduled for March and the appt. with the neurologist is set for the week after the MRI.  she has also been referred to an Ear/nose/throat specialist as they say that the blood vessels and veins in her nose are "fragile & bulging". The pediatrician printed out a copy of the CAT scan report for us.  Unfortunately I don't understand the report, and although the pediatrician tried to explain as best she could she wasn't able to translate it into something I comprehend.  Could you please explain the following comments in terms I might understand.  Looking up the various terms on the internet makes things look worse than they probably are!! Here are the findings on the report.  "There is hypoattenuation within the high left parietal lobe which is not specific, possibly ischemic, possibly due to white matter disease"  A translation of that possible diagnosis would be greatly appreciated!!  FYI, she is a high level hockey player and was knocked out in a game over a year ago.  She was diagnosed with a 2nd degree concussion.  Last May she had an "episode" which was diagnosed as vertigo. Thank you for any assistance you can offer in the translation of those daunting words in the report.  March seems such a LONG way off and as you can understand we are VERY concerned about her.

[DrNoopurMD]

Hi There,

I can understand the anxiety and tension that you have right now. Please relax, if the nose bleeds were due to fragile bulging veins, they can be easily cauterized to prevent recurrence.

As far as the CT scan findings are concerned, there are some changes in the white matter in the parietal region of the brain. These white matter changes could have occurred due to blockade of small blood vessels in the brain resulting in ischemia or they may even be due to white matter disease. White mater disease simply refers to some changes in the white matter which can occur due to chronic headaches, migraines, hypertension, diabetes, stroke, and previous infections in the brain.

http://stroke.about.com/b/2008/07/22/white-matter-disease.htm

It is important to correlate these findings with her neurological examination to arrive at a diagnosis.
I wish you good luck and let us know if you have further questions.

[tomsant]

Episodic headache and bleeding nose in 16 F, for 3 yr. ("Migraines" professionally diagnosed, or your conclusion?)

Nosebleeds associated with 'migraines'? : We have to consider situations which can cause headache along with nosebleeds. Has her BP been checked during such episodes? Also has lab tests in a case of bleeding been done? Hope her monthly periods are fine.

Fragile and bulging blood vessels in nose: These are found in many 'bleeding noses' and sometimes these bleeding points need to be cauterized (burnt) to make a scar so that it is sealed off (but some can recur). What was the ENT's recommendation? A cauterization of these points? Or leave it alone? Or further investigations?

CT scan report: Okay, you must understand that these are conclusions from black, gray and white images and you have toleave the final opinion to your neuro. What you have quoted just means that the left parietal lobe of the brain (the left side top of brain) looks a bit different from the usual, but this may be not point to any specific illness, or may be due to poor blood supply to that region (ischemic) or due to white matter disease (The brain tissue is broadly divided by its color into gray matter and white matter; gray matter mainly contains never cells and covers the outside while white matter composed mostly of nerve fibers, is inside) If the neuro doesn't find anything to correlate this observation, he may ignore it.

(But I wonder how this is related to the nosebleed.)

Hope MRI will throw more light into the 'white matter' area, the headache, the concussion she had a year back, and the vertigo in May.

You are her mom, and we can appreciate how concerned you will be. But try to reassure yourself, you live in a part of the world with very advanced facilities, if needed.

Best rgds and Godspeed,

Thomas Antony