Case History => male 48. Giddiness (last 10-12 years) while getting up suddenly from sitting position, may be once in 2 months. Nuchal pain off & on - increased in last 2 months. Had 2 episodes (the second immediately within may be 5-10 seconds after the first) of unresponsiveness (fell down) early morning on 28th January, 2008 after getting up from sleep and micturating. Hyperasthesia over the left lower limb off & on - but no complain now. Sleep (N), Anxiety (+).
Consulted neurologist on 10th March, 2008 & her Investigation findings are =>
ECG and EEG => Normal
Pressure => BP 120/80mmHg (lying) & 114/80mmHg (standing).
CT Scan of Brain (Plain) => Done on 10th March : A hypo dense lesion is seen in the right frontal parasagittal region. No mass effect is seen. Third and lateral ventricles are normal. Cerebral sluci, sylvian fissures and interhemispheric fissures are normal. Cerebellum & brainstem are normal. Fourth ventricle is in midline and is normal in size. Basal cisterns are normally visualised and are not compressed or obliterated. Both C.P. angles are normal. Pituitary fossa is normal. Supraseller regions are normal. Bones under review are normal. Impression :: Right Frontal Parasagittal Gliotic Lesion.
Provisional diagnosis by neurologist on 11th March =>
(1) MICTURITION SYNCOPE
(2) Right Frontal Gliosis under evaluation (advise MRI of Brian and review thereafter)
Multiplanar multiecho MRI of the brain => Done on 28th March : A lesion appearing hyperintense in T2 weighted images and hypointense in T1 weighted images is seen in the right frontal parasagittal region. This lesion shows hypointense signal centrally and hyperintense signal peripherally in FLAIR images. No mass effect is seen. Third and lateral ventricles are normal. Cerebral sulci show mild prominence. Cerebellar hemispheres, brainstem, aquaduct of sylvius and fourth ventricle are normal. Basal cisterns appear normal. Cerebello-pontile angles appear normal with no evidence of space occupying lesions. Sella and the supraseller regions are normal. Size and signal intensity of pituitary gland appear normal. Impression :: Focal Gliotic Lesion in the Right Parasagittal Region. Mild prominence of the cerebral sulci.
Final diagnosis by neurologist on 29th March => Right frontal gliosis. If any recurrence of syncope / unexplained LOC, to come back for institution of antiepileptic drug therapy.
My querry, please => What does the presence of the focal gliotic lesion indicate? What are the possible reasons for the gliotic lesion? Can the lesion arise out of injury during the syncope of 28th Jan'08 (i.e., within 40 days of the incident) Can this be a case of "mini stroke" though the neurologist has ruled that out from the MRI? Is the mild prominence of the cerebral sulci due to aging only as indicated by the neurologist? Do I require further follow-up investigation?
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