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MRI interpretation - focal seizure
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MRI interpretation - focal seizure

I was recently diagnosed with focal seizures coming from the left side of my brain.  The eeg stated left temporal eliptogenic focus. Then an MRI was done which stated there is a 6mm focus of left frontal deep white matter t2 hyperintensity, not assocaited with enhancement or restricted diffusion.  The doctors keep asking me if I fell or hit my head, but I can't remember anything recently or much in the past.  I am 34, in  good health, I only remember when I was about 7 I fell on my head off the monkey bars, but it wasn't severe.

The medication has controlled the seizures.  But, Could this just be scar tissue causing the seizures and can it go away? What does the MRI mean? How can this come up at age 34?

Also. I had originally thought my symptoms were hormal. Hotflashes, warm tingling feelings, wave sensations. I was on the pill for several years. I stopped the pill and the symptoms seemed to become less. How could the pill hormones contribute to the seizure symtpoms?

Thanks for your help!
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Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a detailed history, I can not tell you what the exact cause of your symptoms is or how to treat them. However I will try to provide you with some useful information.
Without being able to see the MRI it is difficult for me to say what it is, or how associated it is with your problems. MRI is a very sensitive tool that sometimes shows abnormalities that are very small and subtle, and they should be correlated with the patient’s symptoms. T2 hyperintensities in the MRI depending on the clinical context, and depending on how it looks, can represent multiple conditions. Patients with a previous stroke in this region can have a residual T2 hyperintensity. Some congenital problems can be seen later in life as a T2 abnormality. It can also be a vascular abnormality or a CSF space, or even can be associated with conditions like Multiple Sclerosis. However the MRI appearance is important, as these lesions can be T2 hyperintensities, but sometimes may look different depending on each condition. It may also represent previous trauma, as you have been told, or may be a silent abnormality.
When a patient has focal seizures, it is important to determine if there is an underlying lesion. In your case, the T2 hyperintensity. Both are on the left side, however without seeing the EEG and the MRI, it is difficult to correlate both in space. It is possible that the MRI abnormality could be causing the seizures, but I cannot be sure about this. Some institutions can perform EEGs with very good spatial resolution and correlate the origin of spikes (seizure origin) with the region where the abnormality is seen in the MRI. If both abnormalities correlate in space, we can say with more certainty that the lesion can be causing the seizures.
In your case, it may be important to determine the cause of the lesion. As I said, sometimes the lesion looks benign, and no further testing may be required. However Multiple sclerosis can produce T2 lesions in the white matter, and it may be important to do further work up, like a Lumbar Puncture to send studies for MS.
I think you should discuss your concerns with your neurologist, and determine if the T2 lesion that you have correlates with the focus of the seizures, and to determine if further studies are needed to look for the cause of the T2 abnormalities. It is also important to understand that we as physicians treat patients and not studies, and therefore the clinical correlation is very important, and should guide the decision of doing further tests.
I hope this information is useful.
2 Comments
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Avatar_f_tn
Thanks for the response. It was helpful.  The neurologist did correlate the EEG with the MRI location on the left side of my head. I had been having dizziness, auras, and wave feelings as symptoms.  The Doctor will be performing another MRI and EEG in 3 months to follow up.  

Thanks again. This is a great service!
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