Old bleed found on MRI, headaches and confusion

[rytiffin]

In 1995 I had 15% of the left upper side of the brain removed.  The bleed was a venous bleed.  The doctor at the time felt it was the result of dead tissue around the vein breaking down and the pressure became greater than the supporting tissue, thus the bleed.  The cause for the bleed was due to a high impact car accident when I was a teenager.  I was told that in the continuing years I would need to have an MRI done every year to check for future bleeding and problems that may arise.  

Around six months ago I was starting to have sharp painful headaches that would last a minute and then go away as fast as they came.  I was also encountering trouble with my hearing and I became more agitated and confused than what I normally encountered since the surgery and I would have seizures in which I would blank out and not remember anything and sometimes get violent with them.  I went to the neurologist and was sent for an MRI and it showed that I had a spot on the brain in the area that was removed.  The doctor said it could be the cause from an old bleed.  I am concerned about this since this is why I had to have brain surgery to begin with.  I had an MRI done three years previously and nothing was found.  The neurologist at the time told me that the brain was improving and looking good.  

I also had a CT done a couple months after the MRI and was told that came out fine.  The neurologist told me that a CT is better at showing new bleeding and a MRI is better at showing an old bleed and that is why the CT probably didn

[CCF-Neuro-M.D.-PW]

I cannot give you the best opinion without seeing your scans directly

what I get from your story is ?you had a traumatic brain injury from the accident, then a further bleed in 1995 requiring another brain surgery. Was there any evidence that there was an underlying vascular malformation (for example by an angiogram or MRI appearance).

When the MRI images old blood the MRI signal comes from iron left in the tissue from the breakdown of blood. This usually remains for a long long time. Certain type of MRI images (such as 'gradient echo') are very good at picking this up - but it does not mean that there is a new problem. Blood that is not chronic, but up to several weeks old will appear differently on MRI, allowing the distinction between blood that is new to several weeks old, or the residua of an old bleed. The old bleed or trauma could have the potential to cause seizures as seems to be the case, but should not have a significantly increased risk of bleeding unless there was an underlying vascular malformation. An angiogram could answer this question

I dont know why the old bleed is showing up on the MRI now. As I mentioned earlier certain types of MRI scans are more sensitive at picking up blood, and there is some variability in the quality of the scan and its interpretation.

Good luck

[rytiffin]

I forgot to mention that the headaches I was encountering went away at first but now they're back.  The reason I sleep so much is from the headaches.  Nothing seems to make the headaches go away.