Re: Your Response to My Question Re: Epilepsy

Posted By ccf neuro M.D. on May 25, 1997 at 21:23:21:

In Reply to: Re: Your Response to My Question Re:  Epilepsy posted by Merton S Zatman on May 19, 1997 at 09:16:00:







: Dear Friends
Your so very speedy response to my enquiry about my MRI scan was very helpful and certainly served to put my mind at ease
Believe it or not, I have only within the last hour received a copy of the MRI report which reads as follows;-
" MR Angio Head
Normal
MRI Head
There are a few non-specific foci of signal change within the cerebral white matter. The right lateral ventricle is dilated in its mid portion and is associated with linear periventricular signal change, suggestive of an old mature ischaemic lesion. No vascular abnormality has been demonstrated."
Quite apart from not understanding it, I hope to see the consultant this evening when perhaps he may explain it, I find it difficult to reconcile this with the EEG report where the comment commenced by saying "Unequivocally abnormal ". I thoght this to be quite strong and specific language and highly contrary to what the MRI report says.
Is it reasonable that there may be such a strong contradiction?
Many thanks

Merton






Merton, The MRI report is quite interesting in that it does appear to suggest a chronic abnormality (likely an old area of stroke or brain injury) in the right frontal area of your brain, where the EEG suggested a structural lesion. Have you ever had a stroke, or car accident with head injury in the past--- even remote past? If so, this subtle area of abnormaility may be the leftover clue of its prior occurrence (remember, as I stated before, lesions in this area of the brain are often clinically asymptomatic)radiographically, and the epilepsy its leftover clinical clue, likely secondary to microscopic scarring in the affected area of the brain where the insult occurred. The normal MRA of the brain is very reassuring that you do not have significant intracranial vascular disease. Presumably the extracranial portions of the carotid arteries have been looked at as well with a carotid artery ultrasound to exclude the possibility of atherosclerosis there as the source of a potential clinically silent old stroke. If you have any risk factors for atherosclerosis and heart disease such as hypertension (high blood pressure), a high cholesterol level, diabetes, smoking, or a strong family histroy, your heart needs to be checked out, as sometimes clots form in the chambers of the heart and are pumped out to the brain where they cause strokes. If this was the first symptom of such a problem, the sooner it is detected and treated the better, as the risk for future clots forming would potentially exist. An EKG and echocardiogram are reasonable tests to exclude such things, if you or your physicians have any reason to suspect them. Certainly the EEG and MRI reprts are compatable with each other--- sometimes an abnormality that is radiographically subtle can be physiologically or electrically more pronounced, and vice versa--- one measures visible evidence of damage and the other actual FUNCTION of the affected portion of brain--- the information they provide thus complement each other, even if superficially contradictory.