Sudden seizures of body parts

[Ramesh-Purohit]

  Hi,
  The following MR ANGIOGRAM report is of my father send to me
  from india. He had few complaints of giddiness, and had 3 sudden
  seizures of leg (right), hand(right) on tongue in over 1 year
  period.
  I will appreciate if somebody can explain me the exact cause
  of this problem and available options for medical treatment.
  I apologize for any typing or spelling errors.
  Thank you very much.
  -Ramesh
  ====================================================
  PERSONAL DETAILS
  =================
  Sex- MALE, Age-50 Yr.,
  Family History- His father had acute Asthma in old age.
  CHIEF COMPLAINT
  ================
  Giddiness one-year back. Difficulty in speaking.
  Tingling sensation on right side of body since one month.
  MR ANGIOGRAM
  ==============
  MR Angiography of the intracranial arteries was performed
  using 3D time of flight technique with TONE and MOTSA. The
  neck vessels were examined using 2D time of flight technique.
  An additional T2 weighted sequence was performed through the
  brain.
  A well-defined focal hyper intensity is seen with the mild left
  Parasaggital frontal region, extending inferiority involving
  the body ofcorpus callosum and mildly indenting the medial
  body of left lateral ventricle. Small focal hyper intensity is
  seen within the right posterior parieto-occipital subcortical
  lesion. Cerebellum, brainstem and rest of the cerebral parenchyma
  appear normal.  Mild prominence of ventricles, cisterns and
  sulci noted suggesting age related  parenchymal atrophy.
  Incidentally bilateral inflammatory soft tissue noted within
  maxillary, ethmoid and frontal sinuses with a well-defined
  hypointense soft tissue within left maxillary sinus.
  Intracranial internal carotid arteries, middle cerebral arteries
  and left anterior cerebral artery appear normal.
  Al segment of right anterior cerebral artery appears hypoplastic.
  Both common carotid arteries and external carotid arteries are
  normal. Mild stenosis of both internal carotid arteries at their
  origin. Right posterior cerebral artery has fetal supply. Left
  posterior cerebral and basilar appears normal. Right vertebral
  artery smaller than left - normal variant.
  CONCLUSION
  ============
  Fairly recent onset anterior cerebral artery infarct within left
  parasaggital frontal region extending inferiority to involve
  the body of corpus callosum and mildly effecting the medial portion
  of body of left lateral ventricle.
  Mild parenchymal atrophy. Maxillary, ethmoid and frontal sinusitis.
  Mild stenosis of both internal carotid arteries at their origins.
  PRESCRIPTION (As available in India)
  =============
  Tab EWSPRIN (150) CONTINUE
  Tab NUTRISAN " "
  Tab TRENTAL (400) 1 MONTH
  =================================================================
Dear Ramesah,
The MRI report, per their final interpretation, is describing a "stroke" on the left, frontal part of the brain.  The body of the reports also describes as area on the right; but they do not define this further in the final conclusion.  I am unable to comment without looking at the films.  The angiogram, from their report description, did not find any specific areas of blockage.  There is mild narrowing of the carotids (arteries in the neck) and some congentital changes (presence of fetal PCA, hypoplastic aca).  These are the important points of the report.  The rest just describes the sequences the films were takes and general descriptions of other areas of the brain.  Also, the area involved on the left frontal region could cause speech changes and numbness on the right side of the body.  In general, workup/management, should include workup for the source of the stroke (EKG, echocardiogram, labs) and good neurological  exam (to define the extent of defecit).  Management depends on the source of the stroke.  Trental is a medication that works on platelets.  In the US, it is not our first drug of choice. Alternatives include Ticlid, Plavix, or aspirin.  I am not familiar with the other two drugs that you listed.  If not already done, I recommend an evaluation by a neurologist.  Discuss working up the cause of the stroke and medication for prophalaxis.  good Luck.