perfusion/diffusion scan

  I have two questions --
       1. I was put on Dilantin for presumed seizure activity. Into day three         on the Dilantin I developed an ataxic gait. When my level was              checked that week it was 18.5. Have you seen a Pt. develop an              ataxic gait with a level that was in the theraputic range? I am            off it now and feeling fine.
       2. I have a 1 cm lesion in my occipital lobe which does not enhance           much wiht contrast. The consensus seems to be to watch the lesion          with repeat MRIs every 3 months. Most docs I have seen agree on            plan except for the neuroncologist who looked at the results of            my perfusion/diffusion test and saw that there was increased               perfusion to the area of the lesion and recommended me immediately         to a surgeon. I know that this test is fairly new and used by few          for diagnostic reasons. Now I am stuck with having to decide if I          should go ahead with surgery or not. What is your understanding            this method?
                                      Thanks, Laurie 26 yrs. old

[CCF neurology MD MM]

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The resonse to dilantin like the response to any chemical is very variable
between individuals, the varying response to alcohol is a good everyday
example. This reaction at a theraputic level is not all that unusual .
The perfusion scan reveals the degree of blood flow around a lesion in the
brain, the fact that this is enhanced suggests that the lesion may not
be as inactive as previously thought and would certainly prompt
consideration of early surgery as opposed to the wait and see approach.
This si a small lesion which can be easily treated at this stage regardless of its
exact nature, if a neuro-oncologist has expressed concern I would advise
that you seek a surgical opinion as suggested.