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MRI Brain Interpretation
Hello Everyone, could someone please expand upon these results.
SYMPTOMS:
tension headache 9 months+, tinnitus.
cognitive dysfunction: impairment of memory, slow thinking, dysthymia, tired.
I am 24/male/caucasian generally in good spirits and never depressed but just feel like crap 24/7.
Current suspicions are Toxoplasmosis or CSF fungal infection. I have not been tested for either, yet.
---------------------------------------------
Narrative
MRI HEAD WITH AND WITHOUT CONTRAST 07/26/2010
TECHNIQUE:Routine brain MRI with and without IV MultiHance contrast..
FINDINGS:
Brain and CSF-spaces: There multiple tiny round T2 hypointense foci
scattered in both cerebral hemispheres right greater left with at least 20
such lesions seen. T2 and FLAIR images do not demonstrate abnormal signal
in the temporal regions.
Diffusion: No abnormalities.
Cerebellum: Normal.
Brainstem: Normal.
Pituitary: Normal.
Vasculature: No occlusions noted.
Otomastoid findings: Normal.
Orbits: Normal.
Paranasal sinuses: Normal.
IMPRESSION:
1. Multiple, punctate T2 hyperintense foci in the brain as above. The
appearance is suggestive of amyloid deposition but this would be unusual in
a patient of this age. Other etiologies include prior trauma or congenital
infection.
2. Typical MR findings of encephalitis or meningitis not identified.
SYMPTOMS:
tension headache 9 months+, tinnitus.
cognitive dysfunction: impairment of memory, slow thinking, dysthymia, tired.
I am 24/male/caucasian generally in good spirits and never depressed but just feel like crap 24/7.
Current suspicions are Toxoplasmosis or CSF fungal infection. I have not been tested for either, yet.
---------------------------------------------
Narrative
MRI HEAD WITH AND WITHOUT CONTRAST 07/26/2010
TECHNIQUE:Routine brain MRI with and without IV MultiHance contrast..
FINDINGS:
Brain and CSF-spaces: There multiple tiny round T2 hypointense foci
scattered in both cerebral hemispheres right greater left with at least 20
such lesions seen. T2 and FLAIR images do not demonstrate abnormal signal
in the temporal regions.
Diffusion: No abnormalities.
Cerebellum: Normal.
Brainstem: Normal.
Pituitary: Normal.
Vasculature: No occlusions noted.
Otomastoid findings: Normal.
Orbits: Normal.
Paranasal sinuses: Normal.
IMPRESSION:
1. Multiple, punctate T2 hyperintense foci in the brain as above. The
appearance is suggestive of amyloid deposition but this would be unusual in
a patient of this age. Other etiologies include prior trauma or congenital
infection.
2. Typical MR findings of encephalitis or meningitis not identified.
Best Answer
quick update:
Hi all, I'm back from the beaches of Florida; spending two months out in the sun felt really great. Getting away from everything and having total relaxation. But unfortunately this did nothing for my nearly year long chronic daily headache and fatigue. But I do have an unbeatable tan! I swam nearly every day in the gulf and drank as I pleased.
Considering the gambit of doctors test that remain unremarkable and all tests point to nothing is wrong. I'm at the point where I want the 'shot in the dark' treatments. Yet, most of my doctors remain reluctant to treat without any signs of infection or disease. I've given this time, it's been long enough. I'm at a loss for words and steadily reaching the apex of hope and despair. meh :/
Hi all, I'm back from the beaches of Florida; spending two months out in the sun felt really great. Getting away from everything and having total relaxation. But unfortunately this did nothing for my nearly year long chronic daily headache and fatigue. But I do have an unbeatable tan! I swam nearly every day in the gulf and drank as I pleased.
Considering the gambit of doctors test that remain unremarkable and all tests point to nothing is wrong. I'm at the point where I want the 'shot in the dark' treatments. Yet, most of my doctors remain reluctant to treat without any signs of infection or disease. I've given this time, it's been long enough. I'm at a loss for words and steadily reaching the apex of hope and despair. meh :/
For what its worth I do apprecaite your insight, and emotions can have an ignored undercurrent inside every self-proclaimed rational person. I'll be taking an extended vacation to kinda clear my head and get away from the daily grind, while catching up on some sun at the beach. until next time, take care
I wish I could offer you some more insight...but unfortunately my experiences are primarily with medical imaging, so it's not really fair of me to speculate much beyond that.
It is possible that the hypodensities on your MR could be trauma related, a T2-GRE sequence would show if it was hemosiderin deposition from prior hemorrhage...this sequence is very sensitive.
I will tell you, however, from both personal and clinical experiences....Generalized symptoms are very, very difficult to diagnose as there is a tremendous amount of cross over. However, usually common things are common, and the real zebras such as toxo or fungal meningitis are clinically unlikely outside of the setting of AIDS/HIV, and there are probably more common simpler explanations for your symtoms. Also remember that not all symptoms necissarily stem from one process, and further more the brain is a powerful mimiker, and though none of us ever want to feel like things are psychosomatic, there are times in all of our lives where we experience things that are "all in our head".
Though I also consider myself a pragmatic well grounded person...and believe it or not some similarities in background as I am an avid PHP/Javascript/Mysql coder...I can also tell you from personal experience that you always have to consider that nearly any symptom (especially constitutional ones) may be exacerbated if not manufactured by our brains...
Unfortunately, an internet forum is not the easiest or most straight forward place to get answers to complex questions...I hope that this has helped you some, and please understand I mean absolutely no disrespect by mentioning psychosomatic as a possible etiology of your symptoms...but as a rational well reasoned person something that you should always keep in mind regardless.
I wish you the best of luck in sorting this out. It is imperative to continue follow-up with your doctor.
One other piece of advice...be patient with your doctors as they work up your symptoms, it is unlikely that anyone will have an ahaa and tell you exactly what is wrong on the first visit, and likely it will take quite some time to try and sort out your symtoms with several dead ends along the way. Try not to get frustrated, and understand that is all part of the normal medical diagnostic process for many illnesses.
It is possible that the hypodensities on your MR could be trauma related, a T2-GRE sequence would show if it was hemosiderin deposition from prior hemorrhage...this sequence is very sensitive.
I will tell you, however, from both personal and clinical experiences....Generalized symptoms are very, very difficult to diagnose as there is a tremendous amount of cross over. However, usually common things are common, and the real zebras such as toxo or fungal meningitis are clinically unlikely outside of the setting of AIDS/HIV, and there are probably more common simpler explanations for your symtoms. Also remember that not all symptoms necissarily stem from one process, and further more the brain is a powerful mimiker, and though none of us ever want to feel like things are psychosomatic, there are times in all of our lives where we experience things that are "all in our head".
Though I also consider myself a pragmatic well grounded person...and believe it or not some similarities in background as I am an avid PHP/Javascript/Mysql coder...I can also tell you from personal experience that you always have to consider that nearly any symptom (especially constitutional ones) may be exacerbated if not manufactured by our brains...
Unfortunately, an internet forum is not the easiest or most straight forward place to get answers to complex questions...I hope that this has helped you some, and please understand I mean absolutely no disrespect by mentioning psychosomatic as a possible etiology of your symptoms...but as a rational well reasoned person something that you should always keep in mind regardless.
I wish you the best of luck in sorting this out. It is imperative to continue follow-up with your doctor.
One other piece of advice...be patient with your doctors as they work up your symptoms, it is unlikely that anyone will have an ahaa and tell you exactly what is wrong on the first visit, and likely it will take quite some time to try and sort out your symtoms with several dead ends along the way. Try not to get frustrated, and understand that is all part of the normal medical diagnostic process for many illnesses.
thank you Sir for the quick response.
this is my 'can of worms':
Toxo and Fungal Meningitis are conclusions I've derived at, not my doctors. It would seem odd to jump directly to this outcome but through the process of elimination from test results and attempted Rx I've come to those two possibilities; I'm always open for other options. My GP, Neurologist, Infestious Disease docs are clueless as to what could be the root cause of my headaches & cognitive dysfunction.
"There are other things that can cause T2 hypointensity such as areas of dense calcium or areas of increased iron such as hemosiderin from prior bleed"
While in the Military 3 years ago I suffered a TBI with intracranial hemorrhages w/skull fracture, LOC & multiple contusions. I'm limited on documention from that event but I'm assuming this would be a fair bet as to why the T2 hypointensity exist. But I cannot stress enough how I feel this is not related to my current ailments. I recovered surprisingly quickly from this TBI and never had any unusual headaches until recently.
Note:
I'm a US citizen and lived overseas for 4 years: in South Korea 1yr, Japan for 3 yrs.
I started falling apart cognitively about a year and a half ago, about the time I started taking Aldara for MC and Adderall for ADHD and I have progressively worsened since then. It has gotten to the point where I forced myself to drop out of college this semester. And this is the last thing I wanted to do. School is my life and I enjoy it very much, but my health is usurping my abilities to perform well in school.
My immume system has been suppressed / altered by two Rx in the past year and a half.
Fall '09; Over used topical Aldara to treat Mulloscum, treatment lasted 4 months. clear MC but developed a chronic case of Tinea Versicolor.
Fall '10; Used Prednisone for almost 2 months. Started with 100mg then tapered. did not help symptoms and developed Tinnitus.
Current Rx:
Ibuprofen 800mg
Current Diet:
past 6 wks: salad and protein; no sugar, low carb
Testing:
All STD's - unremarkable
CBC - mostly unremarkable
Tyroid - unremarkable
EBV - showed reactivation(active IgM). retested ~2 months ago(IgM no longer active)
CMV - unremarkable
Urinalysis - unremarkable
Hepatitis C, B - unremarkable
Diabetes - unremarkable
Lymes - unremarkable
MRI Head - noted
MRI Cervical Spine - unremarkable
Blood Culture for fungal - unremarkable
Spinal Tap(not cultured) - unremarkable
*Neurolgist ruled out Magrines
Anecdote:
Summer '10 developed shingles on chest. Dermatologist perscribed Acyclovir: 800mg 5xdaily for 2wks. This did clear up the rash fairly quickly, however.
For the first 2 days of treatment I thought I was cured of all my cognitive symptoms(very unexpected). I felt smart again(able to think quickly on my feet and follow the Professor in Calculus class) I felt normal, extremely energized(ran for 1 hour outside) usually only run for 30mins x4 weekly and overall very happy. I felt like a different person for only those first 2 days when I took the Acyclovir. This has never happened before in my life and not since.
~1 day after finishing the 2wk course of Acyclovir I developed this Tension type Headache that hasn't gone away since.
For the past year and a half I've been good spirited but abnormally fatigued, more cognitively then physically. And no, I'm not a hypocondriac. I try my best to be logical minded, my major is Computer Science, its just my thought process. I'm also a Libertarian and a Secular Humanist. So I feel like I'm fairly well grounded and attempt to come at situations objectively. Needless to say I am at my wits end...
this is my 'can of worms':
Toxo and Fungal Meningitis are conclusions I've derived at, not my doctors. It would seem odd to jump directly to this outcome but through the process of elimination from test results and attempted Rx I've come to those two possibilities; I'm always open for other options. My GP, Neurologist, Infestious Disease docs are clueless as to what could be the root cause of my headaches & cognitive dysfunction.
"There are other things that can cause T2 hypointensity such as areas of dense calcium or areas of increased iron such as hemosiderin from prior bleed"
While in the Military 3 years ago I suffered a TBI with intracranial hemorrhages w/skull fracture, LOC & multiple contusions. I'm limited on documention from that event but I'm assuming this would be a fair bet as to why the T2 hypointensity exist. But I cannot stress enough how I feel this is not related to my current ailments. I recovered surprisingly quickly from this TBI and never had any unusual headaches until recently.
Note:
I'm a US citizen and lived overseas for 4 years: in South Korea 1yr, Japan for 3 yrs.
I started falling apart cognitively about a year and a half ago, about the time I started taking Aldara for MC and Adderall for ADHD and I have progressively worsened since then. It has gotten to the point where I forced myself to drop out of college this semester. And this is the last thing I wanted to do. School is my life and I enjoy it very much, but my health is usurping my abilities to perform well in school.
My immume system has been suppressed / altered by two Rx in the past year and a half.
Fall '09; Over used topical Aldara to treat Mulloscum, treatment lasted 4 months. clear MC but developed a chronic case of Tinea Versicolor.
Fall '10; Used Prednisone for almost 2 months. Started with 100mg then tapered. did not help symptoms and developed Tinnitus.
Current Rx:
Ibuprofen 800mg
Current Diet:
past 6 wks: salad and protein; no sugar, low carb
Testing:
All STD's - unremarkable
CBC - mostly unremarkable
Tyroid - unremarkable
EBV - showed reactivation(active IgM). retested ~2 months ago(IgM no longer active)
CMV - unremarkable
Urinalysis - unremarkable
Hepatitis C, B - unremarkable
Diabetes - unremarkable
Lymes - unremarkable
MRI Head - noted
MRI Cervical Spine - unremarkable
Blood Culture for fungal - unremarkable
Spinal Tap(not cultured) - unremarkable
*Neurolgist ruled out Magrines
Anecdote:
Summer '10 developed shingles on chest. Dermatologist perscribed Acyclovir: 800mg 5xdaily for 2wks. This did clear up the rash fairly quickly, however.
For the first 2 days of treatment I thought I was cured of all my cognitive symptoms(very unexpected). I felt smart again(able to think quickly on my feet and follow the Professor in Calculus class) I felt normal, extremely energized(ran for 1 hour outside) usually only run for 30mins x4 weekly and overall very happy. I felt like a different person for only those first 2 days when I took the Acyclovir. This has never happened before in my life and not since.
~1 day after finishing the 2wk course of Acyclovir I developed this Tension type Headache that hasn't gone away since.
For the past year and a half I've been good spirited but abnormally fatigued, more cognitively then physically. And no, I'm not a hypocondriac. I try my best to be logical minded, my major is Computer Science, its just my thought process. I'm also a Libertarian and a Secular Humanist. So I feel like I'm fairly well grounded and attempt to come at situations objectively. Needless to say I am at my wits end...
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The imaging findings you describe would not lead me to think of Toxoplasmosis. Infections that produce findings on MRI will be HYPERintense, not hypointense on T2 weighted images, this is because infections produced edema and swelling which is bright on T2 or can form abscess which again would NOT be hypointense.
T2 hypointensity implies low water content, and is can be related to protienacious material, hence the suggestion of Amyloid deposition. There are other things that can cause T2 hypointensity such as areas of dense calcium or areas of increased iron such as hemosiderin from prior bleed, although the pattern of T2 hypointensities at least as described are not typical (usually you see outlining along the surface of the brian (gyriform hypointensity) or clustered areas within the brain itself). Hemosiderin is best seen on T2 Gradient Echo (T2-GRE) images and basically shows up as black signal voids.
As far as Fungal Meningitis or Encephalitis. Depending on the severity, there may be minimal or no imaging findings. The gold standard of diagnosis is a lumbar puncture (Spinal Tap) to test the CSF fluid and do cultures. However, fungal meningitis is rare in patients who do not have HIV/AIDS, it can occur but represents a small minority of cases and even then there is usually some other cause of immunosuppression in these people such as chronic alcholism, chemotherapy for cancer, organ transplant with immunosuppression, etc....Fungal meningitis in a non-immunosuppressed person is uncommon. Have you had a lumbar puncture yet? That should give you more answers.
Also, are these diagnosis that you have derived at, or that your doctor is concerned about. I am just wondering because based on the vague constitutional type symptoms you are describing it seems a bit odd to jump straight to Toxo or Fungal Meningitis; if these are concerns of your doctor there may be other reasons that are not presented here....