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vertigo, brain lesions on MRI,
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vertigo, brain lesions on MRI,

I am a 50 year old female. An MRI in 2003 showed "a large linear area of hypertensity on T2 and FLAIR extending from the left frontal lobe posteriorly into the left parietal lobe.  The lesion is in the region of the "watershed" distribution of the anterior and middle cerebral arteries.  mild porencephalic dilatation on the left frontal horn.  'prominence of the left torus tubarius in the posterior nasopharynx in the region of the eusatchian tube. 'hypertintensity on T2 and minimal mucosal enhancement following administration  gadolinium."  Findings most compatible with bilateral "watershed" infarcts.

To my knowledge I have never had a stroke.  I am a personal trainer and have exercised aerobically and with strength training for 25 years.  I had a vertigo spell when performing a back hyper extension exercise in an inverted position (which I had done many times before).  After continuing to feel constantly dizzy and unable to exercise without getting dizzy and headaches,I finally (9months after the vertigo event) sought help.
Some history:
I competed in women's bodybuilding  in 2001.  The attack was in 2002.  I did no drugs of any kind just exercised and dieted for 6 months prior to the shows.  Several days prior to the shows I did reduce water intake.
I have an oral defect where the left side of my mouth never developed teeth properly and my palette is not aligned. I have been treated for depression over the past 15 years with prozac and effexor.  
Effexor helped but would like to get off it.    I still cannot exercise  without  headaches ,dizziness and nauseau.
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4 Comments
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Avatar_n_tn
I know enough abt physiology to say that I've heard this term
'watershed cerebral infarction' before but generally it's been
applied to the elderly. Very active 50 & a trainer. I'm just
guessing as far as cause. In elderly, it relates to upper body
cervical spondylotic myelopathy (trauma to the central cord). In
your case & the timely dizziness, I'd say it must have been
related to the 2002 'hyper back-extension'. When this condition
is 'bilateral' & involves the arteries mentioned, blood supply
was compremised between these 2 arteries from a small blood clot
probably do to your occupation (some type of trauma ocurred).
The clot probably travelled but not sure if from a main or
vessel extension artery. The dilatation of the left frontal on
the report could explain the hdaches/dizzy/nausea. Your Neuro
must have looked (hopefully) himself at films. Not sure of the
treatment but you should have a new MRI to compare films. Yrs.
ago I had off/on hdaches w/ a undiagnosed condition. My MD asked
abt symptoms of a stroke/ordered ultrsound 'subclavian ?'& ran
Sed/CRP bloodtest etc +. Things were ordered to rule out. We
discovered I had a ischemic stroke & the spot on film was an
infarction (tissue death & now sealed). Never knew when or how
it happened other than stress had been a long term factor. I
was educated alittle more! It's always there & 1 more mri fol/up
2 yrs later confirmed sealed/no lobe involvement/ok. I would go
to an Opthamalogist for a eye-health/funduscopic exam to ck for
signs of bilateral-papilledema (vessel swelling behind eyes), as
a precaution. You have something vascular going on & I'm not
sure of the out-come considering being a long term trainer.
Knowledge can guide you in preventing further problems. I think
the Effexor is a help but it's a bandaid. I know the effects on
the blood flow but not the treatment. Get eye exam/new mri/take
things slower/maybe a C-spine mri to. It said 'infarcts' plural.
I'm thinking there's compression that can cause a later problem
unless you do fol/up. We want you to stay in shape for years!
I'd stop the hyper-extensions. You're in great shape but the
strain on vessel can sometimes cause things. Get copies for a
hm-file on all tests. Ck. BP often at rest w/ maybe a cuff type
you can take in tote. Did your MD just say Bye-bye w/no fol/up?


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Avatar_n_tn
Thanks for your response.  Had a second MRI 1 yr later. No change.  I can't work out any where near the capacity that I used to.  I seem to have an almost constant very mild head ache or pressure and when I workout it interferes by most of the time getting a full blown headache.  My blood pressure is 90/60 to 110/70.  It's always been low.  Haven't tested it during exercise.  Also, I did have menengitis about 15 years ago (the kind that I was hospitalized for but not treated with anything) but percocet, for the violent headaches.  I hadn't really had any problems until 2002.  I so much want to know what's going on with me.  Been to 2 nueros with different diagnosis'.  First (probably menopause) second ( some bpvm or something).  None of which explain the lesions.  They said 'probably congenital'. I was a perfectly healthy extremely active person and now I am teaching water aerobics to old ladies b/c any exertion causes headaches, or to feel somewhat disoriented or leaves me with a general all over nauseaus sick feeling.  I don't know what other testing or whatever I should do.  This is so frustrating.
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Avatar_n_tn
I offered some suggestions. Get a Cervical spine MRI w/ focus
on the C1 & C2 disks to skull base. The nasopharynx mentioned
was the congenital problem they were talking abt. Do what ya'
think but your problem will possibly get worse considering the
report vs your age. Active now may cause damage later unless
you limit range of motion till cervical is ruled out. Atleast
the water alters muscle & arterial stress. Your condition in
your report was do to some type of trauma to brain. Glad they
repeated. Gd-luck.
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Avatar_n_tn
Thanks.  I see my doc on Monday and am going to request that.  I'll post my results.  Thanks so much.  I do know that it is going to get worse.  I can feel it affecting my day to day funtioning including memory and task organization.  Did I mention that I have been managing this exercise facility for almost 20 years?  Thanks again for your suggestions! Dansmomom
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