Lacunar infarct (radiologist) or artifact (neurologist)

[ontherecord]

Greetings again doctor,



I had an MRI with and without contrast in April 2004 and recently had a follow-up visit with my neurologist.  In the INPRESSION section of the radiologist's report, he writes, verbatim, "THERE IS A 3 MM LACUNAR INFARCT IN THE RIGHT PUTAMEN. NO OTHER INTRACRANIAL ABNORMALITY IS DETECTED."



This week I visited my neurologist (10-15 years experience, double board-certified), he reviewed the the entire set of scans, including the one in question, and said it was an artifact, that it meant nothing, and the radiologist was reading too much into it.  In my neurologist's own words, he said it was "nonsense." Nonetheless, "out of prudence" he said, because it's on the record, right or wrong, he ordered some bloodwork, which tests the level of certain anticoagulants and antibodies in the blood, although he didn't think it was necessary.  The radiologist recommends, in the report, that "If an AVM or anuerysm is suspected, MR angiography is the non-invasive study of choice and should be requested as a follow-up study."



I don't want more testing, frankly, but I want to get to the bottom of this.  An esteemed doctor here in the NY area (cardiologist, recently published a book) is looking to set up a consultation for me with a neuroradioligst at an academic health center.  I know that without reviewing the scans, there is only so much you can offer in terms of advice, but is this the right course of action?



And what exactly is a 3 MM lacunar infarct?

And is it the type of thing that good doctors can disagree on?

I'm 26, male, for reference.

Than

[CCF-Neuro-M.D.-CS]

Lacunar infarcts are tiny infarcts typically caused by blockage of small arteries. This is very tiny, and there may be some disagreement. If there is any question, having another physician review the films is reasonable. Good luck.