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Emergency Room CT Scan (of head) results

Oct 23, 2008 - 11 comments

The results from the CT Scan of my head done after I was admitted to the ER on 10/14/08:

"History of left-sided weakness and facial tingling. MRI performed at an outside hospital 1 month ago reportedly demonstrated a pineal cyst. (Note: I said my MRI was in JULY, not one month ago!!! I even corrected the nurse on this when he said, "this was done last month?" Ugh!)

An unenhanced axial CT of the head was obtained and reviewed in bone, soft tissue, and intermediate windows. No comparison studies are available. (Note: I brought my MRI disk and report with me!!! I even offered it to the ER doctor to look at, but he said no to the disk--and read the report.)

Findings: There is a focal region of hypodensity in the central pons on image 13 series 2, which may represent artifact. The ventricles and sulci are age appropriate in size and appearance. no evidence of mass, mass effect, or midline shift. No evidence of acute transcortical infarct or intracranial hemorrhage. No intra-or extra-axial fluid collections. The basal cisterns are open. The calvarium is intact and there is no evidence of acute fracture. Visualized sinuses, mastoid air cells, and middle ear cavities are clear. Orbits are unremarkable.

Impression: Focal region of hypodensity in the central pons, which may represent artifact. A lesion in this region would not explain the patient's symptoms. Recommend correlation with the previous MRI study. If the previous study is not available and there is persistent clinical concern, an MRI of the brain could be performed for further evaluation. (Note: Couldn't an ischemic stroke cause my symptoms?!?!)

Attending review (aka the "better" radiologist looked at this, too): Agree with above."



...I guess the pineal cyst didn't show up in the CT Scan results? I'm not sure if it even should, but I do know that this scan was not done with contrast. Thank goodness my next MRI is in a week and a half! I don't know what this "hypodense" region means, and I don't like it one bit...not after googling the possibilities and coming up with nothing good.

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by mommy2two2008, Oct 23, 2008
Praying your MRI next week will finally be the answer! Huggles Jules ~Kim

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by Jules77733, Oct 23, 2008
You and me both...I just don't know how a hypodense region in the pons couldn't have caused my symptoms--everything I've googled suggests an aneurysm or an ischemic stroke...but maybe these both occur with bleeding into the brain (which would be seen on the MRI). Perhaps my pineal cyst is an epidermoid cyst, or something? These can be benign or malignant and are rarely found in the pineal region. I guess it's always possible. I can't wait to hear what my neurologist has to say about all of this lol.....

Thanks! =)

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by selmaS, Oct 23, 2008
I am praying with u and mommy that ur MRI gets to the bottom of it for u.....drs just r plain dumb....they take on too much, so they do not compute what we r saying, nor do they remember what they've said in previous appts......uuuuuuuuuuugh....anyway I understand the frustration, but join in the hopes u find what is causing u greif and find relief.....

"selma"

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by 898, Oct 23, 2008
Introduction

A focal neurological deficit consists of a set of symptoms or signs in which causation can be localized to an anatomic site in the central nervous system. The site of the pathologic abnormality is typically deduced through the history and physical examination prior to imaging. The clinical localization of a suspected lesion is extremely useful (and should be encouraged on the part of the examining physician) in that it assists the radiologist in directing the imaging portion of the evaluation. Focal neurological deficits may develop suddenly or may evolve chronically. Once a deficit occurs, it may remain stable, continue to worsen in a continuous or step-like fashion, or resolve. Resolution may be partial or complete.

Additionally, deficits may be unifocal, implying a single lesion, or multifocal, suggesting multiple discrete lesions. A patient presenting with a focal neurological deficit should be considered for imaging of the entire neuraxis. The presentation may suggest causation. For example, an acute temporal course prompts evaluation for cerebral infarction, but a more chronically progressive course is often due to a mass lesion. Specific disease entities are fully reviewed in separate ACR Appropriateness Criteria® sections. The patient who presents with a focal disorder of motor or sensory function caused by intracranial pathology is addressed in this summary.

Acute Focal Neurological Deficit

The sudden development of a focal neurological deficit suggests a vascular ischemic event such as an infarction. Infarctions typically remain stable in the immediate period of presentation or worsen due to complicating hemorrhage or edema. A deficit from a transient ischemic attack resolves within 24-hours. Neurologic deficits from acute reversible ischemia may take up to 30-days to completely resolve. CT scanning is often used to screen patients for suspected infarction, but it may miss early cytotoxic edema. An obscured insular ribbon and a dense middle artery are signs indicating infarction but may be absent in a given patient. Diffusion weighted (DW) MR imaging detects cytotoxic edema in the first few hours of an infarction and may remain positive for a week to ten days. Spin echo sequences before and after intravenous enhancement may add significant information as the infarction evolves. A detailed summary of ischemic vascular disease is the subject of another Appropriateness Criteria® topic.

An intracerebral hemorrhage may also cause sudden onset of focal findings. The clinical examination may help to define the cause of the hemorrhage. A pupil involving third cranial nerve palsy associated with headache, for example, suggests subarachnoid hemorrhage due to aneurysm rupture. Sudden hemiparesis in the setting of hypertension suggests a hemorrhage in the basal ganglia. CT is generally the preferred modality for initial screening for intracranial hemorrhage because of its availability, rapid scanning time, and sensitivity in detecting blood. Recently, MR imaging has been found to be sensitive for both acute and chronic blood products and, when available, can exclude hemorrhage in patients with a suspected infarction before intravenous administration of tissue plasminogen activator (tPA). Moreover, MR imaging has been shown to be superior to CT in detecting acute petechial hemorrhagic transformation in acute ischemic stroke. A study showed that with appropriate sequence selection, acquisition time of an MR scan can be significantly decreased to about 10 to 15 minutes.

Traumatically induced or spontaneous subdural and epidural hematomas may also produce acute focal deficits. CT is the modality of choice for screening patients for suspected extraaxial hemorrhage.



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by Jules77733, Oct 23, 2008
selmaS--thank you for your kind words, they mean a lot to me! It's always good to know I'm not alone...this is definitely frustrating, and I hope the MRI tells me something more. =/

898--I read through your entire post and it was very interesting to me, especially because I was thinking this might've been some kind of ischemic stroke or aneurysm (but there was no sign of bleeding anywhere). I'm not sure what to make of it except that maybe this is part of the pineal "cyst", making it an epidermoid pineal cyst or something like that? this means it might need to come out, for sure. I don't know...but the CT scan wasn't done with enhancement, while my MRI is. I'm not sure why the pineal cyst didn't show up on the CT scan though. Any thoughts?

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by sallyann27, Oct 24, 2008
wow. the doctors where you are scare me! can they really be this useless?!!! awh i hope you can find one specialist who gives you a straight answer. thoughts are with you as always, SA

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by Jules77733, Oct 27, 2008
sallyann27--They scare me too, sometimes. I don't understand why they can't come up with a definitive diagnosis, or at the very least, treat this as if it were serious. It's one thing to say, "you have a hypodense region in your brain", but not know what that hypodense region is and order more tests because it's a serious matter...it's another thing when they say, "you have a hypodense region in your brain", then don't do anything about this. It's making me unbelievably frustrated, and I'm typically a very patient person!!! Thank you for your kind words...I hope my neurologist can help me when I see him next time. He'll have my new MRI results and my CT scan results. I think these respiratory problems, feeling weak/paralyzed, and dizziness/bad headache are a result of Provigil and Propranolol interacting. I need to talk with my neurologist about this, because I did ask the UPenn neurologist (neurologist #2) if this would be a problem...and he said, "I have no problem with that," [me taking Provigil and Propranolol at the same time].

I can't believe I've been sick for almost 9 months now. =(

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by 898, Oct 27, 2008
"hypodense region in your brain" is descriptive term, which can mean sevral things, for example it can be found among the patients following head injury such as contusion. The CT scan without contrast makes no sense as it is very difficult to study abnormalities in the blood flow.

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by Jules77733, Oct 27, 2008
I think they just wanted to rush the CT scan, since the only people getting scans done were people from the ER...but there was a semi-line (not really), and my scan only took about 5 or 10 minutes...I was so drugged that I don't really remember, but I do remember it being short and thinking, "Why aren't they added any contrast? I already have an IV line in my arm...they might as well!" But they didn't.

I'm thinking that my pineal cyst isn't just a simple, non-enhancing pineal cyst anymore (or maybe it never was!). I think the symptoms I experienced that sent me to the ER were a result of drug interactions, though...namely, Provigil and Propranolol, plus the 24oz of Mountain Dew I drank that day. Because yesterday, I had 400mg of Provigil and 60mg Propranolol, taken at the same time, and I felt preeeeeeetty similarly to the way I felt when I checked myself into the ER. It was bad. The scariest part is the difficulty breathing.

I'm getting an MRI with contrast done in a week...I hope this tells me something. If it doesn't, I'm going to be stuck feeling this way for a long time, because doctors are clueless otherwise.

I did visit California last January...and I remember getting bitten by sand fleas on the Malibu beach. Do you think I could've contracted a parasite or something from them?

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by tombully, Feb 22, 2010
what dos small lines means on ct scan on your head

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by Jules77733, Apr 30, 2010
@tombully: They use those lines to determine where each "cut" is taking place...i.e. where the x-ray stopped to take a picture as it moved along the plane of my head. When the radiologist looks at my scans he/she could tell exactly what part of the brain they were looking at since it's not always easy to identify this. These lines are usually placed on the first picture you see on your resulting CT scan: an actual x-ray of the head. If you're not talking about this, though, then lines on an actual CT scan of the head might mean that you moved while the picture was being taken, causing refraction of the x-rays and possibly creating an artifact.

Hopefully, that makes sense! If not...perhaps you could show me a picture of what you mean by "small lines"?

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