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My son's CT & MRI

My wife and I adopted our son at the age of 2; he is now 10½ years old. Since the age of 2 my son has suffered with headaches and start to vomit just minutes after it starts "this always happens". (There is no family medical information, however we did adopt his older brother who shares the same biological mother, he has no problems but ADHD). About 3 years ago my son was diagnosed with migraine headaches, he takes medication daily for this and he also takes meds for ADHD. My son’s school also wishes to test him for Aspurgurs (sp) a form of Autism. Last week I took my son to the ER due to a migraine and severe vomiting. The ER doctor did a CT scan and the impression stated “Tiny nonspecific low attenuation focus right frontal white matter, to be correlated clinically”. My son was hospitalized, two days later his doctor had a MRI completed, the impression that the Radiologist underlined stated, “Most likely diagnosis is a prominent perivascular space”. Question: What does this mean, is it a hereditary disorder, birth defect, trauma, or some debilitating disorder, or can this cause death? My son is having migraines 2 or more times a week, sometimes 2 a day. My son’s neurologist has left her practice at the children’s hospital so our family doctor is trying to get my son in to see another neurologist ASAP.  Thank you so much for your time in this matter, whatever answers you give my wife and I will discuss this with the doctors.    
4 Responses
Avatar universal
I'm really sorry to hear that your son is dealing w/ migraines at such an early age.  I don't have any information on that specific diagnosis but can relate since i suffer from migraines and i passed it onto my now 16yr old.  His started at about 12.  We see a neurologist every six months and he is also on daily meds.  He has imitrex and maxalt for when they get really bad and they also just prescribed him another nasal spray treatment (can't remember the name).  It's so hard to see them going thru this so young and it's hard as a child to get thru school and sports in that condition.  Last year he missed several days b/c of it but he really tries to go anyway. My son hates to take most of the meds b/c he says it makes his head feel like it's on fire and of course he can't function or get anything done.  Very frustrating as a parent!  There are SO many things that trigger migraines and it's so hard to pin it down.  We have tried to figure out if it's food related and no luck so far.  Have they given you a list of foods to watch out for?   It sounds like at least you have some diagnosis to start with and hopefully you will find another neuro soon.  Good Luck!!!
281728 tn?1190433387
I've suffered from migraines my whole life.  I really feel for your son and I hope that you can find the right doctor who can help him live a more normal life.  He is very fortunate to have you fighting on his side.  From what I am gathering "prominent perivascular space" means a large space around the vessels.  I saw this term in reference to MS.  I am sure there are a lot of other reasons for this as well.  I suggest you look for the nearest children's hospital to figure out if it is a birth defect or a degenerative illness.  It makes sense that this has something to do with his migraines...migraines are vascular.  I think "prominent perivascular space" would be a vascular malformation...not sure.  You could probably ask that question on the "Ask a Doctor Forum."  Maybe someone can suggest a specialist nearby.

I recently discovered that I have a pulmonary arteriovenous malformation (PAVM) that is most likely the major cause of my migraines....and it is hopefully fixable.  I wish they would have found it when I was little so I could have had some sort of a normal life.  Even if it means you have to travel, I would look for a children's hospital with specialists in vascular malformations as soon as possible.  Please don't stop searching until you get an answer.  Being sick all the time is really rough, especially when you are a kid, but having parents who are supportive and understanding really makes a big difference and builds self-confidence.  Not getting answers or treatment invalidates a person's pain.  He will remember when he grows up how well you took care of him when he was sick.  Good luck and my prayers are with you.  
Avatar universal
I know how your feeling. My son is 12 he has had migraines since he was 4. They run in our family. My husband gets them and also my self. He has missed a whole year of school and he has gone thru 3 neurologists. Right now we are going to an acupuncutrist and nutritionist. All of his mri's and cat scans have come back "normal migraines". We are trying a all natural diet, organic foods, and gluten free. We have tried different meds on him. Everything from neurontin, topamax, depakote, all of the imitrex, maxalt, you name it he has been on it. Maybe the natural way is the way to go. It doesn't hurt to try. He has waken up everyday with a headache for 2 years. It is very frustrating. I will let you know how he is doing. We have been alnatural for a week and a half. His school is suggesting a neuropsycologist. Any idea what that is?
281728 tn?1190433387
Wow.  I really feel for your son.  A neuropsychology is an more experimental branch of medicine linking thought patterns to physical health.  You might try searching the term on ask.com or you can see the wikipedia definition at


I think it is worth a try if your insurance covers it and it can only help.  I seriously doubt it will solve his problem completely though, maybe just help with frequency and intensity...and help identifying and avoiding triggers, and dealing with stress.  

His story sounds a lot like mine.  Does he have migraine with aura?  Tests have shown that 70% of migraine with aura sufferers have a PFO, which is a left-to-right shunt (hole) located in the heart.  PFO's (patent foramen ovale) are very common...about one in five people have one.  For most of those people it is closed until they bear down.  But some people it is always open, getting larger with any straining.  This hole allows unoxygenated, unfiltered blood to travel to the brain causing irritation and inflammation.

Left-to-right stunts have been linked in many studies to migraines with aura and many people who have it repaired have vast improvement in their migraine symptoms.  They have been practicing this in Europe for a while now.  PFO's are congenital, that means you are born with it, but usually doesn't cause any noticable problems.  They can however get worse with age.  Then there are other reasons for left-to-right shunts, like AVM in the lungs and the result is the same.  AVM's tend to get a lot worse at puberty and are associated with HHT (hereditary hemorrhagic telangiectasia.)

If you've been to so many neurologists and have had clear brain CT's and MRI's with AND without contrast, then perhaps the problem is elsewhere in the body.  I am not satisfied to treat a child with pshychiactric medications instead of exhausting all the posibilities.  The long-term effect of many of these drugs on the body is not good.  There has got to be a physical cause for his severe and relentless pain at such a young age...something congenital that progresses with puberty, like vascular malformations....there's probably lots of other things that could be the cause, but I only know what I have studied in my quest for my own answers.  I suggest that you follow my lead and be agressive about finding answers.  Keep trying different doctors.  Keep posting and researching...I use ask.com and wikipedia quite a bit.

The test for a shunt is easy and inexpensive and can be performed with a neurologist or a cardiologist.  It is called an Echo Bubble Study, Doppler Bubble Study, or Contrast Echocardiography.  You can ask.com it...I love jeeves.  Here's how it goes:

They inject tiny microbubbles of agitated saline into an iv in the arm and an ultrasound sensor on the chest determines whether some of these bubbles enter the left-sided chambers of the heart.  The bubbles should go from the right side of the heart to the lungs and get filtered out at that point.  Then the newly oxygenated blood goes to the left side of the heart.  So if any of the bubbles get through to the left side of the heart, then there is a shunt in the cardio/pulmonary circuit.  

If they appear immediately on the left side, then it is a PFO...meaning it passed to the left side while in the heart.  If there is a 3-5 beat lag before they appear on the other side, then it is a PAVM (an arteriovenous malformation of the lungs.)  They should do the test at resting, then repeat it while he is bearing down, because most PFO's are closed at resting.  If the bubbles do not pass through, then the test is negative.  If the test is positive it isn't a bad thing, because the procedure to fix a PFO is simple and safe.  If it is a PAVM then you are going down a longer road, but it is still safely treatable most of the time.  Embolization is usually an outpatient procedure.  A coil or balloon is inserted through a catheter in the leg.  Not very scary, so I've read.  

Good luck and hope you find your answers.
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