Aa
case of my aunt
hello sir, m sending u my bhuaji's mri report, she's on bed since almost 3 months now n now toh she just opens her eyes in between and closes- there's no verbal response, left side is paralysed. since 2 weeks now, she's not even seems to be aware of her surroundings n people.
below is report telling some suspected diagnosis but few docs also suspect toxoplasma infection- she is diabetic sice almost 15 years i guess n still her sugar levels are raised. she's hypertensive too.
her IgG levels for infection came positive, around 17 and IgM negative,,, so shall we go on for her treatment with pyremethamine or sulfadiazine for t/t of toxoplasma n watch for the response.
her brain biopsy is not indicated as she is very weak.
would please help me out in knowing buaji's condition better.
SHANTA MALHOTRA 69 year Female, 24-02-09
CEMR STUDY OF THE BRAIN WITH DEDICATED MR-SPECTROSCOPY
PROTOCOLS : DEDICATED CEMR – FLOW COMPENSATED T1 SE SEQ. IN AXIAL , CORONAL AND SAGITTAL PLANES, ADDITIONAL CE- PERFUSION AND DEDICATED MRS USING SINGLE VOXEL SPECTROSCOPT AT TE – 30, 135, 270 AND CHEMICAL SHIFT MUTLIVOXEL AT 135E, IMAGES PRESENTED – SPECTRAL AND METABOLITE IMAGES.
Previous plain MR study done on 22.02.09 showed multifocal right cerebral hemispheric space occupyin g lesions with areas of hemosidderin deposits with extensive diffuse perilesional edema in right fronto – temporo – parietal, including right basal ganglio – capsular region and right occipital lobe , the largest lesion in right frontal lobe. d/d – multicentric neoplastic – metastasis / lymphoma etc. as per age of patient / ? other multicentric lesions.
Present CEMR reveals significant but heterogeneous enhancing focal intraparenchymal right cerebral hemispheric lesions – one large measuring 4.0x3.7x4.5 cm in right frontal, other small measuring 1.94x2.56x1.3 cm in right occipital lobes with rest of non enhancing perilesional edema.
While additional CE-perfusion do not reveal frank hyperperfusion. No frank increased CBV, CBF in present study in above mentioned lesion.
On additional dedicated MRS, using SVS [30,135,270 se] and CSI [135 se] reveals variable metabolite/spectral images within right frontal lesion concerned showing –
___________________________________________________________________
Absent myoinositol low myo:cr ratio in low metabolite spectrum as compare to contalateral counterpart.
Markedly reduced to near absent NAA, cr integral as compare to myoinositol low myo:cr ratio in low metabolite spectrum as compare to contalateral counterpart.
Increased choline integral in major part of focal lesion [ranging 1.37 to 2.6 as compare to 0.82 to 1.44 on contralateral side]. Note is made of significant increased Cho:CR ratio, Cho:NAA ratio in above mentioned lesion. Additional lip + lactate peak
______________________________________________________________________
While no other enhancing lesion in rest of supra-/entire of infra – tentoriral regions. No midline shift/extracereberal collection noted in present study.
The VII/VIII th nerve complexes do not reveal any abnormality.
T, he pituitary gland, orbits and retroorbital spaces are normal.
The circle of Wills structures and cerebral venous sinuses shows normal flow void. No cortical venous sinus thrombosis noted.
IMPRESSION
ABOVE CEMR MORPHOLOGY SUPPORTED BY DEDICATED MRS CONSISTENT WITH MULTICENTRIC SOLID SPACE OCCUPYING LESION OF MOST LIKELY – NEOPLASTIC [D/D HYPOPERFUSED METASTASIS /LYMPHOMA ETC] IN ETIOLOGY WITH ASSOCIATED PERILESIONAL EDEMA AND MASS EFFECT AS DESCRIBED ABOVE . ADVICE : COMPLETE CLINICAL/ STEROTACTIC BIOPSY CORRELATION AND FOLLOW-UP FOR EXCLUSION OF AGGRESSIVE NEURODESTRUCTIVE INFLAMMATORY GRANULOMAS.
Dr Tejinder kaur
below is report telling some suspected diagnosis but few docs also suspect toxoplasma infection- she is diabetic sice almost 15 years i guess n still her sugar levels are raised. she's hypertensive too.
her IgG levels for infection came positive, around 17 and IgM negative,,, so shall we go on for her treatment with pyremethamine or sulfadiazine for t/t of toxoplasma n watch for the response.
her brain biopsy is not indicated as she is very weak.
would please help me out in knowing buaji's condition better.
SHANTA MALHOTRA 69 year Female, 24-02-09
CEMR STUDY OF THE BRAIN WITH DEDICATED MR-SPECTROSCOPY
PROTOCOLS : DEDICATED CEMR – FLOW COMPENSATED T1 SE SEQ. IN AXIAL , CORONAL AND SAGITTAL PLANES, ADDITIONAL CE- PERFUSION AND DEDICATED MRS USING SINGLE VOXEL SPECTROSCOPT AT TE – 30, 135, 270 AND CHEMICAL SHIFT MUTLIVOXEL AT 135E, IMAGES PRESENTED – SPECTRAL AND METABOLITE IMAGES.
Previous plain MR study done on 22.02.09 showed multifocal right cerebral hemispheric space occupyin g lesions with areas of hemosidderin deposits with extensive diffuse perilesional edema in right fronto – temporo – parietal, including right basal ganglio – capsular region and right occipital lobe , the largest lesion in right frontal lobe. d/d – multicentric neoplastic – metastasis / lymphoma etc. as per age of patient / ? other multicentric lesions.
Present CEMR reveals significant but heterogeneous enhancing focal intraparenchymal right cerebral hemispheric lesions – one large measuring 4.0x3.7x4.5 cm in right frontal, other small measuring 1.94x2.56x1.3 cm in right occipital lobes with rest of non enhancing perilesional edema.
While additional CE-perfusion do not reveal frank hyperperfusion. No frank increased CBV, CBF in present study in above mentioned lesion.
On additional dedicated MRS, using SVS [30,135,270 se] and CSI [135 se] reveals variable metabolite/spectral images within right frontal lesion concerned showing –
___________________________________________________________________
Absent myoinositol low myo:cr ratio in low metabolite spectrum as compare to contalateral counterpart.
Markedly reduced to near absent NAA, cr integral as compare to myoinositol low myo:cr ratio in low metabolite spectrum as compare to contalateral counterpart.
Increased choline integral in major part of focal lesion [ranging 1.37 to 2.6 as compare to 0.82 to 1.44 on contralateral side]. Note is made of significant increased Cho:CR ratio, Cho:NAA ratio in above mentioned lesion. Additional lip + lactate peak
______________________________________________________________________
While no other enhancing lesion in rest of supra-/entire of infra – tentoriral regions. No midline shift/extracereberal collection noted in present study.
The VII/VIII th nerve complexes do not reveal any abnormality.
T, he pituitary gland, orbits and retroorbital spaces are normal.
The circle of Wills structures and cerebral venous sinuses shows normal flow void. No cortical venous sinus thrombosis noted.
IMPRESSION
ABOVE CEMR MORPHOLOGY SUPPORTED BY DEDICATED MRS CONSISTENT WITH MULTICENTRIC SOLID SPACE OCCUPYING LESION OF MOST LIKELY – NEOPLASTIC [D/D HYPOPERFUSED METASTASIS /LYMPHOMA ETC] IN ETIOLOGY WITH ASSOCIATED PERILESIONAL EDEMA AND MASS EFFECT AS DESCRIBED ABOVE . ADVICE : COMPLETE CLINICAL/ STEROTACTIC BIOPSY CORRELATION AND FOLLOW-UP FOR EXCLUSION OF AGGRESSIVE NEURODESTRUCTIVE INFLAMMATORY GRANULOMAS.
Dr Tejinder kaur
just do it my friend,there is no time to ask question.i suspect infection,so obviously antibiotics.and deferroxamine to clear the blood,O2 to help the brain complications.let me knw when ur aunt is better.
please may i ask you the reason why have u ecommended this deferroxamine and oxygen at high pressure and broad spectrum antibiotics. m myself a doctor ,, doing internship so would like to know the reason behind your advise
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