Question: Hello. I started to have severe headaches in feb 2020 almost on a daily basis. I had a brain mri w/ contrast on 5/12/20 and an eeg on 7/9/20 and both came back clear.

Fast forward to today, I sought a second opinion b/c I continue w/ headaches although not as bad, and my eeg report came back abnormal. The neurologist mentioned the possibility of epilepsy. I have had no seizures that I know off or had any common symptoms associated w/ seizures. The doctor scheduled me for a 24 hour eeg. He went over my results rather quickly so I would like further clarification.

My Symptoms: headaches, sometimes nausea, very lethargic.

-Can you explain the report and what outcomes this result could mean? Does it lean more toward a brain tumor or epilepsy?

-Do these readings mean that I was having a seizure at the time of test, or do the waves remain this way once you have had a seizure?

- Is it common to have a normal eeg and then an abnormal one in a short amount of time (7 months for me) ?

-If the 24 hour eeg comes back clear will that mean I’m ok or will I have to get monitored yearly because of this abnormal result?

-How does epilepsy look like on an mri?

-Should I get another mri w/ contrast to rule out a brain tumor and any other epilepsy concerns?

As I said previously I have had no noticeable symptoms that would indicate epilepsy. I have 3 kids and and my youngest is 1 and I do know of the complications of epilepsy and pregnancy which I had none of, so this abnormal result has me baffled.
I am attaching my mri report and and today’s eeg report . Thank you for your time.

Hello. I started to have severe headaches in feb 2020 almost on a daily basis. I had a brain mri w/ contrast on 5/12/20 and an eeg on 7/9/20 and both came back clear.

Fast forward to today, I sought a second opinion b/c I continue w/ headaches although not as bad, and my eeg report came back abnormal. The neurologist mentioned the possibility of epilepsy. I have had no seizures that I know off or had any common symptoms associated w/ seizures. The doctor scheduled me for a 24 hour eeg. He went over my results rather quickly so I would like further clarification.

My Symptoms: headaches, sometimes nausea, very lethargic.

-Can you explain the report and what outcomes this result could mean? Does it lean more toward a brain tumor or epilepsy?

-Do these readings mean that I was having a seizure at the time of test, or do the waves remain this way once you have had a seizure?

- Is it common to have a normal eeg and then an abnormal one in a short amount of time (7 months for me) ?

-If the 24 hour eeg comes back clear will that mean I’m ok or will I have to get monitored yearly because of this abnormal result?

-How does epilepsy look like on an mri?

-Should I get another mri w/ contrast to rule out a brain tumor and any other epilepsy concerns?

As I said previously I have had no noticeable symptoms that would indicate epilepsy. I have 3 kids and and my youngest is 1 and I do know of the complications of epilepsy and pregnancy which I had none of, so this abnormal result has me baffled.
I am attaching my mri report and and today’s eeg report . Thank you for your time.

The website is not allowing me to upload the reports so i am typing my eeg report below.

CONDITIONS OF RECORDING: This 16 channel EEG is performed w/ patient awake.

DESCRIPTION: Electrocerebral activity consists of well modulated 9-10 Hz background activity that attenuates symmetrically w/ eye opening. Low-amplitude faster frequencies are seen frontally.

ABNORMAL POTENCIALS: See impression.

ELECTRCARDIOGRAM: A single EKG rhythm strip performed during recording reveals no significant arrhythmias.

IMPRESSION: This is an abnormal awake EEG. Intermittent slow theta activity at 5-6Hz is seen in bilateral frontotemporal regions which may suggest mild cerebral dysfunction. In addition intermittent sharply contoured waves are also seen in bilateral temporal regions which are suspicious for being epileptiform. A 24 hour EEG is recommended for more detailed evaluation.

Consider follow up study in one year, if clinically indicated.

The website is not allowing me to upload the reports so i am typing my eeg report below.

CONDITIONS OF RECORDING: This 16 channel EEG is performed w/ patient awake.

DESCRIPTION: Electrocerebral activity consists of well modulated 9-10 Hz background activity that attenuates symmetrically w/ eye opening. Low-amplitude faster frequencies are seen frontally.

ABNORMAL POTENCIALS: See impression.

ELECTRCARDIOGRAM: A single EKG rhythm strip performed during recording reveals no significant arrhythmias.

IMPRESSION: This is an abnormal awake EEG. Intermittent slow theta activity at 5-6Hz is seen in bilateral frontotemporal regions which may suggest mild cerebral dysfunction. In addition intermittent sharply contoured waves are also seen in bilateral temporal regions which are suspicious for being epileptiform. A 24 hour EEG is recommended for more detailed evaluation.

Consider follow up study in one year, if clinically indicated.

MRI-3T BRAIN PRE AND POST IV CONTRAST

HISTORY: R51 Headache/Facial Pain M54.81 Head/Neck Pain

CLINICAL HISTORY: 27-year-old female with new onset of headaches.

TECHNIQUE: Sagittal, coronal, and axial images of the brain were obtained with a 3 Tesla
MR scanner both before and after the uneventful administration of intravenous contrast (14
cc of Gadoterate Meglumine).

COMPARISON: A previous CT of the head dated 5/5/2020 was available for review.

FINDINGS: No hemorrhages or masses are demonstrated. No acute infarcts are demonstrated.
No regions of abnormal contrast enhancement are demonstrated. Midline structures are
normal in position and ventricles are normal in size. Flow is documented in the major
vessels.

The paranasal sinuses are clear.

IMPRESSION: Normal examination.


ICD 10 - - -

Signed by: Dr. XXXXXXX Jungreis
Signed Date: 5/12/2020 1:58 PM EDT

MRI-3T BRAIN PRE AND POST IV CONTRAST

HISTORY: R51 Headache/Facial Pain M54.81 Head/Neck Pain

CLINICAL HISTORY: 27-year-old female with new onset of headaches.

TECHNIQUE: Sagittal, coronal, and axial images of the brain were obtained with a 3 Tesla
MR scanner both before and after the uneventful administration of intravenous contrast (14
cc of Gadoterate Meglumine).

COMPARISON: A previous CT of the head dated 5/5/2020 was available for review.

FINDINGS: No hemorrhages or masses are demonstrated. No acute infarcts are demonstrated.
No regions of abnormal contrast enhancement are demonstrated. Midline structures are
normal in position and ventricles are normal in size. Flow is documented in the major
vessels.

The paranasal sinuses are clear.

IMPRESSION: Normal examination.


ICD 10 - - -

Signed by: Dr. XXXXXXX Jungreis
Signed Date: 5/12/2020 1:58 PM EDT

Thank you for your response.
- So does this one abnormal result mean for a fact I could have epilepsy or could it be a fluke?
-Could moving during the test affect this result? Looking back I did move quite a bit.
-If the 24 hour test comes back normal could I safely say I have no epilepsy?
-If it comes back abnormal does it clearly mean epilepsy?

Thank you for your response.
- So does this one abnormal result mean for a fact I could have epilepsy or could it be a fluke?
-Could moving during the test affect this result? Looking back I did move quite a bit.
-If the 24 hour test comes back normal could I safely say I have no epilepsy?
-If it comes back abnormal does it clearly mean epilepsy?

Thank you once again.
My report states “Intermittent slow theta activity at 5-6Hz is seen in bilateral frontotemporal regions which may suggest mild cerebral dysfunction”.

1)Is this slow activity relatable to suspected epileptic activity or is it a separate issue?
2)What exactly does this mean?
3)What could be a possible cause of this?
4)Could this result be altered by moving allot during test, stress or other factors?

I am attaching an article that mentions both slow theta waves/epileptiform charges just like in my case.

**Slow-growing tumors, such as meningiomas, are usually associated with focal slow activity that occurs more frequently in the theta range. Epileptiform discharges can coexist with focal slow activity produced by brain tumors, especially slow growth (the least destruction of the brain parenchyma with slow growth tumors increases the possibility of detection of epileptiform discharges)**

3) Does this sound like my case?
-if needed At what point would another mri be advisable?

4) Since I have no history of seizures, If the 24 hour test comes back with same kind of abnormalities, do doctors usually wait and monitor for a first seizure to occur or is treatment started right away regardless of an absent seizure history.

Thank you.

Thank you once again.
My report states “Intermittent slow theta activity at 5-6Hz is seen in bilateral frontotemporal regions which may suggest mild cerebral dysfunction”.

1)Is this slow activity relatable to suspected epileptic activity or is it a separate issue?
2)What exactly does this mean?
3)What could be a possible cause of this?
4)Could this result be altered by moving allot during test, stress or other factors?

I am attaching an article that mentions both slow theta waves/epileptiform charges just like in my case.

**Slow-growing tumors, such as meningiomas, are usually associated with focal slow activity that occurs more frequently in the theta range. Epileptiform discharges can coexist with focal slow activity produced by brain tumors, especially slow growth (the least destruction of the brain parenchyma with slow growth tumors increases the possibility of detection of epileptiform discharges)**

3) Does this sound like my case?
-if needed At what point would another mri be advisable?

4) Since I have no history of seizures, If the 24 hour test comes back with same kind of abnormalities, do doctors usually wait and monitor for a first seizure to occur or is treatment started right away regardless of an absent seizure history.

Thank you.