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Suggest Treatment For Chronic Ischemic Gliosis
Question: Hi thank you for your time in this matter My wife who is 61 just was told she has chronic ischemic gliosis that showed up on a C T scan . she has had a problem with dizziness vomiting nausea, head pain not a headache but sharp pains in the different areas of the head, twitching, blurriness. If I lie down it goes away within 30 mins to an hour.
1. Is it curable
2. How fast does this progress
3. What can I do immediately
4. Is there treatment-medication?
5. I was already told that part of the brain show dead signs of blood not flowing
1. Is it curable
2. How fast does this progress
3. What can I do immediately
4. Is there treatment-medication?
5. I was already told that part of the brain show dead signs of blood not flowing
Brief Answer:
When the Bark is Worse than the Bite
Detailed Answer:
Good evening. I am Dr. Dariush Saghafi and am a neurologist in XXXXXXX Ohio. I am happy to answer some questions for you regarding this condition.
It strikes me as being very possible that whoever interpreted the results of the CT scan for your wife may have unintentionally made the "bark seem worse than the bite" in this condition which admittedly sounds rather morbid. The truth of the matter is we tend to use another term much more frequently among neurologists and that is "small vessel ischemic disease." I don't know if that SOUNDS any better to you but how about if I tell you that this entity is seen best on MRI scans. It is FREQUENTLY seen on CT scans. It often times is not as significant as some doctors make it out to be because it can be seen in otherwise NORMAL INDIVIDUALS WITHOUT ANY NEUROLOGICAL SYMPTOMS.
We never attribute any symptoms of pain, headache, sharp pains, twitching, or visual blurriness because it simply cannot cause any of those symptoms. It is typically thought of also as an entity as DEEP WHITE MATTER DISEASE or WHITE MATTER DEGENERATIVE DISEASE and again, I repeat, the normal process of aging is enough to bring this on in a person of 61 years of age.
Now, having said that you must understand that there are factors and conditions which can be associated with an EARLIER and more generalized appearance in the brain of this condition. Those risk factors and associated conditions are:
1. Hypertension (high blood pressure)
2. Diabetes Mellitus (high sugar)
3. Hypercholesterolemia (high cholesterol)
4. Hypertriglyceridemia (High fats and triglycerides)
5. Smoking
6. Chronic kidney disease
7. Dialysis
8, Peripheral arterial disease (arteriosclerosis)
9. NORMAL AGING
And there are dozens of more that I could list. I hope you get the idea that this is anything by an UNCOMMON CONDITION and therefore, it's all in the clinical context in which it is interpreted which says whether or not it is relevant from a clinical point of view.
But let's go ahead now and answer your specific questions having to do with the condition of CHRONIC ISCHEMIC GLIOSIS
1. Is it curable
>>> Since this condition is reflective of a degenerative process in the brain which will occur simply based upon aging...."curing" this state of the brain in SOME cases is like asking the question, "Can wrinkles on the skin be CURED?" The answer is NO....but there are things we can do to lessen its burden within the substance of the brain or slow its progression. And this leads to Question #2
2. How fast does this progress
>>>>Speed of progression is highly dependent upon the intervening risk factors of which I mentioned 9 of them. One of course is not under anybody's control and that is the aging process. However, the others such as hypertension, hypercholesterolemia, diabetes mellitus (which can be controlled with insulin, oral medications, diet, and exercise), smoking, and others can be controlled, eliminated, or otherwise, followed and treated by specialists. And so the speed of progression is highly dependent upon the number of risk factors and the intensity or severity of each.
3. What can I do immediately
>>>> I would need more information on your wife's habits, lifestyles, and other health conditions to know whether or not she has any of the risk factors (or others) I mentioned. Those then, represent points of being able to "do something". In days gone by we used to prescribe aspirin, Aggrenox, and other antiplatelet agents but on average the risk factors of all of those agents (unless they are being given to TREAT A STROKE due to ischemic vessel disease) is really not considered standard of care and very possibly carries more risk for GI bleeding and other complications compared to any benefit it may give.
4. Is there treatment-medication?
>>>>>See the above answer. My recommendation on the basis of your information is that you look to control risk factors and change lifestyle as appropriate in order to slow this process down rather than using medications which can cause other complications.
5. I was already told that part of the brain show dead signs of blood not flowing
>>> This is misinformation. A CT scan says nothing about circulation of blood in the brain. The better diagnostic study to obtain for this condition is an MRI and any MRA but even there in order to say anything about the circulation we would really want to get an angiogram and this is WAY TO AGGRESSIVE a procedure to perform in your wife.
If these answers have given you a bit more information on the condition I would appreciate your written feedback and your STAR RATING of the discussion.
If you have no further questions or comments I'd also appreciate your CLOSING THE QUERY on your end which tells the network that we can archive this for future use.
When the Bark is Worse than the Bite
Detailed Answer:
Good evening. I am Dr. Dariush Saghafi and am a neurologist in XXXXXXX Ohio. I am happy to answer some questions for you regarding this condition.
It strikes me as being very possible that whoever interpreted the results of the CT scan for your wife may have unintentionally made the "bark seem worse than the bite" in this condition which admittedly sounds rather morbid. The truth of the matter is we tend to use another term much more frequently among neurologists and that is "small vessel ischemic disease." I don't know if that SOUNDS any better to you but how about if I tell you that this entity is seen best on MRI scans. It is FREQUENTLY seen on CT scans. It often times is not as significant as some doctors make it out to be because it can be seen in otherwise NORMAL INDIVIDUALS WITHOUT ANY NEUROLOGICAL SYMPTOMS.
We never attribute any symptoms of pain, headache, sharp pains, twitching, or visual blurriness because it simply cannot cause any of those symptoms. It is typically thought of also as an entity as DEEP WHITE MATTER DISEASE or WHITE MATTER DEGENERATIVE DISEASE and again, I repeat, the normal process of aging is enough to bring this on in a person of 61 years of age.
Now, having said that you must understand that there are factors and conditions which can be associated with an EARLIER and more generalized appearance in the brain of this condition. Those risk factors and associated conditions are:
1. Hypertension (high blood pressure)
2. Diabetes Mellitus (high sugar)
3. Hypercholesterolemia (high cholesterol)
4. Hypertriglyceridemia (High fats and triglycerides)
5. Smoking
6. Chronic kidney disease
7. Dialysis
8, Peripheral arterial disease (arteriosclerosis)
9. NORMAL AGING
And there are dozens of more that I could list. I hope you get the idea that this is anything by an UNCOMMON CONDITION and therefore, it's all in the clinical context in which it is interpreted which says whether or not it is relevant from a clinical point of view.
But let's go ahead now and answer your specific questions having to do with the condition of CHRONIC ISCHEMIC GLIOSIS
1. Is it curable
>>> Since this condition is reflective of a degenerative process in the brain which will occur simply based upon aging...."curing" this state of the brain in SOME cases is like asking the question, "Can wrinkles on the skin be CURED?" The answer is NO....but there are things we can do to lessen its burden within the substance of the brain or slow its progression. And this leads to Question #2
2. How fast does this progress
>>>>Speed of progression is highly dependent upon the intervening risk factors of which I mentioned 9 of them. One of course is not under anybody's control and that is the aging process. However, the others such as hypertension, hypercholesterolemia, diabetes mellitus (which can be controlled with insulin, oral medications, diet, and exercise), smoking, and others can be controlled, eliminated, or otherwise, followed and treated by specialists. And so the speed of progression is highly dependent upon the number of risk factors and the intensity or severity of each.
3. What can I do immediately
>>>> I would need more information on your wife's habits, lifestyles, and other health conditions to know whether or not she has any of the risk factors (or others) I mentioned. Those then, represent points of being able to "do something". In days gone by we used to prescribe aspirin, Aggrenox, and other antiplatelet agents but on average the risk factors of all of those agents (unless they are being given to TREAT A STROKE due to ischemic vessel disease) is really not considered standard of care and very possibly carries more risk for GI bleeding and other complications compared to any benefit it may give.
4. Is there treatment-medication?
>>>>>See the above answer. My recommendation on the basis of your information is that you look to control risk factors and change lifestyle as appropriate in order to slow this process down rather than using medications which can cause other complications.
5. I was already told that part of the brain show dead signs of blood not flowing
>>> This is misinformation. A CT scan says nothing about circulation of blood in the brain. The better diagnostic study to obtain for this condition is an MRI and any MRA but even there in order to say anything about the circulation we would really want to get an angiogram and this is WAY TO AGGRESSIVE a procedure to perform in your wife.
If these answers have given you a bit more information on the condition I would appreciate your written feedback and your STAR RATING of the discussion.
If you have no further questions or comments I'd also appreciate your CLOSING THE QUERY on your end which tells the network that we can archive this for future use.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Saghafi thank you so mush for your quick answers my wife has a good chance of sleeping tonight. wish you where closer to us. I have made an appointment for her with a Dr. XXXXXXX Avry Helman in XXXXXXX Calif can we show this to him after he tells us his thoughts as to compar
3. What can I do immediately
>>>> I would need more information on your wife's habits, lifestyles, and other health conditions to know whether or not she has any of the risk factors (or others) I mentioned. Those then, represent points of being able to "do something". In days gone by we used to prescribe aspirin, Aggrenox, and other antiplatelet agents but on average the risk factors of all of those agents (unless they are being given to TREAT A STROKE due to ischemic vessel disease) is really not considered standard of care and very possibly carries more risk for GI bleeding and other complications compared to any benefit it may give.
ANSWER:
My wife has diabetes and is insulin dependant. Although she has it under control with diet, exercise and keeping her weight under control she is still dependent on insulin nonetheless. She works in an office working on reports all day long and is President of her Union so she has a lot of stress which I am certain factors into all this. She also has high cholesterol. The doctor today said her cholesterol is down from the previous year (the good cholesterol still out ways the bad) and she is not too much concerned at this point however she is taking Pravastatin 20 mg to keep it further under control. The other medicines she is currently on is as follows:
Mirtazapine 30 mg (for depression); Lorazepam 1 mg (sleep aide); Levothyroxine 50 mcg (thyroid meds)
My wife tends to worry a lot and has a lot of work related stress. She is always exhausted and never has energy to do vigorous activity. She also goes to sleep early each night at approximately 7 pm because her energy level is depleted by days end. She does wake up fairly early between 5:30-6 however she usually has diarrhea to contend to each morning which usually subsides around noon. She can be very coherent one moment and feeling great then you will see a shift in her eyes and they become glossy. At that point the symptoms will worsen and she becomes a bit lethargic. It is sometimes a passing symptom and other times it will linger for hours, rarely for days on end. This has been an ongoing health concern for approximately 2 years. We all associated it with her diabetes and when she had mentioned it to doctors in the past, they too thought it was diabetes related. It wasn't until the symptoms became more frequent that it was an immediate cause for concern. In addition lately, since her diabetes has been somewhat more predictable yet the symptoms persist, we knew something more serious was occurring.
3. What can I do immediately
>>>> I would need more information on your wife's habits, lifestyles, and other health conditions to know whether or not she has any of the risk factors (or others) I mentioned. Those then, represent points of being able to "do something". In days gone by we used to prescribe aspirin, Aggrenox, and other antiplatelet agents but on average the risk factors of all of those agents (unless they are being given to TREAT A STROKE due to ischemic vessel disease) is really not considered standard of care and very possibly carries more risk for GI bleeding and other complications compared to any benefit it may give.
ANSWER:
My wife has diabetes and is insulin dependant. Although she has it under control with diet, exercise and keeping her weight under control she is still dependent on insulin nonetheless. She works in an office working on reports all day long and is President of her Union so she has a lot of stress which I am certain factors into all this. She also has high cholesterol. The doctor today said her cholesterol is down from the previous year (the good cholesterol still out ways the bad) and she is not too much concerned at this point however she is taking Pravastatin 20 mg to keep it further under control. The other medicines she is currently on is as follows:
Mirtazapine 30 mg (for depression); Lorazepam 1 mg (sleep aide); Levothyroxine 50 mcg (thyroid meds)
My wife tends to worry a lot and has a lot of work related stress. She is always exhausted and never has energy to do vigorous activity. She also goes to sleep early each night at approximately 7 pm because her energy level is depleted by days end. She does wake up fairly early between 5:30-6 however she usually has diarrhea to contend to each morning which usually subsides around noon. She can be very coherent one moment and feeling great then you will see a shift in her eyes and they become glossy. At that point the symptoms will worsen and she becomes a bit lethargic. It is sometimes a passing symptom and other times it will linger for hours, rarely for days on end. This has been an ongoing health concern for approximately 2 years. We all associated it with her diabetes and when she had mentioned it to doctors in the past, they too thought it was diabetes related. It wasn't until the symptoms became more frequent that it was an immediate cause for concern. In addition lately, since her diabetes has been somewhat more predictable yet the symptoms persist, we knew something more serious was occurring.
Brief Answer:
The picture becomes more focused
Detailed Answer:
Thank you for the return message.
Now, the picture is a bit more focused. And so your wife has clear and present risk factors which play a role in the development of her condition of small vessel ischemic degeneration or chronic ischemic gliosis as they told you. And she is also stressed and still working as hard as ever. I'm not sure what to make of the diarrhea because that is not part of the brain issue so you'll need to check with your primary on that...perhaps gluten allergy or what is becoming more popular to talk about these days, "celiac disease" etc. or psychological issues at play with everything else?
At any rate, with respect to the brain condition tighter diabetic control and being compliant with her thyroid meds to make sure her numbers are good is the ticket to help in slowing down progression of her disease process and helping her feel less fatigued and tired. There may be room to suggest looking into her vitamin D levels as well as this is getting more and more attention when it comes to brain health these days. As a neurologist I like to see serum levels that are "higher" on the lab values than what most internists find acceptable. So depending upon your lab's scales and the numbers they use I always shoot for the upper 1/3 of the scale and make sure the patient takes supplements as necessary to keep it there.
As a headache specialist as well I would investigate her for a possible headache syndrome of some type given the fact she is on multiple medications, has diabetes, appears to be fatigued chronically, may not be sleeping well as a result, and so forth. The ischemic disease is not thought to really contribute substantially to any particular headache type but then, again a lot is riding on the severity of her condition. Dizziness and nausea could be related to her headache syndrome. Dizziness in part could be related to her gliosis but that really depends on the severity and overall distribution.
There is an something called Binswanger's disease where so much burden of white matter degeneration exists subcortically that patients' mental status may start to become affected as well. Nowadays people refer to this as subcortical leukoencephalopathy. The comment you made about her gliosis showing up on the CT scan to the point where another physician said she had never seen that before makes me wonder about this as a possibility....but again, the downside of being 3000 miles distant over telecommunications lines only! In Binswanger's there seems to be a genetic predisposition involved meaning that it can passed on in families. If she were to have something of this nature you may wish to go a few steps further to identify what if any genetic relationships could exist, especially if you folks have kids.
I haven't had the opportunity to see either her scans or report. Your neurologist will have the advantage of those things He may wish her to have an MRI to further clarify what is being seen on CT or he may simply accept those results if they appear valid enough and consistent with his examination results. I think in either case it's all good. We know what is likely either causing or at least highly contributory to the problem and so the solution is more obvious whether it's an MRI or CT of the head. Again, I wouldn't necessarily look to do invasive studies such as vascular angiograms and I think carotid ultrasounds of the neck are fairly useless when it comes to deciding the overall health of the vascular tree in the brain. They can only look at a very small window of the system and again, if there is no history in your wife of a stroke and no focal neurological signs on the doctor's exam I don't particularly see the value in such a study.
As far as her "blanking out" spells which you say can go on for up to hours at a time..I think that could use a little checking into and so we'll see what your neurologist suggests based on a little more history. Seizure disorder seems a bit unlikely based on what you've said so far but if it were me I'd like more information perhaps by interviewing your wife more directly as well as those who have seen her in these states for prolonged periods of time before completely taking that off the table. And again, could an entity such as Binswanger's be at work and could it produce this type of picture? Depends on the picture and the story which I HOPE you will tell me about as soon as information is available.
Also, I will add that I am another network involved in telemedicine consultation where you'll find me Wed-Sat. from 3a-6a (ET) at www.healthtap.com/drsaghafi and so if you were so inclined to have a WEBCAM chat which could be live streaming we could certainly arrange such a meeting. I don't know exactly what the logistics would have to be so that you could be routed to ME since I'm in OHIO and you're in California. The system tends to route calls to the doctor available in the state you're calling from, however, when you sign on you do have the option of choosing a specific doctor by name (DARIUSH SAGHAFI) to ring him/her and see if they are online. I am on guaranteed shifts as I said Wed.-Sat. in the wee hours of the morning as well as Sundays 11p-3a. You are welcome to ring me. Even if not by webcam we can communicate by streaming voice through microphone or simply message back and forth in real time. Each session is a maximum of 30 minutes.
Once again, best of luck in your visit with Dr. Helman (I don't know him but I'm sure he's amply qualified to handle your wife's case). You are welcome to share what I've written but I would defer ultimately to his judgment since he'll have had the advantage of actually seeing and laying hands on the patient which is infinitely preferable when making important decisions or trying to sort things out as we're doing here.
If you're ever in the XXXXXXX area of the world feel free to say hello. Hope all goes well. I would love an update on your wife's status if you care to share down the road.
If you feel that any of this information has been additionally helpful to your cause I would greatly appreciate your written feedback and a STAR RATING. That's how they keep feeding us the peanuts here to keep going! HA!
Also, if you have no further questions or comments your CLOSING THE QUERY signals to the network that the case is ready for processing, credit, and archival for future use.
This response required 39 min. of physician directed time in its review, research, and documentation of the final draft for envoy.
The picture becomes more focused
Detailed Answer:
Thank you for the return message.
Now, the picture is a bit more focused. And so your wife has clear and present risk factors which play a role in the development of her condition of small vessel ischemic degeneration or chronic ischemic gliosis as they told you. And she is also stressed and still working as hard as ever. I'm not sure what to make of the diarrhea because that is not part of the brain issue so you'll need to check with your primary on that...perhaps gluten allergy or what is becoming more popular to talk about these days, "celiac disease" etc. or psychological issues at play with everything else?
At any rate, with respect to the brain condition tighter diabetic control and being compliant with her thyroid meds to make sure her numbers are good is the ticket to help in slowing down progression of her disease process and helping her feel less fatigued and tired. There may be room to suggest looking into her vitamin D levels as well as this is getting more and more attention when it comes to brain health these days. As a neurologist I like to see serum levels that are "higher" on the lab values than what most internists find acceptable. So depending upon your lab's scales and the numbers they use I always shoot for the upper 1/3 of the scale and make sure the patient takes supplements as necessary to keep it there.
As a headache specialist as well I would investigate her for a possible headache syndrome of some type given the fact she is on multiple medications, has diabetes, appears to be fatigued chronically, may not be sleeping well as a result, and so forth. The ischemic disease is not thought to really contribute substantially to any particular headache type but then, again a lot is riding on the severity of her condition. Dizziness and nausea could be related to her headache syndrome. Dizziness in part could be related to her gliosis but that really depends on the severity and overall distribution.
There is an something called Binswanger's disease where so much burden of white matter degeneration exists subcortically that patients' mental status may start to become affected as well. Nowadays people refer to this as subcortical leukoencephalopathy. The comment you made about her gliosis showing up on the CT scan to the point where another physician said she had never seen that before makes me wonder about this as a possibility....but again, the downside of being 3000 miles distant over telecommunications lines only! In Binswanger's there seems to be a genetic predisposition involved meaning that it can passed on in families. If she were to have something of this nature you may wish to go a few steps further to identify what if any genetic relationships could exist, especially if you folks have kids.
I haven't had the opportunity to see either her scans or report. Your neurologist will have the advantage of those things He may wish her to have an MRI to further clarify what is being seen on CT or he may simply accept those results if they appear valid enough and consistent with his examination results. I think in either case it's all good. We know what is likely either causing or at least highly contributory to the problem and so the solution is more obvious whether it's an MRI or CT of the head. Again, I wouldn't necessarily look to do invasive studies such as vascular angiograms and I think carotid ultrasounds of the neck are fairly useless when it comes to deciding the overall health of the vascular tree in the brain. They can only look at a very small window of the system and again, if there is no history in your wife of a stroke and no focal neurological signs on the doctor's exam I don't particularly see the value in such a study.
As far as her "blanking out" spells which you say can go on for up to hours at a time..I think that could use a little checking into and so we'll see what your neurologist suggests based on a little more history. Seizure disorder seems a bit unlikely based on what you've said so far but if it were me I'd like more information perhaps by interviewing your wife more directly as well as those who have seen her in these states for prolonged periods of time before completely taking that off the table. And again, could an entity such as Binswanger's be at work and could it produce this type of picture? Depends on the picture and the story which I HOPE you will tell me about as soon as information is available.
Also, I will add that I am another network involved in telemedicine consultation where you'll find me Wed-Sat. from 3a-6a (ET) at www.healthtap.com/drsaghafi and so if you were so inclined to have a WEBCAM chat which could be live streaming we could certainly arrange such a meeting. I don't know exactly what the logistics would have to be so that you could be routed to ME since I'm in OHIO and you're in California. The system tends to route calls to the doctor available in the state you're calling from, however, when you sign on you do have the option of choosing a specific doctor by name (DARIUSH SAGHAFI) to ring him/her and see if they are online. I am on guaranteed shifts as I said Wed.-Sat. in the wee hours of the morning as well as Sundays 11p-3a. You are welcome to ring me. Even if not by webcam we can communicate by streaming voice through microphone or simply message back and forth in real time. Each session is a maximum of 30 minutes.
Once again, best of luck in your visit with Dr. Helman (I don't know him but I'm sure he's amply qualified to handle your wife's case). You are welcome to share what I've written but I would defer ultimately to his judgment since he'll have had the advantage of actually seeing and laying hands on the patient which is infinitely preferable when making important decisions or trying to sort things out as we're doing here.
If you're ever in the XXXXXXX area of the world feel free to say hello. Hope all goes well. I would love an update on your wife's status if you care to share down the road.
If you feel that any of this information has been additionally helpful to your cause I would greatly appreciate your written feedback and a STAR RATING. That's how they keep feeding us the peanuts here to keep going! HA!
Also, if you have no further questions or comments your CLOSING THE QUERY signals to the network that the case is ready for processing, credit, and archival for future use.
This response required 39 min. of physician directed time in its review, research, and documentation of the final draft for envoy.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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