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What Does This MRI Report Indicate?
Question: 1- Do I have brain cancer/tumor?
2- What would be the confirmatory diagnosis for IIH?
3- What would cause this to happen?
4- What would you recommend as next steps?
2- What would be the confirmatory diagnosis for IIH?
3- What would cause this to happen?
4- What would you recommend as next steps?
Brief Answer:
There is no brain tumor or cancer
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. You do not have any brain tumor or cancer.
2. Going by the clinical features and MRI scan findings there is a condition idiopathic intracranial hypertension and called pseudotumor cerebri. In this condition there is empty sella with increased pressure inside the brain and there are visual problems due to the effect of increased pressure on the optic nerve.
3. In medical literature the cause for this is said to be decreased CSF absorption, increased CSF production, increased intravascular volume, and increased intracranial venous pressure. CSF is brain fluid. Intravascular volume is volume of blood flowing. Intracranial venous pressure is the pressure in blood flowing through veins in brain.
4. If it is clinically confirmed by doing neurological examination then a shunt is placed to equalize the pressure in the brain and make it normal.
5. Many people get relief after the shunting is done. Treatment includes optic nerve fenestration for those in whom vision is affected. Medicines like acetazolamide can be given depending on clinical symptoms.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
There is no brain tumor or cancer
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. You do not have any brain tumor or cancer.
2. Going by the clinical features and MRI scan findings there is a condition idiopathic intracranial hypertension and called pseudotumor cerebri. In this condition there is empty sella with increased pressure inside the brain and there are visual problems due to the effect of increased pressure on the optic nerve.
3. In medical literature the cause for this is said to be decreased CSF absorption, increased CSF production, increased intravascular volume, and increased intracranial venous pressure. CSF is brain fluid. Intravascular volume is volume of blood flowing. Intracranial venous pressure is the pressure in blood flowing through veins in brain.
4. If it is clinically confirmed by doing neurological examination then a shunt is placed to equalize the pressure in the brain and make it normal.
5. Many people get relief after the shunting is done. Treatment includes optic nerve fenestration for those in whom vision is affected. Medicines like acetazolamide can be given depending on clinical symptoms.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. I wanted you to review the MRI's themselves and not the report for your opinion. I didn't want you to be biased in the report's findings.
From what you wee on the attached MRI's do you seen:
1- a tortuous optic nerve?
2- an empty sella?
3- Any abnormality in the brain? tumor or lesions anywhere?
From what you wee on the attached MRI's do you seen:
1- a tortuous optic nerve?
2- an empty sella?
3- Any abnormality in the brain? tumor or lesions anywhere?
Brief Answer:
No tumor like feature seen in the picture attached
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. There is torturous optic nerve on both the sides with left greater than right.
2. The empty sella is seen and I confirm the finding.
3. No other gross tumor like area is seen in the pictures you have attached. The ventricles, empty sella, optic nerves and clinical symptoms suggest idiopathic intracranial hypertension. Please remember that in the stress is on inability to find any tumor in the presence of slit like ventricles, empty sella, optic nerve changes with indicative findings on MRV.
You can upload the complete CD contents to file sharing facility like Dropbox or google drive and send me download link. I will have a look at the pictures in my workstation.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
No tumor like feature seen in the picture attached
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. There is torturous optic nerve on both the sides with left greater than right.
2. The empty sella is seen and I confirm the finding.
3. No other gross tumor like area is seen in the pictures you have attached. The ventricles, empty sella, optic nerves and clinical symptoms suggest idiopathic intracranial hypertension. Please remember that in the stress is on inability to find any tumor in the presence of slit like ventricles, empty sella, optic nerve changes with indicative findings on MRV.
You can upload the complete CD contents to file sharing facility like Dropbox or google drive and send me download link. I will have a look at the pictures in my workstation.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor-
I would be happy to share, however, I will need your email address.
Please see link below:
https://drive.google.com/file/d/0B0hTLnojqoLbakZ6OVg4OXhlVVU/view?usp=sharing
I would be happy to share, however, I will need your email address.
Please see link below:
https://drive.google.com/file/d/0B0hTLnojqoLbakZ6OVg4OXhlVVU/view?usp=sharing
Brief Answer:
The MRI pictures show the following
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. The MRI scan has been reviewed by me. The pictures show the findings mentioned earlier
(i) Empty sella
(ii) Slit like ventricles
(iii) Tortuous optic nerves left greater than right
No brain tumor is noted.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
The MRI pictures show the following
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. The MRI scan has been reviewed by me. The pictures show the findings mentioned earlier
(i) Empty sella
(ii) Slit like ventricles
(iii) Tortuous optic nerves left greater than right
No brain tumor is noted.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks dr.
What could be the cause?
What other tests would you suggest?
Anything of concern to you?
What could be the cause?
What other tests would you suggest?
Anything of concern to you?
Brief Answer:
Please discuss with ophthalmologist and neurologist and start treatment
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. In the last few months I have seen 4 patients having a problem similar to your condition. Early treatment is suggested to avoid progression of symptom.
2. First I suggest that you get examined extensively by an ophthalomologist and then have your ophthalmologist discuss with the neurologist.
3. Treatment is to be started immediately if your vision is suffering. It is difficult to say the course of illness and therefore please get treated early.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Please discuss with ophthalmologist and neurologist and start treatment
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. In the last few months I have seen 4 patients having a problem similar to your condition. Early treatment is suggested to avoid progression of symptom.
2. First I suggest that you get examined extensively by an ophthalomologist and then have your ophthalmologist discuss with the neurologist.
3. Treatment is to be started immediately if your vision is suffering. It is difficult to say the course of illness and therefore please get treated early.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks for your patience Dr. This has been a confusing time for me:
I have a few last follow-up questions:
1-Would these finding all be incidental? Are these issues congenital? Would I have been living with this for a while? I had a bathroom fall 3 months ago, and hit my head pretty hard on the bathroom floor, could this a symptom of that? I am sorry for asking some many questions, however, I am shocked that there are abnormal findings and that Dr's. don't know the cause.
2- Is there anything life threatening? Should I have these tests done quickly?
3- Also, I have noticed that my brain feels foggy. I don't remember things like I used to and I don't feel like my brain is clear or as sharp as it used to be. I am a bit forgetful of recent, could this be symptom if IIH?
4- I am also feeling a bit dizzy, could this have anything to do with the IIH that I am experiencing?
5- What will the fundoscopy tell me?
6- How evasive is the CSF fluid removal? Would you recommend this procedure? How long will it take? Will I be able to return to normal activities quickly?
7- What are some good neurological centers in XXXXXXX or other parts of India?
I have a few last follow-up questions:
1-Would these finding all be incidental? Are these issues congenital? Would I have been living with this for a while? I had a bathroom fall 3 months ago, and hit my head pretty hard on the bathroom floor, could this a symptom of that? I am sorry for asking some many questions, however, I am shocked that there are abnormal findings and that Dr's. don't know the cause.
2- Is there anything life threatening? Should I have these tests done quickly?
3- Also, I have noticed that my brain feels foggy. I don't remember things like I used to and I don't feel like my brain is clear or as sharp as it used to be. I am a bit forgetful of recent, could this be symptom if IIH?
4- I am also feeling a bit dizzy, could this have anything to do with the IIH that I am experiencing?
5- What will the fundoscopy tell me?
6- How evasive is the CSF fluid removal? Would you recommend this procedure? How long will it take? Will I be able to return to normal activities quickly?
7- What are some good neurological centers in XXXXXXX or other parts of India?
Brief Answer:
Problem is with vision and it should be treated urgently
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. This cannot be said to be an incidental finding because there is a probability that the problems you have are explained by the MRI scan and this was slowly progressing since few months to years. Though it cannot be entirely congenital and most patients are diagnosed in adult age group however few children can have this problem. The fall in the bath room cannot cause this to occur and it is probable that the fall was because of this problem if it happened from balancing problem.
2. The problem is with vision getting affected. This is the reason early treatment is suggested. It is difficult to say the course of illness and if permanent vision will be affected and therefore please get treated early.
3. Foggy brain activity and memory problems can happen from effect of increased pressure on the cognitive centers in the brain.
4. The increased brain pressure can explain dizziness.
5. Fundoscopy will help having a look at the papilledema and any other problems in the eye. It will help to rule out any other causes and if the peripheral vision loss is from any other condition.
6. The CSF removal or shunting depends on the nature of symptoms and fundoscopy findings. There are many techniques of management by CFS manipulation and some are basic and can be done in the office and few require surgery. Some amount of rest from mental activities is suggested and most patients get back to doing their normal work in office after two weeks.
7. In XXXXXXX there are many places which can be of help to you. In the government hospitals there is NIMHANS and in the private set up there is St.Johns Medical College, BGS Hospital, Manipal Hospital, and XXXXXXX XXXXXXX Institue of Higher Medical Sciences to name a few.
In XXXXXXX there is Sree XXXXXXX Tirunal Institute for Medical Sciences and Technology which is a good center for neurology in south XXXXXXX and you can consult doctor there.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Problem is with vision and it should be treated urgently
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. This cannot be said to be an incidental finding because there is a probability that the problems you have are explained by the MRI scan and this was slowly progressing since few months to years. Though it cannot be entirely congenital and most patients are diagnosed in adult age group however few children can have this problem. The fall in the bath room cannot cause this to occur and it is probable that the fall was because of this problem if it happened from balancing problem.
2. The problem is with vision getting affected. This is the reason early treatment is suggested. It is difficult to say the course of illness and if permanent vision will be affected and therefore please get treated early.
3. Foggy brain activity and memory problems can happen from effect of increased pressure on the cognitive centers in the brain.
4. The increased brain pressure can explain dizziness.
5. Fundoscopy will help having a look at the papilledema and any other problems in the eye. It will help to rule out any other causes and if the peripheral vision loss is from any other condition.
6. The CSF removal or shunting depends on the nature of symptoms and fundoscopy findings. There are many techniques of management by CFS manipulation and some are basic and can be done in the office and few require surgery. Some amount of rest from mental activities is suggested and most patients get back to doing their normal work in office after two weeks.
7. In XXXXXXX there are many places which can be of help to you. In the government hospitals there is NIMHANS and in the private set up there is St.Johns Medical College, BGS Hospital, Manipal Hospital, and XXXXXXX XXXXXXX Institue of Higher Medical Sciences to name a few.
In XXXXXXX there is Sree XXXXXXX Tirunal Institute for Medical Sciences and Technology which is a good center for neurology in south XXXXXXX and you can consult doctor there.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello Dr.-
Did you notice any small FLAIR hyperintensities in the midbrain and around posterior horns of lateral ventricles?
Did you notice any small FLAIR hyperintensities in the midbrain and around posterior horns of lateral ventricles?
Brief Answer:
The FLAIR hyperintensity around ventricles is expected and part of changes
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. There are small hyperintensities on FLAIR around the ventricles which can be from seepage of CSF in to the adjacent white matter and this is not very significant and probably that is the reason your doctor has not mentioned it. This is expected when there is increased pressure in the brain fluid. In the mid brain there is no obvious hyperintensity that is abnormal in my opinion.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
The FLAIR hyperintensity around ventricles is expected and part of changes
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. There are small hyperintensities on FLAIR around the ventricles which can be from seepage of CSF in to the adjacent white matter and this is not very significant and probably that is the reason your doctor has not mentioned it. This is expected when there is increased pressure in the brain fluid. In the mid brain there is no obvious hyperintensity that is abnormal in my opinion.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
It does, thanks Dr.
I just had a fundoscopy performed yesterday, and there was no papiledema or another abnormalities found. Does this mean that we can rule out IIH and focus on a tensions headache? Would you still recommend a lumbar puncture? Many thanks.
I just had a fundoscopy performed yesterday, and there was no papiledema or another abnormalities found. Does this mean that we can rule out IIH and focus on a tensions headache? Would you still recommend a lumbar puncture? Many thanks.
Brief Answer:
There can be IIH without papilledema and it requires lumbar puncture
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. It is still probable that you have idiopathic intracranial hypertension and I have read 2 articles on IIH without papilledema, the findings of which I want to share with you.
(i) An article on 10 IIH without papilledema patients hows that and I quote "Findings from laboratory and neurologic investigations are normal in most patients with idiopathic intracranial hypertension without papilledema. Initial management should include removal of possible inciting agents, weight loss if applicable, and standard headache therapy. Lumbar puncture and diuretic therapy should precede a trial of corticosteroids. Surgery (lumboperitoneal or ventriculoperitoneal shunt or perhaps optic nerve sheath fenestration) may be indicated for prolonged incapacitating headache that is not responsive to medical management or lumbar puncture."
(ii) Another article on the same topic shows and I quote "The clinical presentation of idiopathic intracranial hypertension without papilledema is only somewhat different from that of idiopathic intracranial hypertension with papilledema. The lower opening pressure in patients without papilledema may explain variations in symptoms and signs between the 2 groups. When there are visual field changes in idiopathic intracranial hypertension without papilledema, non-physiologic visual loss should be considered."
Therefore after reading the above studies, proceeding with lumbar puncture is suggested to treat your symptoms.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
There can be IIH without papilledema and it requires lumbar puncture
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. It is still probable that you have idiopathic intracranial hypertension and I have read 2 articles on IIH without papilledema, the findings of which I want to share with you.
(i) An article on 10 IIH without papilledema patients hows that and I quote "Findings from laboratory and neurologic investigations are normal in most patients with idiopathic intracranial hypertension without papilledema. Initial management should include removal of possible inciting agents, weight loss if applicable, and standard headache therapy. Lumbar puncture and diuretic therapy should precede a trial of corticosteroids. Surgery (lumboperitoneal or ventriculoperitoneal shunt or perhaps optic nerve sheath fenestration) may be indicated for prolonged incapacitating headache that is not responsive to medical management or lumbar puncture."
(ii) Another article on the same topic shows and I quote "The clinical presentation of idiopathic intracranial hypertension without papilledema is only somewhat different from that of idiopathic intracranial hypertension with papilledema. The lower opening pressure in patients without papilledema may explain variations in symptoms and signs between the 2 groups. When there are visual field changes in idiopathic intracranial hypertension without papilledema, non-physiologic visual loss should be considered."
Therefore after reading the above studies, proceeding with lumbar puncture is suggested to treat your symptoms.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Excellent data Dr.-
in the second article, what is meant by "non-physiologic visual loss should be considered".
Best
in the second article, what is meant by "non-physiologic visual loss should be considered".
Best
Brief Answer:
Non physiological means abnormal vision problems
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. I referred back to the article and they have clearly mentioned and I quote "Visual fields were judged to be “Non-physiologic” if the person had non-physiologic constriction of the visual field (the 3-meter visual field was inside the 1-meter visual field at the tangent screen)." This is by getting tested for vision using perimetry.
In simple language this non physiological means due to abnormal reason.
I will like to help you in your investigation and treatment with the help you require and you can continue to ask any questions which are there in your mind.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Non physiological means abnormal vision problems
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. I referred back to the article and they have clearly mentioned and I quote "Visual fields were judged to be “Non-physiologic” if the person had non-physiologic constriction of the visual field (the 3-meter visual field was inside the 1-meter visual field at the tangent screen)." This is by getting tested for vision using perimetry.
In simple language this non physiological means due to abnormal reason.
I will like to help you in your investigation and treatment with the help you require and you can continue to ask any questions which are there in your mind.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Dr. it was helpful.
I am curious to know, however, if we are missing anything here. As I reported, I had a fall 3 months ago, could my symptoms be related to that? (i.e. concussion ?). Could a mild concussion be the cause?
Best-
Also forgot to mention meningitis?
I am curious to know, however, if we are missing anything here. As I reported, I had a fall 3 months ago, could my symptoms be related to that? (i.e. concussion ?). Could a mild concussion be the cause?
Best-
Also forgot to mention meningitis?
Brief Answer:
Concussion injury improves in 3 months
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. The concussion will not cause symptoms involving vision after 3 months. Concussion injury can cause slight headaches, confusion and memory problems which get better over time. Therefore I do not think that your concussion will cause these symptoms.
2. Meningitis is infection of the brain covering. This causes fever with neck rigidity which is not there in you. On MRI scan no sign of meningitis is seen. Rarely meningitis can cause negative scan findings however clinical symptoms are not there.
3. Right now you can get your vision assessed completely. This can be followed by lumbar puncture. Your symptoms look mild and therefore there are good chances of improvement and cure.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Concussion injury improves in 3 months
Detailed Answer:
Hi XXXXXXX XXXX,
Thanks for writing back with an update.
1. The concussion will not cause symptoms involving vision after 3 months. Concussion injury can cause slight headaches, confusion and memory problems which get better over time. Therefore I do not think that your concussion will cause these symptoms.
2. Meningitis is infection of the brain covering. This causes fever with neck rigidity which is not there in you. On MRI scan no sign of meningitis is seen. Rarely meningitis can cause negative scan findings however clinical symptoms are not there.
3. Right now you can get your vision assessed completely. This can be followed by lumbar puncture. Your symptoms look mild and therefore there are good chances of improvement and cure.
Hope your query is answered.
Please do write back if this reply helps.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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