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What Does This MRI Report Indicate?

Posted on Sat, 16 Jan 2016

Question: I need an independent second opinion on an MRI that I have had.

1- Do I have brain cancer/tumor/lesion?
2- What would be the confirmatory diagnosis for IIH?
3- What would cause this to happen?
4- What would you recommend as next steps?

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Answered by Dr. Indu Kumar (1 hour later)

Brief Answer:
I like to assure that there are no signs of cancer or tumour in brain.

Detailed Answer:
Hello
Thanks for writing to HCM

Most of the information is already shared by other doctors.

1.Again,I like to assure you that there are no signs of cancer or tumour in brain.
Imaging and symptoms typically suggest IIH.

2.Clinical symptoms and findings (including eye examination for papilledema i.e optic disc swelling ) and MRI with venography is the best investigation to diagnose this condition.

3.Generally cause is not known for this condition.However,rarely if it is due to certain reasons like kidney disease,SLE etc then it is called as secondary IIH.

4.Uncontrolled papilledema may lead to progressive loss of vision.
Initially,you are rightly trying to manage conservative i,e by means of medicines.
Surgery is advised in non responding cases.

Get well soon.
Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (2 hours later)

Hello Dr. Thanks. I had both an MRV and MRA done. Nothing was found.

I am curious to know what could be the cause of the IIH? Could meningitis be the cause also?

Answered by Dr. Indu Kumar (14 minutes later)

Brief Answer:
Mostly IIH is idiopathic i,e cause in not known.

Detailed Answer:
Hello
Thanks for writing to HCM

Mostly IIH is idiopathic i.e. cause in not known.

If it is due to some illness then it is called as secondary and meningitis is one the reason but percentage is very less.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Indu Kumar (15 hours later)

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?

Answered by Dr. Indu Kumar (6 hours later)

Brief Answer:
This is not a life threatening condition.

Detailed Answer:
Hello
Thanks for writing to HCM

I can understand your problem.This is the limitation of medical science that cause of many diseases are not known to us but we try to manage the disease.
Increased pressure in brain may causes many symptoms and your many symptoms may be related to this.
Don't worry,this is a manageable condition.
This is not a life threatening condition but it may causes deleterious effects to patient including visual loss.
Fundoscopy may assess health of optic disc and optic nerve which is vital for vision.
You are rightly managing with medicines,this ideal protocol in this condition.
Surgical intervention may be required if condition doesn't improve.

CSF fluid drainage by lumbar puncture may be advised after evaluation,this is a short process and it may take 10-15 mins for entire process.

You may consult NIMHANS,this is a very good centre for neurology.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Indu Kumar (38 hours later)

Hello Dr.-

Did you notice any small FLAIR hyperintensities in the midbrain and around posterior horns of lateral ventricles?

Answered by Dr. Indu Kumar (5 hours later)

Brief Answer:
There are few hyper intensities in peri ventricular region.

Detailed Answer:
Hello
Thanks for writing to HCM

There are few hyper intensities in peri ventricular region which may be insignificant and may be ignored.
These hyper intensities may be due to many reasons and you may need follow up MRI to see progression of lesions.
I am sure routine blood investigations has been done in your case.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (3 minutes later)

Hello Dr., what blood investigations would be required? Also what causes these hyper intensities?

Answered by Dr. Indu Kumar (10 minutes later)

Brief Answer:
Hyper intensities are generally due to ischemic changes.

Detailed Answer:
Hello
Thanks for writing to HCM

Hyper intensities are generally due to ischemic changes(due to compromised blood supply).
These are generally due to involvement of small blood vessels.
It is generally due to conditions like hypertension,diabetes mellitus,altered lipid profile etc.

It may also be due to other reasons like post trauma,post infection etc.

You may need detail evaluation for these medical conditions.Generally only underlying etiology need to control.These are not very serious findings.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (11 minutes later)

Thanks, very helpful. I wanted to write to you and let you know that I met with an ophthalmologist yesterday (fundoscopy) and their was no major findings that indicate potential papiledema or any other optic swelling issues. Everything was normal. Would this rule out IIH?

What other tests would you suggest? Is lumbar puncture recommended?

Answered by Dr. Indu Kumar (16 minutes later)

Brief Answer:
IIH is generally associated with papilledema.

Detailed Answer:
Hello
Thanks for writing to HCM

It is good that optic disc is normal.IIH is generally associated with papilledema ,In fact it is the most common association.
But we can't conclude from this findings.Some IIH patient may have normal disc in very early stage.
You may need other eye tests like visual field charting etc.
You may need lumbar puncture test for opening pressure estimation etc.Fluid should be sent for cytology,culture/sensitivity.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar