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What Does This MRI Report Indicate?
Question: Can you explain this MRI result w/o contrast of my head?
CLINICAL INDICATIONS:
1. Diagnoses: Other amnesia/R41.3
2. Reason for Exam:
3. Additional Relevant History: Concussions in 2010, 2012. Migranes, memory loss, unsteady gait
TECHNIQUE: MRI HEAD WO CONTRAST
COMPARISON: NA
FINDINGS: No acute intracranial hemorrhage or mass effect is demonstrated. There is no diffusion restriction to suggest an acute or subacute infarct. Focal encephalomalacia with cortical laminar necrosis along the right inferior frontal gyrus suggests an
old infarct. The major intracranial vascular signal voids are present. The midline structures are unremarkable. Ventricular size is normal. No substantial atrophy is identified. The hippocampi are normal in size and symmetric.
Microvascular ischemic changes are present. Diffuse parenchymal atrophy is noted.
The visualized paranasal sinuses are clear
Impression
1. Right inferior frontal gyral encephalomalacia.
2. No acute infarct.
CLINICAL INDICATIONS:
1. Diagnoses: Other amnesia/R41.3
2. Reason for Exam:
3. Additional Relevant History: Concussions in 2010, 2012. Migranes, memory loss, unsteady gait
TECHNIQUE: MRI HEAD WO CONTRAST
COMPARISON: NA
FINDINGS: No acute intracranial hemorrhage or mass effect is demonstrated. There is no diffusion restriction to suggest an acute or subacute infarct. Focal encephalomalacia with cortical laminar necrosis along the right inferior frontal gyrus suggests an
old infarct. The major intracranial vascular signal voids are present. The midline structures are unremarkable. Ventricular size is normal. No substantial atrophy is identified. The hippocampi are normal in size and symmetric.
Microvascular ischemic changes are present. Diffuse parenchymal atrophy is noted.
The visualized paranasal sinuses are clear
Impression
1. Right inferior frontal gyral encephalomalacia.
2. No acute infarct.
Brief Answer:
MRI finding interpretation
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. It is sad that two major accidents happened to you. I will try to explain each and every finding of MRI to give you the required information.
You have two positive findings
: Inferior frontal gyrus encephalomalacia - It is loss of normal brain matter in right inferior frontal lobe. It might have occurred due to the accidents. At that time, you must have suffered direct injury to brain and it went unnoticed. With time, it healed to some extent but dead area changed into encephalomalacia.
Another possibility is old infarct. It might have occurred due to gradual loss of blood supply to this area of brain. As it occurred over a course of time, it went unnoticed.
I am suspecting it to be due to trauma rather than ischemia. It is because your age is only 45 years and there is history of two sever accidents.
:Diffuse parenchymal atrophy means reduction in size of whole brain matter. It might have occurred due to
Diffuse small vessel ischemia
or
head trauma
Rest of your MRI brain is normal. Now coming to your main symptom - Memory loss.
This memory loss is due to both
: Gliosis in inferior frontal gyrus
: Diffuse cerebral atrophy
But good thing in your case is that your hippocampi are normal. Amygdala-Hippocampi are required for memory. So there are chances of improvement.
Hope I have cleared your queries. If still in doubt, do let me know.
Thanks. Take care.
MRI finding interpretation
Detailed Answer:
Hi XXXX, thanks for asking from HCM.
I can understand your concern. It is sad that two major accidents happened to you. I will try to explain each and every finding of MRI to give you the required information.
You have two positive findings
: Inferior frontal gyrus encephalomalacia - It is loss of normal brain matter in right inferior frontal lobe. It might have occurred due to the accidents. At that time, you must have suffered direct injury to brain and it went unnoticed. With time, it healed to some extent but dead area changed into encephalomalacia.
Another possibility is old infarct. It might have occurred due to gradual loss of blood supply to this area of brain. As it occurred over a course of time, it went unnoticed.
I am suspecting it to be due to trauma rather than ischemia. It is because your age is only 45 years and there is history of two sever accidents.
:Diffuse parenchymal atrophy means reduction in size of whole brain matter. It might have occurred due to
Diffuse small vessel ischemia
or
head trauma
Rest of your MRI brain is normal. Now coming to your main symptom - Memory loss.
This memory loss is due to both
: Gliosis in inferior frontal gyrus
: Diffuse cerebral atrophy
But good thing in your case is that your hippocampi are normal. Amygdala-Hippocampi are required for memory. So there are chances of improvement.
Hope I have cleared your queries. If still in doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
If I may, I guess more of my concern was getting my words to come out I lose them or can't seem to remember how to get it from brain to voice. I know what word I want but won't come. Or I'll be telling a story and take a drink or pause and completely lost for the life of me what I was saying. I have insane insomnia which I've never had in my life. And my thinking gets so confused and anxious when too much is being thrown at me at once to process. It feels like it stops working. But I used to be a beautiful writer and it's so hard to find the words I want that I know in my head but won't come out on paper or my voice. It's been over 6 yrs and it feels like it's getting worse out of nowhere. Not that it came back but the insomnia started the thoughts disappear (mid conversation) and my hands don't seem to work as well .. Can I get anything back? And why does it feel like it's reoccurring at its worst ?
Brief Answer:
Dementia and its management
Detailed Answer:
Hi XXXX, welcome back.
I have read detail of your symptoms. These symptoms are suggestive of "Dementia". It is a neurological disorder which manifests as poor memory, behavioural problem, social withdrawal, language problem, poor thinking etc. All of your symptoms are due to
: Diffuse brain atrophy - As it had caused multiple areas atrophy and thus it is affecting your social behaviour, personality and higher mental function.
Your symptoms have become worse or recurring due to "insomnia". To get you some relief, we have to treat your insomnia along with dementia.
For Insomnia, you can follow few tips
: Avoid coffee/tea or caffeinated drinks.
: Do Yoga or mediation to control your nerves, calm you and it will also control your dementia.
: Also do some exercise intermittently. It will help in sleeping and improving brain function.
: Avoid late night laptop or computer/TV/mobile use
: You can take tablet Zolpidem after proper prescription.
: Eat food which induces sleep like curd/Yoghurt/buttermilk.
To treat dementia, you have to be patient. It will take time to see some improvement.
: Play brain games like Chess/Sudoku/Brain puzzles.
: Yoga/meditation.
: Try to converse as much as possible with your friends or family.
: Take help from speech therapist if there is any problem in articulation.
: Consult occupational therapist to become independent.
: Eat food which contain antioxidants like fruits, green leafy vegetables, almonds etc.
: Avoid alcohol, drug abuse, smoking.
: You can take few drugs after prescription. The following are used to temporarily improve dementia symptoms.
Cholinesterase inhibitors. These medication include donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne).
Although primarily used to treat Alzheimer's disease, these medications might also be prescribed for other dementias, including vascular dementia (as in your case)
Side effects can include nausea, vomiting and diarrhea.
Memantine
: Some nutritional supplement can also help in dementia like
Vitamin E
Omega-3 fatty acids - There is some evidence that eating fish three times a week might lower your risk of dementia.
Ginkgo biloba
:Music therapy, which involves listening to soothing music
:Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
:Aromatherapy, which uses fragrant plant oils
:Massage therapy
:Art therapy, which involves creating art, focusing on the process rather than the outcome.
You can discuss all these possibilities with your doctor. You will see improvement in 2-3 months.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Dementia and its management
Detailed Answer:
Hi XXXX, welcome back.
I have read detail of your symptoms. These symptoms are suggestive of "Dementia". It is a neurological disorder which manifests as poor memory, behavioural problem, social withdrawal, language problem, poor thinking etc. All of your symptoms are due to
: Diffuse brain atrophy - As it had caused multiple areas atrophy and thus it is affecting your social behaviour, personality and higher mental function.
Your symptoms have become worse or recurring due to "insomnia". To get you some relief, we have to treat your insomnia along with dementia.
For Insomnia, you can follow few tips
: Avoid coffee/tea or caffeinated drinks.
: Do Yoga or mediation to control your nerves, calm you and it will also control your dementia.
: Also do some exercise intermittently. It will help in sleeping and improving brain function.
: Avoid late night laptop or computer/TV/mobile use
: You can take tablet Zolpidem after proper prescription.
: Eat food which induces sleep like curd/Yoghurt/buttermilk.
To treat dementia, you have to be patient. It will take time to see some improvement.
: Play brain games like Chess/Sudoku/Brain puzzles.
: Yoga/meditation.
: Try to converse as much as possible with your friends or family.
: Take help from speech therapist if there is any problem in articulation.
: Consult occupational therapist to become independent.
: Eat food which contain antioxidants like fruits, green leafy vegetables, almonds etc.
: Avoid alcohol, drug abuse, smoking.
: You can take few drugs after prescription. The following are used to temporarily improve dementia symptoms.
Cholinesterase inhibitors. These medication include donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne).
Although primarily used to treat Alzheimer's disease, these medications might also be prescribed for other dementias, including vascular dementia (as in your case)
Side effects can include nausea, vomiting and diarrhea.
Memantine
: Some nutritional supplement can also help in dementia like
Vitamin E
Omega-3 fatty acids - There is some evidence that eating fish three times a week might lower your risk of dementia.
Ginkgo biloba
:Music therapy, which involves listening to soothing music
:Pet therapy, which involves use of animals, such as visits from dogs, to promote improved moods and behaviors in people with dementia
:Aromatherapy, which uses fragrant plant oils
:Massage therapy
:Art therapy, which involves creating art, focusing on the process rather than the outcome.
You can discuss all these possibilities with your doctor. You will see improvement in 2-3 months.
Hope it will help you. If still in doubt, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thank you I am sorry but I do have one more question and not sure it can be answered. I do not usually visit this but had they caught the bleeding could anything have been done? Or had I been able to follow up regularly could it been detected? I am not sure if I mentioned but the 2nd head injury I was traveling on the interstate and as I caught a glimpse from my peripheral vision, I looked as a deer can through my driver's side window while I was driving 80mph and landed on my lap. Yes not sure how I survived and this was two years almost to the date of a multiple rollover in my Chevy Tahoe vehicle and my left side of head hit first on impact before the airbags were triggered. Again, lucky and was cut out of vehicle at that scene as well. So question had I been followed medically would I had any chances of a better outcome. I am not certain what they do in emergency when it comes to a direct hit to the head I do know they scanned I believe from records but must not have shown or may have been missed. I read it can gradually bleed after the injury I am not certain. Maybe you can shed some light on these questions. Again, I hate to dwell on what could of been verses the now but I think in this case it will help me to understand
Brief Answer:
Head injury early evaluation advantage and outcome
Detailed Answer:
Hi XXXX, welcome back.
I got your point. If your injury had been picked up early and you had received right treatment at that time, your outcome would have been better than present. It is because some medication like Citicoline/Cerebrolysin and effect of therapy are best seen in recovering brain. Recovery occurs maximum in first 12 months and if full efforts are given within this period, patient improves maximum.
But do not worry. Because your most brain areas are intact. You have chance of improvement with time. One more thing, kindly ask your doctor to evaluate your
: Cerebrovascular system by CT angiography or Doppler ultrasound to know any blockade. If any blockade, treat it before any further damage.
You also asked about late bleeding in brain after head injury. Yes, it is right. Brain bleed usually increases or may occur new bleed in first 72 hours.
I hope I have cleared your queries. Please don't dwell too much on your past. You cant change it. Give your best efforts to make your present and future better.
Hope it will help you. Thanks. Take care.
Head injury early evaluation advantage and outcome
Detailed Answer:
Hi XXXX, welcome back.
I got your point. If your injury had been picked up early and you had received right treatment at that time, your outcome would have been better than present. It is because some medication like Citicoline/Cerebrolysin and effect of therapy are best seen in recovering brain. Recovery occurs maximum in first 12 months and if full efforts are given within this period, patient improves maximum.
But do not worry. Because your most brain areas are intact. You have chance of improvement with time. One more thing, kindly ask your doctor to evaluate your
: Cerebrovascular system by CT angiography or Doppler ultrasound to know any blockade. If any blockade, treat it before any further damage.
You also asked about late bleeding in brain after head injury. Yes, it is right. Brain bleed usually increases or may occur new bleed in first 72 hours.
I hope I have cleared your queries. Please don't dwell too much on your past. You cant change it. Give your best efforts to make your present and future better.
Hope it will help you. Thanks. Take care.
Above answer was peer-reviewed by :
Dr. Sonia Raina
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