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What Do My MRI Scan Test Results Indicate?
Question: My husband had an MRI done and the findings were cosnsistent with a small, old infarct in the inferior right occipital lobe , samll vessel disease and mild cerebral parenchymal volume loss. It also said something about encephalomalacia. We have an appt with a neurologist on Oct 6 but could you give us some insight on this.
Doe the condition encophalomalacia, can it make you confused for periods of time like you're having a stroke?
Doe the condition encophalomalacia, can it make you confused for periods of time like you're having a stroke?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
The first finding a small infarct, means that he has had a stroke, an occlusion of a blood vessel which has led to infarction, damage to the brain area supplied by that vessel. Fortunately it was small and in an area which doesn't cause major deficits. It may explain a period of confusion during the acute phase though. May cause some impairment in the visual field, difficulty seeing things which are on the left side, bumping into them, which may be taken for confusion at times.
The small vessel disease means diffuse changes to the small of the blood vessels, narrowing of their caliber and occlusion of the smallest ones causing tiny areas of damage. It is very common with age so shouldn't alarm you, is found in many people after the age of 65. When mild or moderate doesn't usually cause any noticeable symptoms, only if advanced does it cause slowing and deterioration of the higher mental functions. So since the report doesn't mention advanced or severe small vessel disease should panic about that, in a way it's part of aging. There is no specific treatment apart from controlling factors which may damage blood vessels like diabetes, high blood pressure, cholesterol etc.
Mild cerebral parenchymal volume loss is also a finding which is expected with age. All of us start losing brain cells after our twenties, as years go by these losses sum up and it becomes visible on MRI.
As for encephalomalacia it is not a condition in itself, it is a remnant of an old condition, means simply that in that area some cells have been lost. It is like having a scar on the brain, it is not something which is active and needs no treatment, it may be due to many causes such as old stroke, trauma, infection etc. You do not precise where it is, if on that right occipital lobe then it may be simply the remnant of that infarct, it's the same thing.
So what one must take out of that report is that while there is no medical emergency a screening for stroke causes is necessary to prevent other strokes in the future. A basic screening means heart evaluation for arrhythmia, valvular disease etc and imaging of blood vessels of the head and neck to check for atherosclerotic plaques. Unless a heart source is found treatment should be with Aspirin, a high dose statin like atorvastatin (it is not only for cholesterol but stabilizes atherosclerotic plaques as well), diabetes and blood pressure control.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
The first finding a small infarct, means that he has had a stroke, an occlusion of a blood vessel which has led to infarction, damage to the brain area supplied by that vessel. Fortunately it was small and in an area which doesn't cause major deficits. It may explain a period of confusion during the acute phase though. May cause some impairment in the visual field, difficulty seeing things which are on the left side, bumping into them, which may be taken for confusion at times.
The small vessel disease means diffuse changes to the small of the blood vessels, narrowing of their caliber and occlusion of the smallest ones causing tiny areas of damage. It is very common with age so shouldn't alarm you, is found in many people after the age of 65. When mild or moderate doesn't usually cause any noticeable symptoms, only if advanced does it cause slowing and deterioration of the higher mental functions. So since the report doesn't mention advanced or severe small vessel disease should panic about that, in a way it's part of aging. There is no specific treatment apart from controlling factors which may damage blood vessels like diabetes, high blood pressure, cholesterol etc.
Mild cerebral parenchymal volume loss is also a finding which is expected with age. All of us start losing brain cells after our twenties, as years go by these losses sum up and it becomes visible on MRI.
As for encephalomalacia it is not a condition in itself, it is a remnant of an old condition, means simply that in that area some cells have been lost. It is like having a scar on the brain, it is not something which is active and needs no treatment, it may be due to many causes such as old stroke, trauma, infection etc. You do not precise where it is, if on that right occipital lobe then it may be simply the remnant of that infarct, it's the same thing.
So what one must take out of that report is that while there is no medical emergency a screening for stroke causes is necessary to prevent other strokes in the future. A basic screening means heart evaluation for arrhythmia, valvular disease etc and imaging of blood vessels of the head and neck to check for atherosclerotic plaques. Unless a heart source is found treatment should be with Aspirin, a high dose statin like atorvastatin (it is not only for cholesterol but stabilizes atherosclerotic plaques as well), diabetes and blood pressure control.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Here is a copy of the report can you be more specific. Motion artifact is present on some series. There is no evidence of definite acue infarct or mass effec. There is mild enlargement of the lateral and third ventricles likely on the basis of mild cerebral parenchymal volume loss given the prominence of corticcal sulci of the cerebral hemispheres. Multiple small foci of T@/FLAIR hyperintensity are present within the white matter of the cerebral hemispheres. Though non specific in a patient of this age, these are likely related to small vessel disease.In the inferior rigght occipital lobe on image #9 of the axial series and #23 of the coronal series is a small focal area of mild T@/FLAIR hyperintensity and T! hypointensity consistent with encephalomalacia and suggestive of a samll, old infarct measuring roughly 12 mm in AP, 6 mm in transverse, and 8 mm in craniocaudal dimensions. Impression 1. Findings consistent with a small old cortical infarct in the inferior right occipital lobe as described above. CLinical correlation is reccommended. 2 Findings consistent with small vessel disease 3 Findings in keeping with mild cerebral parenchymal volume loss. What I want to know is if this is going to keep getting worse aand is my husband going to suffer?
Brief Answer:
Read below.
Detailed Answer:
Thank you for providing the full report.
It confirms what I said in my previous answer. The encephalomalacia as I had assumed was in the area of that old stroke, it is just a remnant which won't evolve.
I am not sure what you mean by getting worse. If you mean the infarction, the stroke with the encephalomalacia, then no, what was done was done and it won't get worse, even improves in the first 3-6 months. But as I said screening about the cause is needed so that another stroke doesn't happen in the future.
If you mean the small vessel disease and parenchymal loss, then they may evolve. Not in a matter of days or months but over years. As they progress over the years they may lead to dementia. However that is not something which is appointed only with imaging. As I said they are common with age but not all patients develop dementia, neuropsychological tests are done to evaluate that. So it is hard to speak of the prognosis without knowing if there is any indication of dementia in the first place. But unless he has a new stroke it is not something which will get worse quickly, that I can say, it will be a slow process. All that can be done is slow down the process by controlling risk factors such as diabetes, hypertension and cholesterol.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Thank you for providing the full report.
It confirms what I said in my previous answer. The encephalomalacia as I had assumed was in the area of that old stroke, it is just a remnant which won't evolve.
I am not sure what you mean by getting worse. If you mean the infarction, the stroke with the encephalomalacia, then no, what was done was done and it won't get worse, even improves in the first 3-6 months. But as I said screening about the cause is needed so that another stroke doesn't happen in the future.
If you mean the small vessel disease and parenchymal loss, then they may evolve. Not in a matter of days or months but over years. As they progress over the years they may lead to dementia. However that is not something which is appointed only with imaging. As I said they are common with age but not all patients develop dementia, neuropsychological tests are done to evaluate that. So it is hard to speak of the prognosis without knowing if there is any indication of dementia in the first place. But unless he has a new stroke it is not something which will get worse quickly, that I can say, it will be a slow process. All that can be done is slow down the process by controlling risk factors such as diabetes, hypertension and cholesterol.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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