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What Do These MRI Findings Indicate?
Question: My wife XXXXXXX AGe 40 (working) is diagnosied with LEFT TEMPORO OCCIPITAL GRANULOMA ON AKT since Sep.2015. Had been diagonised with Vertigo under evaluation/positional in Feb 2016. MRI dt.8/9/2016 shows "Atleast three conglomerate ring enhancing lesions are seen along left occipital convexity of larges size of 6mm. Mild perifocal vasogenic edema is seen" MRI dt.06/02/2016 reports " Two conglomerate ring enhancing lesion are seen in subcortical aspect of left temporo occipital lobe of 5 & 3 mm sizes showing thin uniorm wall - LIkely to be granulomatous process ? TB ? NCC. No perifocal edema. Tiny FLAIR hyperintensity is seen in subcortical aspect of left frontal region of ? Nature. Left sided deviated nasal septum. Right middle & inferior turbinate hypertropy "Why diziness/tingling senstion occurs despite on meditation since Sep.2015. How long to continue medicine. Should take another MRI.
Brief Answer:
Continue treatment as advised
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
The Mri findings with background history of tuberculosis suggest brain lesion to be tuberculoma.
The symptoms of dizziness may be related to the lesion itself. Also tingling sensation on right side of body can occur due to location of lesion at the region of sensation control.
The possibility of partial seizures can also be there leading to such tingling and require eeg.
The treatment for tuberculoma is recommended for 9 - 12 months atleast and may have to be prolonged depending upon Mri findings.
Repeat Mri at intervals of 6 months may be required.
Some medication like betahistine or cinnarizine may be added for vertigo.
Be in regular follow up of a neurologist.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Continue treatment as advised
Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
The Mri findings with background history of tuberculosis suggest brain lesion to be tuberculoma.
The symptoms of dizziness may be related to the lesion itself. Also tingling sensation on right side of body can occur due to location of lesion at the region of sensation control.
The possibility of partial seizures can also be there leading to such tingling and require eeg.
The treatment for tuberculoma is recommended for 9 - 12 months atleast and may have to be prolonged depending upon Mri findings.
Repeat Mri at intervals of 6 months may be required.
Some medication like betahistine or cinnarizine may be added for vertigo.
Be in regular follow up of a neurologist.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Priyanka G Raj
At the time of dizziness she has feeling of internal shrinking from head to hand & feels that she had lost control over her body( in hindi : sharir dol zata hai ) This symptoms occurs 2-3 times in a month. Tingling occurs only at the time of dizziness & not regular. Dr. said this might be due to fear feeling. Her Neurophysian has advised to wait for MRI & suggest symptoms disappear after sometime.
MY family doctor has suggested vitamin b12 /protein deficiency and has started Problast Strong cap. OD & Problast D3(vit.D). She feels terribly upset when symtom occurs. Is the course of treatment okay.
For Vertigo she is advised Vertin D 48 mg OD / Spinfree (Cinnarizine & Dimenhdrinate Tab 20/40 mg) which is taken occassional when symptom is present.
MY family doctor has suggested vitamin b12 /protein deficiency and has started Problast Strong cap. OD & Problast D3(vit.D). She feels terribly upset when symtom occurs. Is the course of treatment okay.
For Vertigo she is advised Vertin D 48 mg OD / Spinfree (Cinnarizine & Dimenhdrinate Tab 20/40 mg) which is taken occassional when symptom is present.
Brief Answer:
Get eeg during episodes
Detailed Answer:
Hello,
Anxiety may also lead to such symptoms but you need to get eeg done near to such episode to look for any seizure activity.
Drug can be added accordingly.
Vertin should be taken continously for few weeks.
Regards
Dr N Kumar
Neurologist
Get eeg during episodes
Detailed Answer:
Hello,
Anxiety may also lead to such symptoms but you need to get eeg done near to such episode to look for any seizure activity.
Drug can be added accordingly.
Vertin should be taken continously for few weeks.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Sir Thank you for your detailed reply.
The symptoms of dizziness was not present in the initial 3 months of treatment except at the time of first episode of seizure in Sep.2015
Does this is due to medication effect (i.e. Levipil 500 / Rcinex 450/300 etc). We fear that this may be due to progression of diseases/infection. Thanks
The symptoms of dizziness was not present in the initial 3 months of treatment except at the time of first episode of seizure in Sep.2015
Does this is due to medication effect (i.e. Levipil 500 / Rcinex 450/300 etc). We fear that this may be due to progression of diseases/infection. Thanks
Brief Answer:
Get eeg during episodes
Detailed Answer:
Hello,
Medication related side effects occur daily or present at all times.
Episodic dizziness needs evaluation for partial seizure.
Progression of disease is less likely as drug is being given and no other symptoms are present.
Continue the same medication.
Get back with next brain imaging.
Regards
Dr N Kumar
Neurologist
Get eeg during episodes
Detailed Answer:
Hello,
Medication related side effects occur daily or present at all times.
Episodic dizziness needs evaluation for partial seizure.
Progression of disease is less likely as drug is being given and no other symptoms are present.
Continue the same medication.
Get back with next brain imaging.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
sir a new MRI report dated 10/7/2016 is attached.
In this report radiologist has suggested Active Granulomatous Lesion ? Neurocysticercosis.
Doctor has started ;
Tab Albendazole 400mg BD for 28 days
Tab Predmet 4mg BD 7days & thereafter 20mg BD for next 7days alongwith existing TB medicines
Patient weight is 55 Kg age 40 years.
There is increase in size(1mm) of leison. Dr. said this may be due to different in MRI MACHINE / measurement error.
MRI report of Sep15, Feb.16 & July 16 is attached. Is there any error/inconsistency in these report. Whether course of treatment is correct Or shall I visit other city/speciality hospital.
Kindly advise.
In this report radiologist has suggested Active Granulomatous Lesion ? Neurocysticercosis.
Doctor has started ;
Tab Albendazole 400mg BD for 28 days
Tab Predmet 4mg BD 7days & thereafter 20mg BD for next 7days alongwith existing TB medicines
Patient weight is 55 Kg age 40 years.
There is increase in size(1mm) of leison. Dr. said this may be due to different in MRI MACHINE / measurement error.
MRI report of Sep15, Feb.16 & July 16 is attached. Is there any error/inconsistency in these report. Whether course of treatment is correct Or shall I visit other city/speciality hospital.
Kindly advise.
Brief Answer:
Continue the new treatment advised, need to have a look on images
Detailed Answer:
HELLO,
I have gone through all MRI reports.
The lesion character is found both in tuberculoma and NCC.
The presence of scolex on MRI is diagnostic of NCC, but not present in your case.
The history of previous tuberculosis makes tuberculoma a more likely diagnosis.
Since there is confusion between the two possibilities, the treating doctor is continuing ATT and has given albendazole for NCC.
You may require another imaging after 3-6 months to look for lesion resolution.
NCC resolves sooner after albendazole therapy but tuberculoma may still persist.
You can consult another neurologist for second opinion.
If possible you can upload images or provide some link of google drive to evaluate the images.
Regards
Dr N Kumar
Continue the new treatment advised, need to have a look on images
Detailed Answer:
HELLO,
I have gone through all MRI reports.
The lesion character is found both in tuberculoma and NCC.
The presence of scolex on MRI is diagnostic of NCC, but not present in your case.
The history of previous tuberculosis makes tuberculoma a more likely diagnosis.
Since there is confusion between the two possibilities, the treating doctor is continuing ATT and has given albendazole for NCC.
You may require another imaging after 3-6 months to look for lesion resolution.
NCC resolves sooner after albendazole therapy but tuberculoma may still persist.
You can consult another neurologist for second opinion.
If possible you can upload images or provide some link of google drive to evaluate the images.
Regards
Dr N Kumar
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
https://drive.google.com/folderview?id=0B3XR1zIi2o8bVFREVi10SjBmMHc&usp=sharing
Sir I have uploaded latest MRI cd files in folder link given above. My goolge email id YYYY@YYYY Contact no.0000 / 0000
Sir I have uploaded latest MRI cd files in folder link given above. My goolge email id YYYY@YYYY Contact no.0000 / 0000
Brief Answer:
Continue treatment as advised and repeat MRI in september
Detailed Answer:
Hello,
I have evaluated MRI images.
The lesion is more likely to be NCC but as it is follow up imaging, tuberculoma cannot be ruled out.
It is better to continue ATT till september and Albendazole therapy too.
Repeat MRI after 2 months to stop ATT.
Anti-epileptic drugs may have to be continued.
Regards
Dr N Kumar
Neurologist
Continue treatment as advised and repeat MRI in september
Detailed Answer:
Hello,
I have evaluated MRI images.
The lesion is more likely to be NCC but as it is follow up imaging, tuberculoma cannot be ruled out.
It is better to continue ATT till september and Albendazole therapy too.
Repeat MRI after 2 months to stop ATT.
Anti-epileptic drugs may have to be continued.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Sir
Thanks for your detailed reply.
My query is ;
Which one is Anti-epileptic drug.Predmet 4mg or Levipil 500 ?. Please suggest dosage. How long she has to continue.
The lesion is suggested to be NCC or TB. Does MRI images suggest possibility of any other diseases/tumor etc. Sir please guide as I am planning to visit speciality hospitals in Mumbai/Hyderabad if there is possibility of any other diseases.
Compared to MRI report dated Feb.2016 this MRI has reported increase is size of lesion.Does this indicate progression of disease. My doctor has said this may be due to variation of machine (ie. 1.5T MRI in Feb.16 & 3T MRI in July 2015)
Is there any harm in repeating MRI Plain+Contrast after 2 months as I have heard that injectable medicine in MRI may cause kidney problem etc. Or shall I go for plain MRI.
Thanks
Thanks for your detailed reply.
My query is ;
Which one is Anti-epileptic drug.Predmet 4mg or Levipil 500 ?. Please suggest dosage. How long she has to continue.
The lesion is suggested to be NCC or TB. Does MRI images suggest possibility of any other diseases/tumor etc. Sir please guide as I am planning to visit speciality hospitals in Mumbai/Hyderabad if there is possibility of any other diseases.
Compared to MRI report dated Feb.2016 this MRI has reported increase is size of lesion.Does this indicate progression of disease. My doctor has said this may be due to variation of machine (ie. 1.5T MRI in Feb.16 & 3T MRI in July 2015)
Is there any harm in repeating MRI Plain+Contrast after 2 months as I have heard that injectable medicine in MRI may cause kidney problem etc. Or shall I go for plain MRI.
Thanks
Brief Answer:
Continue treatment as discussed previously.
Detailed Answer:
Hello,
Levipil is antiepileptics drug and should be continued.
Other drugs are to be continued too.
Predmet is required for reducing edema and as albendazole is also given, it needs to be continued as advised.
Possibility of tumor is unlikely.
Two possibilities are tuberculoma and neurocysticercosis.
The size measurement may vary mildly and some increase in size may occur too but it's not a problem.
Most likely in case of ncc, after albendazole the size decreases early.
The repeat imaging will help in clearing the doubt.
Contrast is harmful but with normal renal function and adequate hydration, the side effects is rare.
Plain Mri will not be able to assess the true lesion size and characteristics.
Do get a second opinion and show all the imaging from starting.
In many cases, the lesion character is not diagnostic and decision regarding starting of antitubercular drugs is taken to treat the more problematic disease.
Regards
Dr N Kumar
Neurologist
Continue treatment as discussed previously.
Detailed Answer:
Hello,
Levipil is antiepileptics drug and should be continued.
Other drugs are to be continued too.
Predmet is required for reducing edema and as albendazole is also given, it needs to be continued as advised.
Possibility of tumor is unlikely.
Two possibilities are tuberculoma and neurocysticercosis.
The size measurement may vary mildly and some increase in size may occur too but it's not a problem.
Most likely in case of ncc, after albendazole the size decreases early.
The repeat imaging will help in clearing the doubt.
Contrast is harmful but with normal renal function and adequate hydration, the side effects is rare.
Plain Mri will not be able to assess the true lesion size and characteristics.
Do get a second opinion and show all the imaging from starting.
In many cases, the lesion character is not diagnostic and decision regarding starting of antitubercular drugs is taken to treat the more problematic disease.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Sonia Raina
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