Brief Answer:
Appears to be a stroke which may be responsible for some of her problems

Detailed Answer:
Good morning sir and thank you so much for once again submitting your information to my direct attention for comment.

I believe that this information is of important value and shows the presence of an area in the right frontal area of the brain that suffered a stroke some time ago and has now consolidated to some extent causing there to be a region of ENCEPHALOMALACIA which is the equivalent to a scar in the brain where the stroke took place.

The MRI report states that this area of destruction in the brain is OLD which usually implies a process that is many months to many years in duration. Therefore, as applied to your mother's ability to walk I would suggest that this stroke occurred quite some time ago. Perhaps, the symptoms were subtle at the time since it is not in an area of the brain that generally is known for affecting overall strength of muscles and limbs. Nor would there have been a strong noticeable difference in her speech and language. However, there may have been a drop in her SPEECH/LANGUAGE OUTPUT, INTERACTIVITY with friends and family, DECLINE/DEPRESSION in her outward mood and happiness. She may have become a bit more withdrawn and not as creative in her thinking or talkative, and for the purposes of this discussion her WALKING/BALANCE/EQUILIBRIUM could have been affected. It seems that this is one of the most noticeable things clinically that you picked up on and has started this whole thread of discussion between us.

It would appear that the reason for the stroke was an obstruction or narrowing of what is referred to as the M2 segment of the middle cerebral artery (MCA). This could've come about as the result of a small blood clot that suddenly plugged the artery or it may have developed over time with the artery becoming more and more narrow with time due to atherosclerotic processes.

I know that there is also a finding which appears to show REDUCTION OR ATROPHY (shrinkage) in the cerebellar vermis. This can add to the insult of the right frontal stroke and make her walking and balance even more tenuous and difficult. Atrophy of the vermis can be due to the aging process, a condition known as spinocerebellar degeneration (SCD), as well as in response to toxic substance use. I doubt the latter is the case in your mother but I do include it so you know...primarily alcohol is the most important offender. As far as a diagnosis of SCD is concerned-- I realize that the doctor wrote that down as part of what he believes could be part of the clinical picture but for that to be confirmed she would need to undergo some more testing of a genetic nature since SCD is actually linked to genetic defects. In your mother's case it would be a condition of LATE ONSET as well which is a slightly different form of the problem as opposed to the more commonly seen presentation involving younger age groups. However, it can and does present at later ages of 60 and 70 and beyond.

There are over 60 different types of SCD and the list keeps growing. I recall when I was in training the list was only at about 22-25 types! Wow! Now, look...they are discovering new types everyday....so it really does require specific testing to get the answer as to whether the person has the problem or not.

Her Vit. B12 is in a very good range but her vitamin D is rather deficient and should be boosted up. In patients of mine with neurological issues I generally like to see their vitamin D levels around the 60-80 mark. We accomplish that usually by giving them rather high dose capsules on a weekly basis for 4-8 weeks and then, giving daily supplements after that of about 2000IU in tablet form.

For the specific dosages and protocol for Vitamin D replacement your doctor can advise you....everyone is a little different in their approach. But in your mother's case I would definitely suggest a replacement program for her and you MAY see some improvement in a variety of symptoms...although it really doesn't reverse anything having to do with either the stroke or loss of cerebellar tissue which has deteriorated as a result of the aging process, etc.

And so, the bottom line after having reviewed all of the tests and studies is that your mother's condition (including) staring spells and sudden paucity of language whereby she comes back to the environment and becomes more active, can be explained by the presence of an older small stroke she suffered some time in the past located in the right frontal lobe of the brain (apparently due to either a small blood clot or simply narrowing of the right middle cerebral artery (MCA) in its second segment of distribution. In addition, she may be suffering from balance and walking issues from a condition known as SCD, however, this would have to be confirmed by genetic testing. It is more likely that she merely has some deterioration in the cerebellum due to the aging process as well as perhaps some contribution from the stroke and as a result has some ongoing deterioration in that region of the brain responsible for controlling the fluidity and ease of gait and balance.

Her Vitamin D levels are low but it seems that all other blood tests are in pretty good shape so I'd recommend that she receive Vitamin D replacement therapy and that the target should be in the 60-80 range.

I did not find any copy of her EEG attached to all the files you sent.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?

Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 120 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Still no EEG result

Detailed Answer:
The only file images that are attached are the following:

• IMG-0000-WA0007.jpg
• IMG-0000-WA0000.jpg
• IMG-0000-WA0006.jpg
• IMG-0000-WA0001.jpg
• IMG-0000-WA0002.jpg
• IMG-0000-WA0003.jpg
• IMG-0000-WA0004.jpg
• IMG-0000-WA0005.jpg
• IMG-0000-WA0010.jpg
• IMG-0000-WA0006.jpg

In this group are a couple of duplicates of the MRI reports. Perhaps, you thought that one of those was an EEG report? If you wish you could simply COPY by hand the CONCLUSIONS of the EEG. My guess is that it may read as either NORMAL....or perhaps some mild diffuse slowing over the right frontal lobe and/or posterior aspect of the head.

Also, I had another chance to look at her lab results and it seems that her magnesium is right on the thresh hold of being considered abnormally low. I believe her doctor may wish to give a little bit of magnesium supplementation to bring those numbers up. Also, if magnesium is running that low then, it wouldn't be a bad idea to get both iron and zinc levels since those usually run low as well at the same time.

I very much appreciate your positive rating and input into this transaction and wish your mother a speedy recovery.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 127 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
I'm sorry but still no EEG report

Detailed Answer:
Once again, please do check the files you are sending against this list of files that I have received at least twice:

• IMG-0000-WA0007.jpg
• IMG-0000-WA0000.jpg
• IMG-0000-WA0006.jpg
• IMG-0000-WA0001.jpg
• IMG-0000-WA0002.jpg
• IMG-0000-WA0003.jpg
• IMG-0000-WA0004.jpg
• IMG-0000-WA0005.jpg
• IMG-0000-WA0010.jpg
• IMG-0000-WA0006.jpg

There is no EEG report in any of these files. There are REPEATED MRI imaging reports. I suspect you mean to send the EEG report in place of one of the duplicated MRI reports. I also notice that the numbering of these reports appears to be SEQUENTIAL starting with WA0000.jpg and goes through WA0007 before ending with WA0010.jpg. This would imply that files WA0008 and WA0009 are missing. Are those the EEG reports?

As far as the statement of shrinkage or atrophy of the vermis is considered. There is a statement on the written piece of paper of a doctor apparently that states this. I did not see that statement in the MRI report. Therefore, you should ask that doctor for clarification as to where he obtained the data. Perhaps, he looked at the films and felt that there was some evidence of degeneration of that part of the brain even though it was called on the report.

I believe that in one of my responses to you it was stated that if there were vermian atrophy and if there were no other cause to attribute it to except a genetic type of defect which would have to be some form of LATE onset of SCD that the only way to know that information for sure would be to get genetic testing done at a center that specializes in that sort of thing. However, I believe I also stated that in my opinion if there were vermian atrophy that it would be more likely attributed to age related changes. This means everyone should have a little as they get older and there's not much to do about it in terms of treatment and prevention. I don't believe there is any research data (at least that I'm aware) that talks to the point of whether or not vermian degeneration STOPS at some point. Generally, speaking processes which are progressive and deteriorative (due to age or whatever factor) are not thought of in terms of reaching plateaus and stopping.

But I must underscore the point that I did not make the initial call on that diagnosis I merely copied it from a paper written by another doctor and I do not know where he obtained the information but I'm sure he'd explain his rationale to you if you asked.

Cheers!

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?

Also, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 163 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Could be a maximum limit to attachments? There are 10 in your list

Detailed Answer:
You may want to check with technical support. Perhaps, there is a maximum of 10 attachments that you can upload? Otherwise, it's a big mystery.

As suspected, normal EEG. If she continues to have spells where she is unresponsive for a brief moment then, what needs to be done is either another EEG similar to the previous one that was done. Or better yet, she should do a 24 hr. SLEEP DEPRIVED study with prolonged recording of 60 min. This means she needs to stay up for a full 24 hrs. before the test without using caffeine or any substance to keep her awake. By doing this we tend to stress the brain even more than usual and if there were any epileptiform activity then, we just may "coax" it out of her.

Otherwise, if she's not having any further spells with her alertness then, you don't need to repeat that test. Just let it go for the time being.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?

Also, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 169 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
No new files attached

Detailed Answer:
Greetings. I know you are going to find it hard to believe but in all honesty there hasn't been 1 single NEW file that I've received ever since your first message when you started this thread aside from the original 10 that you sent and I received. I have not received either the EEG report or the pictures of vitamin bottles.

I can tell you that if we are talking about Vitamin D and replacement therapy my preference has always been to have patients who are in need of replacement protocols to take a 50,000IU gelcap once weekly for 4 weeks. Then, after that has been completed I prescribe 2000IU daily thereafter. I then, recheck bloodstream levels in about 8-12 weeks and repeat the cycle if necessary.

I do not typically have patients take once weekly Vitamin D medications without checking them and keeping track of their levels at a minimum of 3-4 months from the outset of intial therapy.

If your mother is taking some other vitamin then, I believe whatever the discretion of her physician is would be agreeable to myself as well.

I wish your mother well and would like to recommend that you consider closing this thread at this point and rating our transaction. If you still feel it is necessary to continue with the additional pictures and other information you may always open a separate query.

Once again, all the best to you, your mother, and your entire family.

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Brief Answer:
Perhaps technical Support can help

Detailed Answer:
I wish I could tell you what the problem may be with uploading the files. Perhaps, technical support can assist you from Healthcaremagic? Unfortunately, I cannot use my email to send or receive medical information from patients due to privacy laws.

If such information is compromised because of my using a nonencrypted or noncompliant HIPAA network the consequence to my license can be dramatic. If you would like to do something as what you did before by posting the information on YouTube that would work and then, just send me the link in your next Healthcaremagic message- that would work as well. Otherwise, I would check with tech support and try to send those as separate files completely.

Incidentally, may I ask you to please close this query as it has exceeded the number of questions allowed in the thread and any further messages will need to be started on a separate thread.

I have tried with previous messages to give you information of value so that even though I did not receive the files I was still able to make some judgements and forward some professional opinions. I am happy to answer more questions and if you feel compelled to send me these files that's perfectly fine and I will review them.

However, in the interest of saving you a little money the report you typed of the EEG is quite adequate. I know what the EEG likes look (in my head) believe it or not just by your descriptive writing. And the same can be said for the vitamins. I already gave you the detail on if it were Vitamin D she were dealing with....but as I said, I am very happy to study and opine on any files you'd care to share....

The trick here seems to be getting the files to me!

Cheers!

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?

Also, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 204 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
New files reviewed-- no new information to add from my last messages

Detailed Answer:
Thank you for going to the trouble of finally making the new files appear.

After reviewing the files I've concluded that my opinions from the previous thread regarding both the Vitamin D and the EEG recording for which the report was NORMAL have not changed.

So as not to repeat information that has already been documented please see above 2 responses for for details. I've outlined how I typically handle Vitamin D replacement in patients. However, each physician may approach this in different ways. There is no 1 single right way. I would recommend you follow the physician's lead if it appears to be reasonable.

I've also given suggestions on the EEG and how to handle things if she were to continue to have spells of any sort.

I will now like to recommend that this thread be CLOSED ON YOUR END so that the transaction can be recorded. Your HIGH STAR RATING WITH FEEDBACK would be appreciated and please remember going forward that I am very happy to answer your ongoing questions but future threads should be according to the criteria set by Healthcaremagic which states that each question asked will be up to 3 questions maximum at which time the query shall be closed and if necessary a new one reopened. Otherwise, time on the physician's part can be compromised. Your cooperation is greatly appreciated.

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.

All the best.


The query has required a total of 264 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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