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What Does My MRI Scan Report Indicate?
Question: On December 5th I was hit in the back of the left side of my head (behind left ear) with a speaker and than the right side of my head (temple?) hit a steel beam. I didn't lose consciousness but there was Immidiate swelling and tenderness behind my left ear and the right side of my head hurt. I went Immidiately to the ER and got a CT scan and was told to follow up with a neurologist or a gp. The ER said I may have sustained a mild concussion. I had my follow up with the neurologist on 12.8 and was told to get an MRI done to be safe. On 12.15 I had the brain MRI and I had a follow up with my neurologist today. The results on my MRI state: THERE ARE TWO FOCI OF INCREASED SIGNAL IN THE RIGHT FRONTAL WHITE MATTER, SUBCORTICAL IN LOCATION PROBABLY REPRESENTING FOCI OF GLIOSIS.
IMPRESSION: FOCI OF GLIOSIS WHICH ARE SUBCORTICAL IN LOCATION IN THE RIGHT FRONTAL LOBE.
Does scar tissue sound likely, considering the head trauma was more concentrated on the back left side of my head? I'm concerned about something more serious, i.e MS. The doctor was a workers comp insurance doctor and couldn't offer anything other than scar tissue.
IMPRESSION: FOCI OF GLIOSIS WHICH ARE SUBCORTICAL IN LOCATION IN THE RIGHT FRONTAL LOBE.
Does scar tissue sound likely, considering the head trauma was more concentrated on the back left side of my head? I'm concerned about something more serious, i.e MS. The doctor was a workers comp insurance doctor and couldn't offer anything other than scar tissue.
Brief Answer:
Neurologist's exam will be beneficial- MS highly unlikely
Detailed Answer:
Good evening and many thanks for choosing this network to ask your question.
Given the fact, that you just suffered a head injury and are not reporting any symptoms consistent with MS or other demyelinating type of disease then, the most likely explanation to the MRI findings would be traumatic injury.
You did say that your head struck a metal beam in the right frontal area. Not only that but there is a mechanism of head injury called coup (pronounced "COO")
contracoup when the site of impact of the brain is injured when an object strikes the skull but the exact opposite side of the brain also can get injured due to the vectors of force that cause the brain to suddenly accelerate toward the skull then, suddenly STOP when it strikes the inner table of the cranial vault. The 2 areas of gliosis could very well represent small subcortical injuries that occurred due to these forces of acceleration/deceleration which likely caused shearing effects of clusters of neuronal connections.
Such injuries show pathological changes as early as several minutes to hours after an injury. Consolidation of these areas of injury can occur as early as 12-18 hrs. with further development of pathological markers within several days. The only thing I would say about this picture that is slightly out of the norm would be that 10 days is a bit on the early side for GLIOSIS to occur. Gliosis is scarring which usually takes longer to develop. However, if the areas involved are small and not well defined then, the radiologist reading the defect may not be able to clearly tell the difference between the microglial starburst clusters vs. actual gliotic changes. For this, more sophisticated staining and microscopic evaluation would be necessary.
In another words, if you'd like to donate some brain tissue (as in a BIOPSY) just to see whether you have a several millimeter wide contusion injury vs. scar. I'm going to guess and say that you'd just as soon pass on that option and believe the doctor who I believe is correct....even though he's "just" a comp and pen doc! LOL....
However, my recommendation that you see a neurologist still stands only because it is my bias (and belief) that anybody who suffers brain injury secondary to a traumatic blow or concussive force can benefit from seeing a neurologist who can perform some more sophisticated testing on you in order to see whether you may have subtle baseline neurological issues that non-neurology physicians may miss. These lesions will in all likelihood condense to even smaller sizes with time and virtually disappear in the future.
I think the chance that they could be anything other than traumatic contusions is very remote.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.
I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information informative and would be grateful for a few words of feedback.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible.
All the best to you during these holidays!
This consult request has taken a total of 59 minutes of time to read, research, and respond.
Neurologist's exam will be beneficial- MS highly unlikely
Detailed Answer:
Good evening and many thanks for choosing this network to ask your question.
Given the fact, that you just suffered a head injury and are not reporting any symptoms consistent with MS or other demyelinating type of disease then, the most likely explanation to the MRI findings would be traumatic injury.
You did say that your head struck a metal beam in the right frontal area. Not only that but there is a mechanism of head injury called coup (pronounced "COO")
contracoup when the site of impact of the brain is injured when an object strikes the skull but the exact opposite side of the brain also can get injured due to the vectors of force that cause the brain to suddenly accelerate toward the skull then, suddenly STOP when it strikes the inner table of the cranial vault. The 2 areas of gliosis could very well represent small subcortical injuries that occurred due to these forces of acceleration/deceleration which likely caused shearing effects of clusters of neuronal connections.
Such injuries show pathological changes as early as several minutes to hours after an injury. Consolidation of these areas of injury can occur as early as 12-18 hrs. with further development of pathological markers within several days. The only thing I would say about this picture that is slightly out of the norm would be that 10 days is a bit on the early side for GLIOSIS to occur. Gliosis is scarring which usually takes longer to develop. However, if the areas involved are small and not well defined then, the radiologist reading the defect may not be able to clearly tell the difference between the microglial starburst clusters vs. actual gliotic changes. For this, more sophisticated staining and microscopic evaluation would be necessary.
In another words, if you'd like to donate some brain tissue (as in a BIOPSY) just to see whether you have a several millimeter wide contusion injury vs. scar. I'm going to guess and say that you'd just as soon pass on that option and believe the doctor who I believe is correct....even though he's "just" a comp and pen doc! LOL....
However, my recommendation that you see a neurologist still stands only because it is my bias (and belief) that anybody who suffers brain injury secondary to a traumatic blow or concussive force can benefit from seeing a neurologist who can perform some more sophisticated testing on you in order to see whether you may have subtle baseline neurological issues that non-neurology physicians may miss. These lesions will in all likelihood condense to even smaller sizes with time and virtually disappear in the future.
I think the chance that they could be anything other than traumatic contusions is very remote.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.
I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information informative and would be grateful for a few words of feedback.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible.
All the best to you during these holidays!
This consult request has taken a total of 59 minutes of time to read, research, and respond.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply. Ha, she actually is a neurologist that the workman's comp insurance adjuster sent me to. She did an EEG (sp?) brain test before I had the mri but after the ct scan and said that it came back normal. ive had symptoms in the past that I went to see a neurologist about. I've been suffering from cluster headaches and migraines off and on for years and what brought me to a neurologist 5 years ago was some blurry vision in my right eye that was intermittent as well as middle back pain. I had a brain Mri done about 5 years ago that came back negative for anything.
What troubles me more now is the statement I out the gliosis 10 days after not being the "norm".
What troubles me more now is the statement I out the gliosis 10 days after not being the "norm".
Brief Answer:
So the plot thickens?
Detailed Answer:
I see....so your symptoms are a bit more extensive than what you first mentioned. Well, then, perhaps- the observation of the gliosis standing out a little bit to me as being part of a more advanced process than what I would've expected is not that far fetched.
Of course, it is still possible that the radiologist over-read the scan and perhaps it's not gliosis that he's seeing at all? If the MRI was done with gadolinium contrast then, was there any mention of any lesions taking up the dye? If no XXXXXXX was used then, I would probably move to do that study next (maybe even DOUBLE contrast if the lesions were particularly small). I would also consider MR studies of the cervical and thoracic spines based on your history of the back pain.
Now, another consideration, however, in your case is that everything could be related to migraine headaches. I know you said you had clusters but I would need more information on your symptoms since it's unusual for women to have cluster headaches and even rarer still to have BOTH MIGRAINES and CLUSTER HEADACHES in the same patient at the same time. Cluster headaches are often mistaken for migraines.
However, blurry vision, small gliotic looking subcortical lesions are commonly seen in migraine patients and we call them UBO's (Unidentified Bright Objects). These are not MS lesions which are plaques or plaque-like....rather subcortical (white matter) lesions that contain protein and amyloid substance commonly seen in migraineurs.
If you are continuing to have either eye pain, blurry vision, or color desaturation in the right eye then, a good NEURO-OPHTHALMOLOGICAL evaluation could also be performed looking for eye movements, saccades, and of course pupillary light responses, especially in the right eye. If any of that is abnormal then, the next thing I would consider doing would be Visual Evoked Potentials. I'm not sure why you may have had an EEG unless you were complaining of lapses in alertness. We typically DON'T do EEG's anymore in patients who are complaining straight headaches.....we used to do them but a few years ago it was determined that EEG's were not necessary and didn't add much to the differential.
I hope this gives you a few more ideas of what you can discuss with your neurologist and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.
I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information valuable and would be grateful for a few words of feedback as well as CLOSING THE QUERY if there are no further comments or questions.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible.
Happy Happy New Year!
This consult request has taken a total of 25 minutes of time to read, research, and respond.
So the plot thickens?
Detailed Answer:
I see....so your symptoms are a bit more extensive than what you first mentioned. Well, then, perhaps- the observation of the gliosis standing out a little bit to me as being part of a more advanced process than what I would've expected is not that far fetched.
Of course, it is still possible that the radiologist over-read the scan and perhaps it's not gliosis that he's seeing at all? If the MRI was done with gadolinium contrast then, was there any mention of any lesions taking up the dye? If no XXXXXXX was used then, I would probably move to do that study next (maybe even DOUBLE contrast if the lesions were particularly small). I would also consider MR studies of the cervical and thoracic spines based on your history of the back pain.
Now, another consideration, however, in your case is that everything could be related to migraine headaches. I know you said you had clusters but I would need more information on your symptoms since it's unusual for women to have cluster headaches and even rarer still to have BOTH MIGRAINES and CLUSTER HEADACHES in the same patient at the same time. Cluster headaches are often mistaken for migraines.
However, blurry vision, small gliotic looking subcortical lesions are commonly seen in migraine patients and we call them UBO's (Unidentified Bright Objects). These are not MS lesions which are plaques or plaque-like....rather subcortical (white matter) lesions that contain protein and amyloid substance commonly seen in migraineurs.
If you are continuing to have either eye pain, blurry vision, or color desaturation in the right eye then, a good NEURO-OPHTHALMOLOGICAL evaluation could also be performed looking for eye movements, saccades, and of course pupillary light responses, especially in the right eye. If any of that is abnormal then, the next thing I would consider doing would be Visual Evoked Potentials. I'm not sure why you may have had an EEG unless you were complaining of lapses in alertness. We typically DON'T do EEG's anymore in patients who are complaining straight headaches.....we used to do them but a few years ago it was determined that EEG's were not necessary and didn't add much to the differential.
I hope this gives you a few more ideas of what you can discuss with your neurologist and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.
I'd appreciate your rating this interaction on a HIGH STAR SCALE if you found the information valuable and would be grateful for a few words of feedback as well as CLOSING THE QUERY if there are no further comments or questions.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible.
Happy Happy New Year!
This consult request has taken a total of 25 minutes of time to read, research, and respond.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Im a 32 year old male by the way. I suffered from migraines mire frequently in my early teens and they sort of stopped in my late teens. I still get them but way less frequently. My cluster headaches are rare, however i do have a high stress job. When i do get the cluster headaches feels like a knife is being shoved into my head from the top and/or i have pain behind my right eye. Ive never had both a cluster and a migraine at the same time. My migraines usually involved increased sensitivyt to light and nausea.
The mri was done without contrast. The eeg was done because of the concussion per my doctor, i had trouble sleeping and had a headache for several days follwoing the trauma and my alertness was delayed. The dr said i have post concussion syndrome.
Would gliosis be another term used for lesions?
The mri was done without contrast. The eeg was done because of the concussion per my doctor, i had trouble sleeping and had a headache for several days follwoing the trauma and my alertness was delayed. The dr said i have post concussion syndrome.
Would gliosis be another term used for lesions?
Brief Answer:
Sorry my bad--- Saw the name XXXXXXX up top
Detailed Answer:
My apologies....I saw the name XXXXXXX and without realizing that was the name of the city in NJ you're from I simply assumed you were a SHE! LOL.......my bad.
I would agree from your presentation that you've suffered from a postconcussion syndrome for sure. Gliosis is NOT the same term as lesion so I think you should separate the two. The term GLIOSIS is simply the scarring process that happens in the brain or spinal cord. Central Nervous System Scar might be a better synonym. Lesion is defined as any ABNORMAL entity within a tissue or organ. This can be anywhere in the body and can be anything such as a stroke, ulcer in the stomach, scratch on the eyeball....see the difference? (No pun intended).
Another way to look at the relationship between the words GLIOSIS and LESIONS is to understand that all areas of GLIOSIS can be referred to as lesions but NOT ALL LESIONS end up being areas of gliosis or possess gliotic changes. Does that make sense?
In your case there are 2 subcortical LESIONS which the radiologist felt had GLIOTIC characteristics by imaging parameters. If you'd like to get a hold of the digital images and upload them and open a new query after this one is closed I'd be happy to review the film and give you fruther opinions.
And as I mentioned in the previous answer if there is any question as to whether or not the LESIONS are "active" or not then, gadolinium contrast could be administered with another MRI scan. I would also throw in the C and T spines just because of your previous history of thoracic spine area pains and your visual symptoms from 5 years ago. You simply want to clear the spines of any lesions as well. Gliosis or scarring would tend NOT to pick up XXXXXXX contrast which would suggest to me that they likely existed PRIOR to be conked on the head. If the lesions take up the XXXXXXX then, that would suggest that the lesions are active, fresher, and would be more likely in that scenario to be related to the injury you just received.
Again, your neurological examination as documented by your neurologist is an important piece of the puzzle in order to determine whether or not the MRI images are relevant to the injury or something else.
Once again, I encourage you to have a conversation with your neurologist now that you have a bit more information on what things mean and where the possible connections are to what happened, what was found, and your history and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.
Many thanks as well if you'd be kind enough to rate this interaction on a HIGH STAR SCALE with a bit of feedback as well as CLOSING THE QUERY if there are no further comments or questions.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible. And if you'd like to upload your MRI images through a Dropbox link or similar you can always open up another query.
Have a SAFE and Happy Happy New Year!
This consult request has taken a total of 111 minutes of time to read, research, and respond.
Sorry my bad--- Saw the name XXXXXXX up top
Detailed Answer:
My apologies....I saw the name XXXXXXX and without realizing that was the name of the city in NJ you're from I simply assumed you were a SHE! LOL.......my bad.
I would agree from your presentation that you've suffered from a postconcussion syndrome for sure. Gliosis is NOT the same term as lesion so I think you should separate the two. The term GLIOSIS is simply the scarring process that happens in the brain or spinal cord. Central Nervous System Scar might be a better synonym. Lesion is defined as any ABNORMAL entity within a tissue or organ. This can be anywhere in the body and can be anything such as a stroke, ulcer in the stomach, scratch on the eyeball....see the difference? (No pun intended).
Another way to look at the relationship between the words GLIOSIS and LESIONS is to understand that all areas of GLIOSIS can be referred to as lesions but NOT ALL LESIONS end up being areas of gliosis or possess gliotic changes. Does that make sense?
In your case there are 2 subcortical LESIONS which the radiologist felt had GLIOTIC characteristics by imaging parameters. If you'd like to get a hold of the digital images and upload them and open a new query after this one is closed I'd be happy to review the film and give you fruther opinions.
And as I mentioned in the previous answer if there is any question as to whether or not the LESIONS are "active" or not then, gadolinium contrast could be administered with another MRI scan. I would also throw in the C and T spines just because of your previous history of thoracic spine area pains and your visual symptoms from 5 years ago. You simply want to clear the spines of any lesions as well. Gliosis or scarring would tend NOT to pick up XXXXXXX contrast which would suggest to me that they likely existed PRIOR to be conked on the head. If the lesions take up the XXXXXXX then, that would suggest that the lesions are active, fresher, and would be more likely in that scenario to be related to the injury you just received.
Again, your neurological examination as documented by your neurologist is an important piece of the puzzle in order to determine whether or not the MRI images are relevant to the injury or something else.
Once again, I encourage you to have a conversation with your neurologist now that you have a bit more information on what things mean and where the possible connections are to what happened, what was found, and your history and that you'll keep me in mind for future questions regarding these or other neurological/medical issues I may be able to help answer.
Many thanks as well if you'd be kind enough to rate this interaction on a HIGH STAR SCALE with a bit of feedback as well as CLOSING THE QUERY if there are no further comments or questions.
Write to me at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if possible. And if you'd like to upload your MRI images through a Dropbox link or similar you can always open up another query.
Have a SAFE and Happy Happy New Year!
This consult request has taken a total of 111 minutes of time to read, research, and respond.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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