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What Does My MRI Scan Report Indicate?

Posted on Fri, 11 Aug 2017

Question: Hello Doctor

I am writing to you for my Father who is 72+.
He has been living healthy life style all this time except he takes HIGH BP medicine regularly.
last week of April all of the sudden his one of the eyelid start dropping. he complains that eyes are getting heavy too. the doctor did the MRI. He went to the Neurologist who prescribed him the Gravitor 60mg with CON-Q-10 capsules.
at the beginning week of starting the medicine he was really getting out of breath but in two weeks he started feeling better. but every time he goes in the sun he will see the dropping again.

Month later he told the doctor that he is starting having difficulties breathing (like just coming out from shower, or while talking he gets out of breath)
or sometimes he feels difficulties in swallowing food. But Eyelid is not dropping anymore since he started the Gravitor.

so the doctor told him to get more tests done.
Am enclosing all reports for your reference (total 15 pages).

after seeing the results the doctor prescribed him another medicine
"Mofilet 500". he has been taking it for last two weeks
but now he complains, even more, difficulties in breathing.
Also, he complains that his eyes are very heavy 24 hrs that all he wants to do keep them close.

Doctor, my father has been a very strong man all his life. he took care of all the children for last 20 years since my mom gone :( we are totally alive because of our father. he will be the last one to complain about his health. but now he is really having issues that are getting very scary for us.

please please tell me the honest answers:
what do you see in the reports?
Is that life threating?
why is he getting more breathing issues? I Would expect the condition to get better with the medicines?
Is that because of the new medicine that he started "mofilet"?
Has the Gravtior stopped working?
what can I do to get him better?

I really looking for your help

thanks

sincerely XXXXXXX

Answered by Dr. Ajay Panwar (17 hours later)

Brief Answer:
Myasthenia gravis

Detailed Answer:
Hi XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist, here to answer your query.

I have seen all the reports you have attached. The investigations are done at RML Hospital at New XXXXXXX which hosts a good Neurology department. RNS report's decremental response clearly says that he is having Myasthenia gravis.

Myasthenia gravis can be life threatening at times, if not properly treated,and patient lands into 'Myasthenic crisis'.

Breathing difficulty can be associated with 'mycophenolate mofetil'(mofilet). If troublesome, it can be substituted with another immunosuppressant-azathioprine, although with a proper substitution schedule and dosing. Further, a hemogram should be done to look for anemia induced by mofilet, as anemia can also cause breathlessness. Lung disease, is uncommon but possible, as a side effect of mofilet.If the problem is severe, a chest X-ray may be done and chest physician's opinion may be taken.

Breathing issues can be due to mofilet(or disease activity as well) and its not that Gravitor has stopped working.However, sometimes, Gravitor dose needs to be increased.Also, steroids are added often as a treatment protocol.

Proper medicines should be taken as advised.Fever,fatigue and other stressors should be avoided. Any new medicine should not be taken before consulting your doctor as several medicines are known to worsen the disease.

Hope that helps.If you have any other questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (2 hours later)

Thank you for your reply
What precautions or preparation one should do in order to prevent or deal with mysthania crisis?

What exactly mofilet work in the body ?please tells me in simple language! Am trying to figure why doctor prescribe him!should he stopped taking mofilet if he has tough time breathing?

Sincerely XXXXXXX

Answered by Dr. Ajay Panwar (17 hours later)

Brief Answer:
Precautions as I mentioned

Detailed Answer:
Hi,
Thanks for being in follow-up.

Regarding precautions-

Regular medicines should be taken
High fever should be promptly treated
Excess cold temperature should be avoided
Proper sleep and rest is must
Mental stress should be avoided

Myasthenia gravis is an autoimmune disease in which our own immune cells act against our body.Mofilet is an immunosuppressant drug because we need to keep our immune cells in control to treat this disease. So, mofilet or other immunosuppressants are required.However, if one nedicine is doing serious side effects, alternative drug is started.

So, the best thing would be to discuss with your treating doctor regarding these side effects,so that he evaluates the breathing difficulty and switches to other drug if needed.

Hope that helps.If you have further questions, I shall be glad to answer them.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ajay Panwar (30 hours later)

Thanks for your reply!

so is that the permanent medicines to take (Gravitor, Mofilet) like he takes the BP tablet?
how to check that the disease in getting in control in place of increasing?

the reason we are asking is that initially when he starts taking gravitor he felt really better but since last 2 weeks since he starts Mofilet he is having breathing trouble, swallow food trouble almost every hour ?

Thanks

sincerely XXXXXXX

Answered by Dr. Ajay Panwar (18 hours later)

Brief Answer:
Yes, medicines are to be taken for long term.

Detailed Answer:
Hi,
Thanks for being in follow-up.

Yes, the medicines are kind of permanent.Immunosuppressants are to be taken for long term.Though, depending on the disease activity, their dose may be reduced.They may be taken for years, if not actually permanent.Sometimes thymus surgery help in long term improvement.

Disease control is best assessed depending on physical symptoms and signs.There are some clinical signs and breathing parameters which your doctor may assess to determine the disease activity.

In this case, best thing would be to show the patient physically to treating doctor as he will be the best person to decide if culprit is mofilet or the disease itself or some other chest related issue.

Hope that helps.If you have further questions, I shall be glad to answer them.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Ajay Panwar (3 days later)

Thank you for your reply doctor

so he went to his neurologist: told him the breathing issues.
the neurologist says Mofilet takes up to 3 months to get used to the body so keep on taking it.
he is not having eye drooping but out of breath is really an issue. since now he gets out of breath real quick.

he just got some more regular tests done to see if there is anything else that causing the breathing issue. enclosing the reports for your reference (total 5 pages)
can you please tell me how the reports look to you

thanks

Answered by Dr. Ajay Panwar (18 hours later)

Brief Answer:
Reports are all fine.

Detailed Answer:
Hi xxxxx,
Thanks for being in follow-up.

I have seen all the reports which you have attached and the reports all seem to be fine.Of course, the body may gradually adapt to mofilet. Breathlessness may just be due to anxiety.

However, if you think it is significant, I would suggest to take the opinion of a chest physician as well.

Hope that helps.If you have any further questions,I shall be glad to answer them

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj