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Thread: Help me understand these MRI results

  1. #1
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    Default Help me understand these MRI results

    Back story...
    My nephew was recently diagnosed with Focal Epilepsy with secondary generalization. He is 2 years old. Had his first tonic seizure back in March. It was written off to be febrile at the time. He continued to have more, most of them focal. Finally referred to neurologist and had an EEG. Showed multiple seizures during the day and many more during his sleep. He was put on Keppra. Did very well for a while until he started to act very wild, uncontrollable, very much unlike himself. Transitioned off of Keppra to Trileptal. Frist day without Keppra he had another seizure. Back on Keppra for another week to slowly increase Trileptal and come off Keppra again. So far so good. He finally had an MRI yesterday. Results were read by radiologists and we have the results. Have yet to speak with his neurologist, a call has been placed since we are concerned with some of the results.

    I myself have some medical background. Currently an EMT and getting ready to finish up my Paramedic soon. I know enough to know that the results are not normal so to speak.

    Can anyone help me decipher any further into this while we wait for the doctor to get back to us?


    IMPRESSION:
    1. Bilateral occipital cortical and subcortical signal may correlate with chronic ischemic changes and remote infarction.
    2. No acute intracranial abnormality.

    Findings: No focal areas of abnormal signal or enhancement are identified to indicate acute infarction, hemorrhage or mass lesion. The ventricles and extra-axial CSF spaces are unremarkable.

    Medical right occipital cortical and subcortical signal abnormality suggest possible encephalomalacia from chronic ischemia. Subcortical and periventricular T2 signal in both occipital poles may correlate with chronic ischemia versus terminal myelination. Small enlarged perivascular spaces in the parietal lobes, bilaterally. Otherwise, gray-white differentiation and myelination pattern appear normal. White matter volume appears unremarkable. Medial temporal lobes appear symmetric and normal.

    The pituitary axis and craniocervical junction appear normal. Normal flow is noted in the major intracranial vessels.

    The paranasal sinuses, right mastoid air cells, skull base and calvarium appear normal. Trace left mastoid effusion.

  2. #2
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    Default

    So my take on this was that he had suffered a stroke at some point. What is confusing to me is that his seizures are frontal lobe and the stoke is occipital lobe. Two unrelated issues?

    My sister has heard back from the charge nurse at the neurologist office who has read over the doctors notes. My nephew has indeed suffered a significant stoke at some point in his occipital lobe. The good side to this is that he has no problems with his vision at this time. There was some in-utero issues with his umbilical cord that were monitored very closely throughout the pregnancy that may have caused a brief decrease in blood flow before birth or during childbirth that lead to the stoke. The findings of the stoke were actually an incidental finding due to the fact an MRI was performed because he has epilepsy.

    They have an appointment tomorrow for further discussion.

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