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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5118
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Are you able to help us to interpret some MRI results

Customer Question

Hello, are you able to help us to interpret some MRI results for brain metastases?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Bob replied 1 year ago.

Hi there. I would be happy to go over the report with you and help explain terms, etc.

Customer: replied 1 year ago.
Hello Dr. Bob. Did you see the files I've attached?
Customer: replied 1 year ago.
These are of my mother-in-law who has second cancer the 2nd time around.
Customer: replied 1 year ago.
Thank you. Are you able to see the files attached?
Customer: replied 1 year ago.
We have dozens of photos but these were the ones that I could see some irregularities. The doctor was supposed to interpret them for us but now it got put off until next week.
Expert:  Dr. Bob replied 1 year ago.

Yes, I was able to open the files. The images are not of high quality, however. It is also almost impossible to know what what one is looking at, and draw conclusions about, only a few images.

Customer: replied 1 year ago.
I understand.
Expert:  Dr. Bob replied 1 year ago.

The other missing piece here would be her prior study...in other words, what findings are new and what were there before.

Customer: replied 1 year ago.
This is the first brain MRI. We have done scans before but only of the abdominal area. The stomach cancer has apparently spread to outside the stomach and into the lymph.
Customer: replied 1 year ago.
About a month ago she started having severe nerve pain on the left side of the face. Especially when eating. We first thought it was TN but the anti-convulsion drugs are not helping much with the pain. This is why the doctor ordered the MRI. He said if the cancer has spread to the brain, there's nothing they can do
Expert:  Dr. Bob replied 1 year ago.

I see. Well, I would love to be able to tell you more, but can only speak in general terms and cannot really address the particulars of this study or her situation. TN can occur for several reasons. A metastatic lesion in the trigeminal nucleus would be an unusual one.

Customer: replied 1 year ago.
Could a tumor cause similar pain?
Expert:  Dr. Bob replied 1 year ago.

Incidentally, the images here are much higher up in the brain than the trigeminal nucleus where the TN nerve originates. Tumors of the brain are usually silent, unless and until they begin to create significant swelling or mass effect. If a met did hit the trigeminal nucleus this could cause pain, though it would be a bit unusual as mentioned.

Customer: replied 1 year ago.
The white spots that you see on the scan. Could those indicate cancer?
Expert:  Dr. Bob replied 1 year ago.

There is one bright spot that may be artifact or might indicate a calcified lesion, which would suggest it had been there for a long time. The less bright white spots could possibly be mets but might also be from contrast material in the blood vessels.

Customer: replied 1 year ago.
They did do a contrast scan as well. I understand. We will wait patiently until Tuesday then. Just really worried about her.Is my time up or can I ask another quick question?
Expert:  Dr. Bob replied 1 year ago.

You can ask until you're satisfied. :-)

Customer: replied 1 year ago.
LOL Thank you. This is about me. 45 year old female. I was diagnosed with TMJ about 5-6 years ago. The pain would come and go. But now reading up about TN I think this could possibly be my problem and not TMJ, which they describe more as a dull throbbing pain. I feel like I'm being electrocuted.
Customer: replied 1 year ago.
Another interesting symptom that I have, which may or may not be related are internal earthquakes. Especially in bed. I feel like the whole bed is shaking. In the beginning I was actually checking online for earthquakes in the area until I realized what was happening.
Expert:  Dr. Bob replied 1 year ago.

Sharp. "lancinating" pains are a hallmark of TN. Most cases can be managed with medication. A few resistent or progressive cases require neurological work up and possibly surgery.

Customer: replied 1 year ago.
Could ultrasound treatments bring improvement?
Expert:  Dr. Bob replied 1 year ago.

You should see a neurologist. These might be fasciculations or atypical seizure activity. Ultrasound is unlikely to help, in my estimation.

Customer: replied 1 year ago.
Will do. Thank you so much.
Expert:  Dr. Bob replied 1 year ago.

You're welcome. Hope all works out for the best for you and your mother-in-law.

Expert:  Dr. Bob replied 1 year ago.

Let me know if you have any additional questions. I would be happy to assist further.

Expert:  Dr. Bob replied 1 year ago.

Hi There. Let me know if you have any additional questions.

If not, don't forget to accept my answer so I get paid for my time assisting you.

Thank you.