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Dr. David
Dr. David, Board Certified MD
Category: Neurology
Satisfied Customers: 45981
Experience:  Experienced physician in Neurology
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14 months ago I had a craniotomy following a head trauma. My

Customer Question

Hi, 14 months ago I had a craniotomy following a head trauma. My recovery was going well until a month ago when i experienced a seizure (first one). my neurologist had me take an 2 EEGs and an Mri. One of the 2 EEGs came back normal. Im currently taking 1000mg Keppra daily to keep seizures under control. I got a report on the MRI, but since my next appt is a few months off was looking to get an interpretation of the the report in terms of my future seizure risk and anything else, positive or not. Below are the details of the report, can you please help.Technique: Pre and postcontrast MRI of the brain submitted for review.
Study consists of sagittal and axial T1-weighted axial T2-weighted FLAIR
diffusion-weighted and gradient echo scans. Coronal FLAIR and
T2-weighted images obtained with special attention to the temporal
lobes. Following contrast administration axial and coronal T1-weighted
images obtained. Volumetric T1-weighted images obtained and
reconstructed in axial coronal planeFindings: Patient is status post right frontal parietal craniotomy and
cranioplasty. The ventricles are midline. There is ex vacuo dilatation
of the temporal horn and atrium of the right lateral ventricle. There is
extensive cortical and subcortical T2 hyperintensity within the cerebral
hemispheric convexity involving the frontal parietal and temporal lobes.
There is focal volume loss in the inferior lateral temporal lobe.
Susceptibility hypointensity is present within these regions consistent
with chronic hemorrhage. Findings consistent with stigmata of prior
traumatic brain injury. There is a focus of heterogeneous T1 hypointense
and T2 hyperintensity in the right frontal lobe with susceptibility
hypointensity likely representing a catheter tract that extends into the
right basal ganglia thalamus and cerebral peduncle. There is no evidence
of hippocampal atrophy or gliosis.There is no evidence of acute infarction hemorrhag
e mass or
hydrocephalus. There is mucosal thickening within the right maxillary
sinus and there is leftward septal deviation. Regional soft tissues and
osseous structures are otherwise normal.Impression: Extensive right hemisphere convexity cortical and
subcortical volume loss and gliosis consistent with traumatic brain
injury. Catheter tract extends from the right superior frontal lobe into
the region of the right basal ganglia thalamus and cerebral peduncle. No
evidence of hippocampal atrophy.
Submitted: 10 months ago.
Category: Neurology
Expert:  Dr. David replied 10 months ago.

This is Dr. David

I am sorry about your prior head trauma and brain surgery.

I'm glad you are taking keprra.

no MRI scan can show if you will or won't get future seizures

taking keppra will decrease chances of you getting future seizures.

it sounds like this is your first brain MRI scan since your brain surgery.

your doctors will want to compared your future brain MRI scans to this one to make sure you are healing properly and not having further bleeding problems

from your current brain MRI findings, it looks like everything which would be expected from brain trauma and brain surgery.

your body will slowly re-absorb the blood and hemorrhage and bleeding in the brain from the trauma and surgery.

you should also be undergoing physical therapy and occupational therapy to help you recovery from your trauma and surgery

let me know if you have questions.

Customer: replied 10 months ago.
Hi, Dr.David and thanks for your response, Yes, I underwent physical and occupational therapy. Would you be able to provide a bit of detail, interpretation on the report impressions. for example, volume loss? Where it references Catheter tract, is this specific to the catheter used for surgery and if so is it normal to be seen? Also in the report it says there is no evidence
of hippocampal atrophy or gliosis. But impression reads there is gliosis, I ask for clarification because my understanding is gliosis is similar to scarring which presents seizure risk.. Thank you.
Expert:  Dr. David replied 10 months ago.

yes, of course.

"There is focal volume loss in the inferior lateral temporal lobe."

I assume the radiologist is talking about the R tateral temporal lobe where you had the brain surgery.

this seems focal and small and seems in the area where the surgery was performed.

yes, gliosis is a sign of scar tissue in the brain and can be from surgery or trauma.

any sort of surgery or trauma to the brain can cause gliosis.

we see gliosis as a type of swelling in the brain

but gliosis doesn't mean you will get seizures necessarily

since it has been 14 months since your surgery and trauma, you most likely have had prior brain MRI scans.

your doctors should be ordering your MRI scans at one facility

so the radiologist can compare your current brain MRI scan to prior scans

to see if your gliosis is getting better. and if the hemorrhage volume is getting better.

Customer: replied 10 months ago.
Dr.David, have had multiple ct scans but this was first MRI. My Neurosurgeon was tracking an extra-axial collection with the ct scans but that resolved. Regarding this MRI report, i didn't pick up a specific reference to a current hemorrhage volume, did you? if so, can you highlight and elaborate a bit. Also was advised by my neurosugeon, months ago that gliosis would stay the same and would not get better. You have a different perspective on that? Many thanks!
Expert:  Dr. David replied 10 months ago.

you are right.

the report doesn't really say anything about hemorrhage volume.

comparing MRI scans to CT scans can be difficult

MRI scans are much better with much better detail in the brain.

your neurosurgeon is right. gliosis will stay there seen in the brain as scar tissue.

the hemorrhage volume can get better.

the catheter tract that extends into the right basal ganglia is normal and from the surgery.

it sounds like a good MRI scan report. no new surprises which is good.

no new risks for seizures. but you still need to keep taking your keppra for now.

let me know if you have other questions.

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