Expert: Mary Gordon - 4/8/2006

Question
Dear Doctor ,
    Have been having some problems with headaches that are like migraines and it scared me so much that I went to have a scan to make sure that everything was O.K. in my brain.  The CT scan results said:
  The ventricles, basal cisterns and overlying cortical sulci are within normal limits. there areas od decreased attenuation involving the posterior centrum semiovale bilaterally most noticeable at the grey-white matter interface. The appearances suggest small vessel disease.MRI however is suggested for further evaluation.
  No mass effect or midline shift is seen to suggest a space occuping lesion. There is also suggestion of subtle decrease in attenuation of the periventricular white matter adjacent to the body of the lateral ventricle again, possibly secondary to ischaemic change. No intercerebral bleed or saurface collection is seen.

   I am not sure what all this means ...I am waiting to have the MRI as suggested but in the mean time i am scared...could you help me please?
Marj

Answer
Hi Marj, I'm not a doctor - I'm just a person who has been a caregiver of a loved one with Alzheimers, and in the process of dealing with that, did a lot of personal research and gained some insight and experience.

You don't mention how old you are, or if you have been experiencing problems other than the headaches. I can't interpret what the CT scan means - and obviously, if they have recommended an MRI as well, even the experts aren't sure they are looking at - if anything. You are scaring yourself to death with what ifs. One foot in front of the other, don't let your imagination run away with you at this point.

Lets have a look at what these results actually say -
"The ventricles, basal cisterns and overlying cortical sulci are within normal limits."  Okay, so nothing there.  

"There areas of decreased attenuation involving the posterior centrum semiovale bilaterally most noticeable at the grey-white matter interface. The appearances suggest small vessel disease. MRI however is suggested for further evaluation."

This is saying they might be seeing some areas of shrinkage that suggest you MAY have some damage or blockages to the tiny arteries in the brain - so they are sending you for an MRI to get a better look at things - which is good, since if there is something going on, better to know now so you and your doctors can figure out what you can do about it.  

"No mass effect or midline shift is seen to suggest a space occuping lesion. "

Okay, so they are saying they are not seeing anything big like a tumour or an aneurism or any other wierd holes or vascular anomalies that would take up space or push things around. Thats good.

"There is also suggestion of subtle decrease in attenuation of the periventricular white matter adjacent to the body of the lateral ventricle again, possibly secondary to ischaemic change. No intercerebral bleed or surface collection is seen."

So, again, they are suggesting there might be some subtle shrinkage (that's what they mean by attenuation), probably from blockages in arteries or something reducing blood flow (i.e. that is what ischaemia is - in more common language - in effect, teeny strokes). They are also saying they are not seeing any signs of bleeding in the brain which is also good.

Obviously, there isn't anything definitive here right now, or they wouldn't be sending you for further tests - but they are suggesting you may be having tiny stroke like events that cause loss of brain tissue - these events can be really tiny and be happening on an ongoing basis - quite often, a person has no symptoms when the actual teeny stroke happens, but over time, subtle damage can accumulate and start to show up in things like balance or memory problems.  

I know this is scary, but its a positive that they are looking - many people have NO symptoms with this until a lot of damage is done - so you having headaches and seeking help is a positive. One reason to get a good handle on what is going on is IF you are having what they call "transient ischemic attacks" they can be an early warning that a bigger more debilitating stroke may be looming.  There ARE things that a doctor may be able to recommend that can help if this is the case. The doctor may, for example, recommend lifestyle changes to prevent stroke like losing weight, exercising more, eating healthier, stopping smoking, reducing alcohol intake, controlling diabetes (if you have it). They may also suggest drugs like blood thinners, or medications to reduce your blood pressure, or lower cholesterol.

So - all of those things are positives - things you may be able to do to help yourself stay healthy - all that stuff we all should do anyway, but don't always pay attention to until we get a scare.

Hang in there - and don't get ahead of yourself. Don't assume the worst. Go for your tests, and let the experts tell you what they think they see, and help figure out the best options for dealing with it, if it is something that needs attention. You are doing all the right things - you are not ignoring the heachaches, you are seeking expert help from doctors - just don't jump to any alarming conclusions before you have all the facts.

I know we'd all like never to have to think about our health for one minute until we are 100, but if there is something going on, and its a warning of something worse, much, much better to know right now, and do what you can to head it off and help yourself enjoy a long healthy life.

Mary G.