Expert: Claes-Gustaf Nordquist, M.D. - 5/1/2009

Question
Hi,

History - 45 year old male in good health, BP normal, NO
Diabetes etc, Blood work came back normal for thyroid

Have a history of sudden onset of loss of balance(not
spinning) being pushed to one side while walking about 2
months back. I never had migraine at all . with the loss of
balance on-set I have a faint headache that is all over my
head , sometimes behind and sometimes in thefront(non-
specific).

March 26 has a brief feeling of fainting(did not faint)
went to ED. They did blood and CT SCAN OF Brain.

The radiology report on CT scan was as follows
"Subcortical abnormality in the right parietal region which
could reprsent an early area of evolving infarction. if
further evaluation is desired MRI with diffusion weighted
imaging may be useful"

Went to by GP and he suggested MRI with and without
contrast.

Did my MRI on April 7 and the report indicated as follows

"There are several scattered foci of increased signal
intensity in the deep white matter in bothcerebral
hemispheres as noted on the axial and sagittal flair
sequences which could be related to small vessel ischeamic
disease or de-myelination"

Went to a neurologist who did a throrough exam . He checked
for strength, and various tests for cranial nerves. I think
I failed the romberg's test for sensory ataxia(I tend to
sway with my heels together and eyes closed - Not fall). He
did a pin ***** test on my feet and said that I have
differing intensity of sensation on my toes and ordered a
nerve conduction study.  According to thedoctor who did the
nerve conduction study i.e measuring velocity as well as
muscle(inserting needle into muscle)  the results look
fine.

The doctor has also ordered a brain MRI (with and without
contrast) and also and MRI of the cervical spine that I am
planning on doing next week.

Wanted to understand whether the CT Scan could be a result
of tumor. The MRI radiologist suggested that further
testing should be done to rule out MS.

Appreciate a quick response

Peter  

Answer
No neither your CT nor your MRI brain scans indicate any brain tumor. What is shown either indicates that you have brain infarcts (similar to heart infarcts but in the brain due to blood circulation problems there)or de-myelination (in that case probably due to MS - multiple sclerosis). You have to discuss that with your neurologist as it is outside my area of expertise here (brain tumors).