Expert: Claes-Gustaf Nordquist, M.D. - 11/29/2010

Question
My son recently had an EEG and MRI (because of the Autism). His EEG showed extremely high peaks on the R side of his brain. His Neurologists (Children's Hospital in Dallas) told me something is blocking his brain waves and when she sees peaks like this they are either caused by "grandma" seizures or a "mass" and I said "what like a tumor"??!! Luckily we had done the MRI the day before and she has the results at the same time. She says it is clean and there is nothing to worry about!? I am confused. I know what seizures are and I am very aware of what they look like. My son has an abnormal EEG that states he has a tumor or seizures but she tells me "oh, he has neither seizures or a tumor so lets run another EEG in about a year, this is good news!" I directly asked her about a CT and wether or not they are better than an MRI for picking up certain kinds of tumors and she tip toed around the question only to tell me there is no reason to order a CT if the non-contrast MRI is clean. My question is should I get a second opinion? I am confused and what little info I have found online is that EEG'S are extremely reliable!! If so then would another MRI using contrast possibly show us something different? Or a CT? Please help?!?

Answer
An MRI scan IS better for finding tumors than a CT scan! So there is in this situation 1. No reason to order any CT scans and 2. No reason even to suspect any brain tumor because if there was one (that could give EEG signs - that requires a certain minimum size big enough to be clearly seen in the scans) it would have been seen and no tumor was seen! Those spikes CAN BE correlated to grand mal (French for big epileptic fits) seizures. Yes they can also be correlated to brain tumors since those can cause epileptic fits. However the MRI scans do not show any tumor and he does not have any epileptic fits. It is possible to have epileptic EEG activity WITHOUT any real fits. So that must be the case here. So no tumor and no clinical epilepsy even if there is epileptic EEG brain activity. So in conclusion I agree with his doctor based on your information! EEG is NOT reliable in picking up brain tumors. There MRI scans - even without contrast - are very reliable. What EEG is very reliable for is confirming or excluding epilepsy not brain tumors! But for a diagnosis of epilepsy there must also be clinical epileptic fits. If there are none there is just epileptic EEG brain activity, nothing more.


You can also reach me at: http://www.liveperson.com/professional/expert-profile.aspx?gsBMQvSJ0S4K1haAm6AtH
There is no limit to the number of questions there. Please note: NEW SITE!