Expert: Claes-Gustaf Nordquist, M.D. - 10/8/2007

Question
QUESTION: 50 yr old female, recently had CAT Scan w/contrasting dye, which showed a grey mass in my brain (i do not know what part of brain).  I am in process of being referred to neurosurgeon (live in rural area).  I was told: mass is NOT a tumor, is NOT an aneurysm, not a stroke.  

Questions: 1)can they actually tell by CAT Scan alone if it is a tumor or not; 2) if it is not a tumor, what else could it be?

Thank you!

ANSWER: I would really need a lot more information - preferably your whole CT scan report - to be able to answer this especially if this lesion may be a tumor or not and what else it could be. A CT scan can by its looks give some indication of what it is, but of course it is not a pathology report which is the real secure basis of a diagnosis. If you can give me the full CT report here I will probably be able to tell you much more!


---------- FOLLOW-UP ----------

QUESTION: Cannot provide the report, unfortunately.  Without looking at the scan, can you say what other causes a mass could be OTHER than a tumor?

ANSWER: The most probable thing IS actually a tumor (not necessarily malignant). Aneurysms and other blood vessel abnormalities are also possible. So are bleedings and more exotic findings like parasites(!). However without more information I do not like to speculate! You have the right to DEMAND your CT report! So try to get it and give it to me here and I'll try to tell you more.


---------- FOLLOW-UP ----------

QUESTION: I am providing the written report, below - if you could translate into laymen terms, I would greatly appreciate it:

"In the right parietal occipital junction central white matter there is a 1 ½ cm  to 2 cm area of slightly decreased attenuation.  

There is no associated mass effect, hemorrhage or abnormal enhancement.  No other focal abnormalities are seen.  The visualized portions of the paranasal sinuses and mastoid air cells appear unremarkable.

IMPRESSION:
Mild decreased attenuation central white matter over the right parietal occipital junction region.  This is consistent with a nonspecific white matter degenerative change.  This could represent sequela from small vessel disease.
"


Answer
What is described is NOT a "mass" at all but an area in the "white matter", which is some distance under the surface of the brain with its "grey matter". This area shows less density than its surroundings and is roughly around half an inch in size. It is situated on the right side of your brain somewhat behind your ear. It is NOT a tumor or an aneurysm. It looks more like something similar to a stroke though perhaps not a fully blown one. The radiologist states that it may be the result of a small blood vessel disease. I can not understand why you have been sent to a neurosurgeon! This is NOT a surgical problem
but instead something that should be checked by a neurologist.