About Vicharn Lipisuwanchote Expertise I am a medical student. I am interested in neurosurgery, so any questions related to neurosurgery are welcome. I will look it up for you if I do not know the answer.
Question Hi there,
I am a 40yr old female with high blood pressure controlled with lysinopril, and was a smoker for 20 years. I went for a normal physical and had balance problems with the romberg test. My internist felt that i may have had a stroke that caused the balance problem. He sent me for a CT which showed "low attenuation focus in left internal capsule". Then came the MRI that showed 6 lesions between 3-8 mm. Went to a neurologist who (in summary) said that they were nonspecific and he didn't know what they were so not to worry. He did offer to send me for a spinal tap to check for MS, but clearly thought that it was not necessary. Now, if I have balance problems, memory problems, inability to multitask, fatigue, as well as worsening weakness in my hands and arms, isn't there something going on? The neuro suggested that I get treatment for depression and then not worry about my "spot". I do have another appointment in a few weeks with another neuro for 2nd opinion, but am concerned that this thing is something serious and looking for some input. If it was a stroke, is there any way to tell? I can't recall a time it wouldve happened unless during birth of daughter 3 years ago. I had pregnancy induced HBP and it was high during labor and very low after epidural then maintained with drugs. Or what else could it be?
Answer it's important to recognize if the lesions are related to your symptoms, like if you have lesion in left internal capsule ,then you should have weakness in right more than left extremities, and other lesions should be in hippocampal complex and celebellum, or extrapyramidal system.
cause is unlikely a stroke which you have to know the exactly onset of the symptoms.
your cause of these lesion should be investigated more.
your symptoms is not typically MS. but if no disease is suspected, maybe is valuable to do spinal tapping, since the disease need treatment to restrict the progression.
most important differential is metastatic brain tumor, which a chest x-ray is extremely suggested.
