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I have a hole in my brain. What next?
January 3, 2010 1:15 PM   Subscribe

I apparently have a hole in my brain. How serious to take this? Seeing a neurologist (again) soon.

I know, YANMD/YANAD, etc.

Results of the CT scan came in and it spotted an "ischemic hypodensity". I went to see the neurologist because of left-side headaches and left-side prevalent restless leg syndrome and he sent me for the scan. Although the headaches are not severe and the RLS is somewhat under control with "Requip", I got concerned.

My questions:
- What's most likely: from birth, tumour, stroke, or something else?
- Assuming not a brain tumour, what's the chance this will spread and be a bigger problem?
- I'm turning 40, what's the chance that my not-so-good-anymore memory is age, compared to being related to this?
- Is there anything else I should know?

FWIW, I'm fairly overweight and if there is a medical reason for this to have happened, that's the first thing I myself would blame. I'm working on that for a variety of reasons, but wonder if obesity could have anything at all to do with this.
posted by swimming naked when the tide goes out to Health & Fitness (9 answers total)
 
An "ischemic hypodensity" literally means a deficiency of blood vessels, or blood flow. To this laymen, that calls to mind "stroke" more than a brain tumor. While there are certainly ways a neoplasm could cause this kind of problem, based on what you've told us I see no reason to be fearful of that cause specifically. These days there is a very neat technology called MRI angiography that lets doctors map all the blood vessels in your head in great detail, and they'll likely want to do something like that.
posted by elektrotechnicus at 1:36 PM on January 3, 2010


- "Ischemic" is a term used to describe injury due to lack of blood flow. Ischemic injury in the brain is often caused by stroke of one sort or another, although there is no way for me to know whether or not stroke is involved in your case. See here for more.

- Memory can be affected by injuries to the brain, absolutely. Make sure to tell your neurologist explicitly about the specifics of your memory difficulties. When you noticed changes, what kind of changes you noticed, when and how they've worsened over the past few years, etc.

- Obesity and some of the other problems that tend to be associated with it, like high cholesterol, do absolutely put you at increased risk for cerebrovascular events (strokes, etc). Of course, there is no way for strangers on the internet to tell you to what extent it may be a contributing factor in your case.

- Your neurologist is the only person who can tell you how seriously to take this, and what to expect in the coming weeks and months. Please do see him or her soon.
posted by killdevil at 1:40 PM on January 3, 2010


I'm turning 40, what's the chance that my not-so-good-anymore memory is age, compared to being related to this?

This is going to be very difficult to ascertain even for your doctor. You'll probably be given a mental status examination (which includes things like being asked to draw a clock, subtract seven from one hundred repeatedly, recite where you are and what time it is). This way you'll have a benchmark from which to judge future developments (which, hopefully, won't be anything beyond normal aging). There are other cognitive tests that can be used along with your personal history (education, professional functioning) to gauge the normalcy of your difficulties.

What's most likely: from birth, tumor, stroke, or something else?

It is possible to be missing blood vessels in your head congenitally, in many cases with no apparent effect (because other vessels maintain sufficient supply - this is the case for me). That's all I know - I couldn't tell you whether that sort of thing could present that way on a CT.
posted by elektrotechnicus at 1:46 PM on January 3, 2010


Obesity and some of the other problems that tend to be associated with it, like high cholesterol, do absolutely put you at increased risk for cerebrovascular events (strokes, etc).

Dieting also puts you at increased risk for cerebrovascular events, so don't beat yourself up about not dieting in the past.

Also, since you don't have a time machine, you can't go back and change your eating and exercise patterns retrospectively. All you can do is change them going forward.
posted by Sidhedevil at 1:47 PM on January 3, 2010 [2 favorites]


Second opinion, and maybe even a third. I know nothing about the condition you describe, I feel like in this instance the more knowledge and the more experts involved, the better. Good luck!
posted by katemcd at 2:43 PM on January 3, 2010


Who is interpreting this scan? Is it an internist, a radiologist, a neurologist, or (best choice in general) a neuroradiologist? Your description sounds like the aftermath of a stroke, but CT scans of the brain can be difficult to interpret and should be considered in light of history and physical findings. Assuming (and this is a big assumption on my part so take it with a large grain of salt) that this abnormal finding is the result of an ischemic event, there are multiple reasons to have a stroke at a relatively young age, some better to have than others. For example, your neurologist may refer you to a cardiologist for an echo to see if you are one of the 20-30% of adults who have a patent foramen ovale which can put you at risk for a stroke due to a paradoxical embolus and which can be easily fixed if there is risk of another stroke. Mind you this is just one branch of a complicated descision tree that does not necessarily apply to you; it is just an example of the sorts of things that can happen. As I said earlier the whole stroke thing may not even apply to you. Ask your neurologist to explain these things to you in simple terms and do not hesitate to tell him if you don't understand something.

Your neurologist is the only person who can tell you how seriously to take this, and what to expect in the coming weeks and months. Please do see him or her soon.

Repeated for emphasis.
posted by TedW at 2:46 PM on January 3, 2010


Questions answered, responses to comments:
- AFAIK, a radiologist wrote the report, based on the scan, and the report was forwarded to my GP and to the neurologist who asked for the scan.
- I'll be making my appointment with the neurologist tomorrow, but it will likely take a month before I get to see him.
- Working on the weight...I'm still at (a reasonably muscular) 250lbs, but that's after a 42lb loss already.
- My memory quality seems obvious to me, but not so much to others. I work in a highly mental field, and playtime involves things like cryptography games and minor electronics. I'm not currently worried about dropping to a vegetative state or anything like that, but (perhaps with a little over-analyzing) I know that things aren't the same as they used to be.
posted by swimming naked when the tide goes out at 4:25 PM on January 3, 2010


[eponysterical] & [I'm an internist with 15 years of practice experience.]

TedW's reply is excellent.

Small ischemic hypodensities are present in many--perhaps even a majority of--people by age 50. I see them occasionally in 40-somethings. Still, some additional workup is probably warranted. An echocardiogram, a duplex ultrasound of the carotid arteries, basic blood tests, and an erythrocyte sedimentation rate (ESR, a blood test) would probably be sufficient. I wouldn't order an MR angiogram based on what you've told us.

If you have high blood pressure or cholesterol, it should be brought under strict control.

You might benefit from taking a "baby" (81 mg) aspirin daily to reduce your risk of additional ischemic events, assuming you're not allergic to aspirin and don't have a stomach acid problem.
posted by neuron at 9:55 PM on January 3, 2010


Thanks all. You've given me something to actually bring to the discussion with the neuro, rather than walking in relatively blind.

Regarding a couple comments: I don't have high blood pressure (it's actually better than "normal") and for cholesterol by "bad" is fine but my "good" is low. I'm trying to improve that with fish and nuts.
posted by swimming naked when the tide goes out at 10:01 PM on January 3, 2010


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