My cone CT shows calcified atheroma noted in internal arteries. What is the diagnosis?

Hi doctor,

Please see the incidental findings on a recent MRI and cone CT done for trigeminal neuralgia below. What actions would you suggest based on the findings below:

• The incidental finding on MRI in the cerebrum and cerebellum shows no mass effect.
• There is no diffusion restriction to suggest recent infarction.
• Scattered small foci of T2 hyperintense signal are present within the supratentorial white matter.
• These are nonspecific but likely reflect sequelae of microvascular ischemic disease.
• The incidental finding on cone CT shows Calcified atheromas noted in the internal arteries intracranially within the circle of Willis.

What is the diagnosis?

Please help.

Hi doctor,

Thanks for your reply.

I am 66 years old. My cholesterol level and my overall health have always been good. However, I have had facial pain of late, and they have been doing tests to try to determine the cause. These were incidental findings on tests done to treat TMJ and masses.

I had what I thought was dental pain, but apparently, it is nerve pain. But when I saw the incidental findings, I became a bit concerned. My doctor suggested that I should go on a Statin tablet.

Please advise.

Hi doctor,

Thanks for your reply.

I take a low dose of Aspirin daily. I have since I was 40. My BP is generally low, but I do have white coat syndrome. I have tried the tablet Lisinopril in the past, but it made me cough. Also, HCTZ gives me a pretty bad headache. Blood sugars are always normal.

My mother had type 1 diabetes and was a heavy smoker. She was quite thin and seemed to have many episodes of low blood sugar, and she used to have her IV glucose throughout my entire childhood. My father had been a smoker and had CHF. He had had several bypasses.

My brother had a stent placed in his early 40s. EKGs are normal, but I have never had an echo. I love to walk and can easily walk 15 miles without getting tired. I was taking my A1C, which was always normal. They suddenly dropped to 4.5 repeatedly, which did not match my BS readings.

My GP said it was nothing and stopped taking the A1C. My hs c-reactive protein is very good. Last year, my ALP was 163 IU/L. They repeated it twice, and it came down to 137 IU/L. But exactly one year later, it went up to 163 IU/L? GGT, all other liver enzymes, and ultrasound of the upper right abdomen are normal.

No one can seem to tell me why it is elevated. I am type B blood, and I am a secretor. The test was done during fasting. This is my history.

Please help.

Hi doctor,

Thanks for your reply.

Any insight into the ALP? It is normal for me.

Please help.