Dr. Ashok Kumar
Geriatrics
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Patient's Query
Hello doctor,
My mother is 75 years old. She is suffering from head spinning and heaviness problem since the last six months. Her blood pressure (BP), sugar, thyroid and other blood test reports are normal. After getting a suggestion from a doctor (Medicine) she had gone on an magnetic resonance imaging (MRI) test. The MRI test (non-contrast) of brain report was given with a doubt of evidence of blooming in glycopeptide resistance enterococci (GRE) in the left parietal lobe and right basi frontal lobe without evidence of perilesional edema and advised for further evaluation with contrast to rule out calcified granulomas and other etiologies. Also, MRI report findings include: Small vessel white matter ischemic changes. Chronic lacunar infarct in the right external capsule. Mild cerebral atrophic changes. The Doctor of medicine gave medicines for the treatment of vertigo and nerve but suggested to show immediately to a neurologist. My mother does not know the brain problem and she refuses to go to a doctor for further checking due to her fear. So, I need your help.
Hello,
Welcome to icliniq.com. I have gone through the detailed query and understand your concerns. In my opinion, there is a definite need for face to face consultation as it seems to me that there is a need for cognitive evaluation. The magnetic resonance imaging (MRI) changes observed are indicative of vascular pathology and should be treated if concomitant symptoms are present. Regarding the doubtful observation over MRI, nobody can help with this. Either one sees the MRI report or you get contrast MRI. This will unearth the true pathology of blooming in the parietal and frontal lobes. Since there is no edema, it can be concluded that there is little possibility of malignancy or recent changes but it does not rule out the chronic healed granuloma. I request you to do following: Ask her to draw a clock (clock drawing test) with simple instruction. Like this is paper and you are going to draw a clock with 10 past 10. If she does not understand, repeat it again but do not offer any assistance. In addition, take care of not repeating again once she starts working. You can attach the clock while posting the follow-up query. Attach the images of MRI rather than the report. However, I will request you to go for contrast imaging as the available MRI may not be more useful to me as suggested by a radiologist. If she is comfortable with online video consultation, I can offer her the possible extent ofevaluation and treatment. I hope this helps you. Thanks and regards.
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Geriatrics
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