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Stroke

Help in understanding MRI explanation

09/14/2005

Question:

My father, who is diabetic, hypertensive and also has elevated triglyceride levels, had been experiencing slurred speech for approx. 2mos, so his family dr. scheduled him for an MRI. The results of his MRI are as follows: "There are multiple small foci abnormality distributed throughout the paraventricular white matter - corona radiata consistent with perivascular chronic ischemic changes of aging, but in addition, there are a couple of more prominent ones in the deep frontoparietal white matter on the left, consistent with small infarcts extending into the superior insula of the left temporal lobe. Conclusion: slight to moderate bilateral perivascular chronic ischemic white matter disease of aging, in additon to small infarcts on the left as described. There are a couple of lacunar brainstem infarcts." Does this mean my father suffered a stroke and that`s why his speech is slurred and he`s having difficulty swallowing? Can you please explain this to me in layman`s terms? He is on Glucotrol for his diabetes, Lopid for his cholesterol, and I don`t think anything for his BP. Shouldn`t he be taking a diuretic or SOMETHING to treat and control his BP? Wasn`t it his uncontrolled BP that most likely caused the lacunes? Instead, his dr. prescribed him only Plavix after the MRI. To what kind of specialist should I now take him, since I am beginning not to trust his family doctor?

Answer:

Re: the MRI report in layman's terms

As the brain ages, we tend to see a change in appearance around the fluid filled spaces (the ventricles).  These changes are thought to be the long-term effects of atherosclerosis which cause less blood flow in these brain regions.  Less blood flow means that the brain tissue can be irreversibly injured, which is what they are referring to as "ischemic injury". 

We do know that we see increasing amount of these changes with age, and see greater amounts of change in patients who have high blood pressure and diabetes.  In a sense, this is the "end effect" on the brain of having risk factors such as hypertension or diabetes, although not all patients with either condition have such changes.  I hope this explains the "perivascular chronic ischemic white matter disease of aging".  Importantly, patients with these changes do not necessarily have any neurologic problems as a result, unless the changes are very severe.  These changes accumulate slowly over time and the brain is able to compensate so that no function is lost.

When blood flow to the brain is suddenly stopped, this is a stroke.  A stroke is accompanied by clinical symptoms such as weakness on one side, slurred speech, visual problems, or problems with thinking or language.  Given his slurred speech, it is possible that your father has had a stroke, although I cannot make definite comment without examining him myself.

The report mentions left sided brain changes that suggest the appearance of a stroke.  If this is the cause of his symptoms, you might expect to see a drooping of his right face, or perhaps slower/less movement on that side.

High blood pressure is the single most important risk factor for stroke, and in a patient with diabetes it is crucial to control the blood pressure for optimal prevention of future strokes.  Since I have not seen your father, I cannot comment--realize that some people cannot take medicine for high blood pressure for various reasons.

If you want to seek an opinion from a specialist, it would be best to see a neurologist.  Some neurologists have had special training in stroke, although stroke is a common problem and certainly any neurologist could provide an opinion.

I hope I have answered all of your questions.  Feel free to respond if I have not.

 

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Response by:

Brett   Kissela, MD Brett Kissela, MD
Assistant Professor of Neurology
Director, Neurology Residency Program
College of Medicine
University of Cincinnati