MRI results & possible impact on cognitive function and/or mood

[Harvinson]

Hi,

I'm a 42 year old female and had surgery two years ago to remove a very-large non-malignant meningioma from my left frontal lobe. I was under the impression I'd be back to 100% within a few months, but I am still struggling after two years. I had an MRI done to assess possible structural change/damage as it is thought this could be contributing to my slow recovery, cognitive deficits/challenges, sense of being overwhelmed by my surroundings/noise and depression.

I'd really like to understand the report findings and know if there is a chance that there is a physical reason for why I'm not better (and that it might not just be "in my head and I have to think myself better" as I've been told). My last CT scan was Dec 2012 and all appeared normal in respect to tumour residual or recurrence. I just had a simple EEG done and the results are within the normal range. This was requested as I've been experiencing phantom smoke smells for the past year. I also have permanent tinnitus post-surgery.  

The MRI findings are below.

"Post surgical changes are demonstrated in the left frontal region. There is an area of gliosis at the surgical bed and note is made of ex-vacuo dilation of the left lateral ventricle. Few foci of high T1 and T2 signal are identified peripherally in the surgical bed in the left frontal lobe, these likely represent dystrophic calcification.

There is no abnormal enhancement in the surgical bed to suggest residual or recurrence. Multiple variable sized high T2- FLAIR foci are scattered throughout the deep white matter in keeping with chronic small vessel ischemic changes. There is mild mucosal thickening of the ethmoid air cells.

The few foci of high T1and T2 signal in the surgical bed likely represent dystrophic calcification. CT is recommended to assess this area of abnormal signal."

Thank you, Tanya

[Harvinson]

Hi Dr Mathur,

Thank you for such a quick response. Funnily enough I was taking gabapentin last year to see if it would help with general symptoms, but at that time I hadn't yet noticed the phantom smoke smells. I first realized they were phantom smells that only I noticed, at the start if this year. I saw a psychiatrist who suggested the EEG to rule out mini seizures. I didn't smell any smoke during the EEG test and the report came back saying everything was in the normal range. Is it possible I could still be having mini-seizures?

And, could the MRI findings be indicating a level of damage that could be contributing to the sphantom someone, tinnitus and mood and energy challenges? When you suggest that brain lesions could be contributing, could these be what the MRI findings state as being "foci of high T1 and T2 signal"? My family doctor told me the MRI report indicated nothing to worry about but I can't help but wonder what the terminology could refer to and why they'd suggest a CT follow up.

If you're able to provide any further insight, I would be very grateful and it will help me discuss this with my GP.

Thank you again.

[Dr. Kokil Mathur]

Hi Tanya!
I am sorry to hear about your medical problems. The persistent phantom smells and tinnitus are often inter-linked and caused by certain brain lesions involving the frontal lobe. This could be the reason for the persistence of the symptoms even after surgery. The symptoms can be managed by anti-epileptic drugs such as gabapentin and anti-depressants such as amytryptaline. Please discuss with your doctor. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.