December 31, 2009

MRI and MR Spec Results

MRI: BILATERAL ABNORMAL SIGNAL INTENSITY THROUGHOUT THE PERIATRIAL WHITE MATTER. IMAGING FINDINGS ARE SYMMETRIC IN APPEARANCE. FINDINGS ARE SUGGESTIVE OF A TOXIC/METABOLIC WHITE MATTER INJURY PROCESS. ADDITIONAL CONSIDERATIONS WOULD INCLUDE REMOTE ISCHEMIC INSULT. IMAGING FINDINGS ARE NEWLY CONSPICUOUS COMPARED TO THE PREVIOUS STUDY.

MR Spec: NONSPECIFIC SPECTROSCOPY WITH ELEVATION OF THE CHOLINE PEAK SUGGESTIVE OF CELL MEMBRANE TURNOVER. THERE IS QUESTIONABLE PRESENCE OF A LACTATE PEAK BURIED WITHIN THE BASELINE NOISE.

Lab Results: AFP: 102.5 (normal range: 0-15); ALT: 312 (normal range: 5-45); AST: 263 (normal range: 20-60)

Doctor's Take: "There are no changes since the evaluation done at Duke University [April 2009, age 16 months], but there are changes compared to the initial MRI done at PCMC [August 2008, age 8 months]." And, "This pattern is totally nonspecific and does not guide us further. I looked for abnormal peaks on the MR spec and there are none."

Our Take: Breaking down the medical jargon, what does "remote ischemic insult" mean? Remote means it happened long time ago. Ischemic means due to circulation (or lack thereof) and insult means brain injury (stroke and embolism are in this family). And my best guess for "periatrial white matter" is the that they meant "periventricular white matter" or the part of the brain with myelinated axons surrounding the ventricles (which contain the CSF) in the brain. Someone please correct me if I am wrong!

(Or, as Prof. Might likes to put it: grey matter is the CPU and white matter is the networking cable. Bertrand appears to have a networking problem.)

Since there has been no change in the MRI since April 2009, even though these findings are suggestive of a metabolic injury process, this also opens up the possibility of ischemic insult (for which Bertrand's cord blood could be used as a therapy) as a possible cause of Bertrand's issues. Unfortunately, this means the field has been widened instead of narrowed, and time may be the only determinant.

7 comments :

  1. I don't really understand what this entry means. Does it mean he had a brain injury some time ago? Does it mean there is new damage? Is this a worse development?

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  2. Bertrand's brain is still abnormal, but apparently unchanged from the last MRI. While the abnormalities seem to indicate an inborn error of metabolism, now there is also the possibility of it being the cause of an old brain injury (due to a possible stroke, hypogycemia, other circulation issue in utero). Only time will tell. If his condition continues to deteriorate it is more likely the metabolic issue. If he continues to be stable or improve, it is more likely a brain injury. I guess, the bottom line is, the doctors still have no clue.

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  3. Thanks for trying to explain in "lego" the medical analyses! Let's keep thinking that there will be improvement in the future!
    Love and Happy New Year!
    Titi Lili

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  4. Wow, this sure opens things up quite a bit. How long has he been having these seizures? Could they be related to infantile spasms of some sort? (I know a baby Hannah's age who had a stroke in utero who has them).

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  5. I can hardly imagine how someone can process this amount of overwhelming information about their child’s unique condition. I think you and your husband are remarkable, loving parents for taking the time to understand the results of the MRI. Bertrand seems like a sweet boy, and I hope he gets through this with proper medical attention and lots of love.

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