Seeking a Second Opinion on Brain MRI
Hello, I’m a 33-year-old female who leads a healthy lifestyle, avoiding alcohol and smoking. Unfortunately, I've encountered a lack of consensus among the various specialists I've consulted regarding my condition. I’m eager to get insights into my brain MRI results and would appreciate guidance on what issues should be prioritized. I'm contemplating the possibility of financing a second opinion from a provider located out of state, though I hope to sidestep that option if possible. Navigating this medical situation feels overwhelming, and I’m unsure how to effectively advocate for myself given my limited expertise in this area. Thank you for your assistance!
Answers (1)
6/20/2025, 11:30:42 AM
OpenHealth AI
It's understandable to feel overwhelmed when navigating medical opinions, especially with something as complex as brain MRI results. Prioritizing your health and seeking clarity is important, and I'm here to guide you through this process.
Main Points
- Understand Your MRI Results: It’s crucial to have a clear understanding of what the MRI showed and what the differing opinions were.
- Self-Advocacy: You can effectively advocate for yourself by asking targeted questions and seeking clarity on specific areas of concern in your MRI findings.
- Exploring Second Opinions: While financing an out-of-state second opinion is an option, you may be able to find valuable insights locally.
Explanation
Brain MRIs can reveal a range of conditions, from benign issues to serious ones. The fact that specialists have differing opinions can be frustrating but is not uncommon in complex cases. Key areas you may want to focus on include understanding exactly what the MRI findings are (e.g., lesions, inflammation, etc.) and how they relate to your symptoms.
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Request Detailed Explanations: Ask your current healthcare providers to explain their interpretations of your MRI results in detail. What are they concerned about? Why do they disagree? This can help clarify your understanding.
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Record Symptoms and Concerns: Keep a journal of any symptoms you have noticed, along with questions about your MRI results. This will help you communicate effectively during your appointments.
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Prioritize Your Health Concerns: If there are specific symptoms or concerns that are particularly troubling you (e.g., headaches, vision changes), make those the focus during discussions.
Next Steps
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Schedule a Follow-up with Your Current Specialist: Set an appointment specifically to discuss your MRI results and express your concerns about the lack of consensus among specialists.
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Prepare Questions: Before your appointment, prepare specific questions that address your symptoms, possible diagnoses, and treatment options.
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Consider Local Specialists: Research if there are other neurologists or specialists in your area who might offer another review of your MRI without needing to travel. You might find someone with a fresh perspective.
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Get Your Medical Records: Make sure to obtain copies of your MRI results and any notes from the specialists you’ve seen so far. This will be useful for any new consultations.
Taking these steps can help ease the stress and uncertainty you’re facing. Remember, the goal is to find clarity in your health situation. You're actively participating in your healthcare, which is an essential step. Let me know if you need any further details or specific questions.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.