Confused About MRI Results and Their Implications
At 28 years of age, I've been struggling with an infection for roughly five months but delayed seeking medical attention due to monetary constraints. Recently, I consulted several physicians regarding persistent and severe "brain fog," which has been alarming. I've noticed a significant decline in my mental well-being, particularly concerning my mood, communication skills, and memory. Unfortunately, the doctors I visited have primarily referred me to one another without providing clear answers. About a month ago, I visited an ENT specialist concerning my sinus infection, hoping that addressing it would alleviate the brain fog. Instead, it seems to have intensified. I returned to the ENT today, who confirmed that the sinus infection is entirely resolved and suspects that my symptoms are of neurological origin. He suggested that it may relate to migraine activity, which offered me some reassurance. However, online research has led me to worry that I may be facing mild brain damage, making me fear that these symptoms might be lifelong. This uncertainty leaves me feeling quite hopeless, especially as people around me keep advising me to stay calm. I have an appointment with a neurologist tomorrow, but I would appreciate any insights or guidance I might receive before then. Summary: I'm deeply concerned that my MRI results might indicate brain damage, leading to potentially irreversible consequences. EXAMINATION: A comprehensive multiparametric MRI scan of the brain was conducted without the use of intravenous contrast material. RESULTS: Brain: A nonspecific punctate hyperintensity in the right frontal lobe's subcortical white matter was noted. There is no sign of acute intracranial bleeding or infarction, nor is there any evidence of midline shifts or mass lesions. Furthermore, diffusion-weighted imaging showed no abnormalities. Ventricles: The ventricles, sulci, and surrounding structures appear normal for my age, with no signs of hydrocephalus. Flow voids: The flow voids at the base of the skull are normal. Extra-axial spaces: There are no signs of extra-axial fluid accumulations or masses. Extracranial findings: Some mild thickening of the mucosal lining in the right maxillary sinus was observed, but the other paranasal sinuses are clear. The mastoid air cells are adequately aerated, and the craniocervical junction is normal. The orbits show no abnormalities. CONCLUSION: The MRI indicates a nonspecific punctate hyperintensity in the right frontal lobe's subcortical white matter, which may be associated with vasospastic issues, such as migraines.
Answers (1)
6/24/2025, 4:31:05 AM
OpenHealth AI
It sounds like you’re feeling overwhelmed and anxious about your symptoms and the MRI results. Your concerns about potential brain damage are understandable, especially when facing ongoing mental fog and mood changes. Let's break this down and address your primary worries.
Summary Points
- MRI Findings: The MRI showed nonspecific changes, which means that while there are some abnormalities noted, they are not definitively linked to a specific neurological disease or brain damage.
- Ongoing Symptoms: Your continuing symptoms of brain fog and declines in mental well-being are significant and should be taken seriously.
- Next Steps with Neurologist: Your upcoming appointment with the neurologist is crucial and can help clarify your condition and develop a management plan.
Explanation
- Nonspecific Punctate Hyperintensity: This term means that there are small spots in the right frontal lobe of your brain that don't show a clear cause. Such findings can stem from a variety of non-threatening sources like migraines, hypertension, or even past infections, but they do not automatically indicate a serious problem like brain damage.
- No Acute Findings: The MRI results did not show any acute issues like bleeding or stroke, which is reassuring. The normal appearance of other brain structures also points toward a lack of serious abnormalities.
- Brain Fog Causes: The symptoms you're experiencing might be related to persistent infection effects, stress, or migraines, all of which can lead to cognitive difficulties.
Prioritized Next Steps
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Prepare for Your Neurology Appointment: Write down a list of your symptoms and any patterns you've noticed related to mood and cognitive function. This will help your neurologist understand your experience better.
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Discuss MRI Results in Detail: Bring up your concerns regarding the nonspecific findings and ask how they might relate to your symptoms. Inquire if any further testing is needed.
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Explore Management Lifestyle Changes:
- Hydration and Nutrition: Maintain good hydration and a balanced diet, rich in fruits, vegetables, whole grains, and lean proteins to support brain health.
- Sleep Hygiene: Ensure you are getting enough restful sleep, as it is crucial for cognitive function.
- Stress Management: Practice relaxation techniques like deep breathing exercises, mindfulness, or light exercise to help reduce overall stress.
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Follow-Up Symptoms: Monitor your symptoms closely after your appointment. If you notice any acute changes (for example, severe headaches, changes in vision, or extreme disorientation), consider seeking immediate medical advice.
Final Thought
It's completely natural to feel anxious regarding your health, especially when facing unexplained symptoms. You're taking a positive step by seeking specialist advice, and there are often effective treatments and coping strategies available. Please remember that you're not alone in this, and seeking clarity with your neurologist will be the next best step to better understand your situation and find relief from your symptoms.
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7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options
# 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:** - **Portocaval shunt size: 9.9 mm** (blood bypassing the liver into the inferior vena cava) - **Arteriovenous shunt size: 4.4 mm** - **Portal vein size: 6.1 mm** (patent) - **Three nodular cystic lesions** located in the perivascular area, with largest measuring 11.6×20.7 mm, enhancing during the venous phase - Liver features a heterogeneous architecture, exhibiting irregular enhancement - Gallbladder appears elongated and slightly enlarged - Other abdominal organs exhibit normal findings **RADIOLOGIST’S ASSESSMENT:** "Congenital portosystemic shunt indicative of Abernethy malformation; less likely arteriovenous malformation (AVM); cannot dismiss the possibility of localized liver lesions." **ADVICE:** Seek consultations with an abdominal and vascular surgeon. ### Blood Tests (August 1, 2025): **Complete Blood Count:** - WBC: 10.44 × 10⁹/L (normal range) - **RBC: 2.1 × 10¹²/L** (LOW - indicating severe anemia) - **Hemoglobin: 69 g/L** (CRITICALLY LOW; normal is 117-166) - Platelets: 403 × 10⁹/L (elevated) **Biochemistry Analysis:** - Urea: 1.80 mmol/L (normal) - Creatinine: 33.4 μmol/L (normal) - **ALT: >1000 IU/mL** (EXTREMELY HIGH - severe liver dysfunction) --- ## FOLLOW-UP IMAGING (December 16, 2025 - 5.5 Months Old) ### Liver Ultrasound: **RESULTS:** - Right lobe: 64 mm, left lobe: 43 mm - Liver capsule appears irregular and vague - **Parenchyma: heterogeneous, showing 7 hypo-isoechoic nodules** (sizes range from 11.5×10.7 mm to 17.6×15.4 mm) - Capsule features uneven contours - Blood flow noted during Doppler examination - No dilation in intrahepatic bile ducts - **Portal vein: 3.9 mm** (decreased from 6.1 mm - indicating improvement) - Common bile duct: 1.4 mm - Gallbladder: measures 43.7×9.2 mm (pear-shaped, wall thickness 2.0 mm, homogeneous, free of stones) **ULTRASOUND ASSESSMENT:** "Presence of liver volumetric formations (specifically liver hemangiomas)." --- ## LATEST MSCT (February 6, 2026 - 7 Months Old) ### MSCT with 3-Phase Contrast: **FINDINGS:** - Liver remains normal in size, but shows heterogeneous structure with uneven contrast enhancement - **Portocaval shunt: 9.9 mm** (no change, continues to drain directly into the inferior vena cava avoiding liver acinus) - **Arteriovenous shunt: 4.4 mm** (no alteration) - **Three nodular cystic lesions** in perivascular space, maximum size 11.6×20.7 mm, enhancing in the venous phase - **Portal vein: 6.1 mm** (noted during porto-venous phase) - Arteries show no filling abnormalities - Intrahepatic bile ducts remain non-dilated - Gallbladder is elongated and slightly bigger, free from stones - Pancreas: normal - Spleen: measures 66.9×38.5 mm (not enlarged), splenic vein is 3.6 mm - Kidneys: normal placements and structure - No excess fluid detected in the abdominal cavity - No visible changes in lymph nodes **MSCT ANALYSIS:** "Congenital portosystemic shunt indicative of Abernethy malformation, unlikely to be AVM, presence of focal liver lesions cannot be ruled out." **RECOMMENDATION:** Engage with an abdominal and vascular surgeon. --- ## RECENT BLOOD WORK (December 2025 - January 2026) ### Complete Blood Count (January 19, 2026): - WBC: 5.8 × 10⁹/L (SHOWS IMPROVEMENT) - **RBC: 2.93 × 10¹²/L** (IMPROVED but still low) - **Hemoglobin: 72 g/L** (SHOWS IMPROVEMENT but still low) - Platelets: 223 × 10⁹/L (BACK TO NORMAL) - Neutrophils: 30.0% - Lymphocytes: 64.8% - Monocytes: 4.6% ### Biochemistry (January 28, 2026): - Total protein level: 67 g/L (slightly deficient) - Creatinine: 20.7 μmol/L - **Total Bilirubin: 242 μmol/L** (STILL HIGH - unchanged) - **Direct Bilirubin: 142 μmol/L** (VERY HIGH) - **ALT: 50 IU/mL** (DRASTICALLY LOWER from >1000!) --- ## OVERVIEW OF PROGRESS OVER 6 MONTHS | Parameter | August 2025 | January 2026 | Change | |------------------|-------------|---------------|--------------------------| | **Hemoglobin** | 69 g/L | 72 g/L | ↗ Slight improvement | | **RBC** | 2.1 | 2.93 | ↗ Improved | | **ALT** | >1000 | 50 | ✓✓ MAJOR IMPROVEMENT | | **Bilirubin** | 245 | 242 | → Unchanged (still elevated) | | **Portal vein** | 6.1 mm | 3.9 mm (US) | ↗ Decreased | | **Platelets** | 403 | 223 | ↘ Normalized | | **Shunt size** | 9.9 mm | 9.9 mm | → No Change | --- ## CURRENT SITUATION (February 2026 - 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.
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