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Memory loss, impulse control with lesions in brain.

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As with with everything else I just wanted to thank you for these thoughtful and in depth responses.
Just a few other questions to wrap this up --

Since the lesions in my brain are likely not the cause of the memory loss. Could there be a secondary condition that could cause BOTH the lesions in my brain as well as the memory loss and impulse control?
Also as I've shown you I have pretty severe periodic limb movement disorder. And a blood test showed elevated levels of calcium in my blood but that went back to normal. I feel like it would be extremely unlikely that somehow I have 4 completely unrelated conditions, all of which are unusual and rare for a person my age.
Is there anything you can think of that could cause all 4 of these conditions and link them all together? And again i have a family history of auto immune disorders so i assume they could all be side effects of either something like that, or some other strange condition.
If you have any thoughts on this or speculation I'd be very appreciative.

since I opened up a new chat it re-allowed me to upload images so I attached some of the images of the lesions in the back of my brain. Hope that helps you make your diagnosis.


Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Hello,
Thank you for getting back.
First of all, I agree that your problems are unusual at this age, and hence, we can expect unusual or unrelated causes for four of your symptoms.
In your case, memory problems are due to brain disease, but the lesions seen on the MRI are not the cause. As I mentioned, a detailed neuropsychological evaluation and PET CT scan of brain can help us understand the cause of memory loss.
Lesions in brain can cause periodic limb movements.
Regarding high calcium and brain lesions, a condition called as sarcoidosis can cause both. However, other tests such as CHEST X-Ray or CT scan of chest, along with a blood test called ACE (angiotensin converting enzyme) level can help us exclude this condition.
Low grade collagen vascular disease and vasculitis can cause these brain lesions, however, other blood tests such as ANA etc would be positive. Also, MR angiogram would be abnormal.
I hope it helps.


Patient replied :

I was hoping I could ask you a follow up question regarding my MRI results. I got a second MRI done and I'd like to attach the MRI findings and hopefully you can take a look and help to interpret those for me:
IMPRESSION:
1) Mild cerebral atrophy and ex-vacuo dilation of the ventricular system
2) Previously seen tiny t2-hyperintense foci within the deep white matter of the posterior left frontal lobe and right periattrial white matter are no longer visualized
3) On the FLAIR images, there is minimal hyperintense signal within the periventricular white matter surrounding the right occipital horn and left occipital horn. This finding may be due to mild chronic small vesel ischemic desease.
4) Mucosal thickening and small retentino cysts lining the right maxillary sinus.

could you break down what each of those four impressions mean and also tell me if any of them could explain either the sleep disorder or the memory loss.


Expert:  Dr. Sudhir Kumar replied 3 Days.

Please see the reply in bold:
IMPRESSION:
1) Mild cerebral atrophy and ex-vacuo dilation of the ventricular system--------Shrinkage of brain
2) Previously seen tiny t2-hyperintense foci within the deep white matter of the posterior left frontal lobe and right periattrial white matter are no longer visualized------Absence of old abnormalities (good news)
3) On the FLAIR images, there is minimal hyperintense signal within the periventricular white matter surrounding the right occipital horn and left occipital horn. This finding may be due to mild chronic small vesel ischemic desease.--------lack of blood supply to some parts of brain
4) Mucosal thickening and small retentino cysts lining the right maxillary sinus.-----Infection of sinus

Sleep disorder can not be explained by any of these.
Both 1) and 3) findings can explain memory loss.


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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