Dear Dr. Roach: I am a 68-year-old woman in good health. In July 2015, I experienced some short-term confusion and muddled thinking after several days of a high fever (102 degrees). I went to a neurologist, thinking I might have had a TIA.

The doctor ordered an MRI, and told me that the results were normal, and that my symptoms likely were due to metabolic encephalopathy. This spring, my internist sent me for a head CT scan, as I had six weeks of nausea and weight loss. (I'm 5 feet 2 inches and weigh 118 pounds.) Again I was told the results were normal. The hospital's website posts my test results, and now that I have read them for myself, I have some major concerns.

The 2015 report mentions a lacunar infarct in the left cerebellum. The 2017 report mentions prominent ventricles, infarcts in the left cerebellar lacunar and left lentiform nucleus perivascular space, in addition to a small low-attenuation area in the left centrum semiovale.

None of this sounds normal. The lacunar infarct sounds like a stroke to me. What should I be doing, and what does all of this mean?

-- L.R.

A: The MRI is very suggestive that you have had several strokes. The term "infarct" means death of cells, which is the underlying mechanism of a stroke. The locations of the abnormalities seen on your scans are suggestive of damage to small blood vessels, especially by high blood pressure. Neither a CT nor an MRI is definitive, but I think these are likely to represent a stroke.

It sounds like at best, there was a miscommunication about what the scans showed, and at worst, the doctor who told you the results were "normal" was acting paternalistically, perhaps to spare you from worrying. If so, I think this was a mistake. Being told the results were "normal" may have lowered the urgency for you to take steps to prevent a further stroke. Depending on your specific condition, this may include tighter blood pressure control, use of a statin drug, aspirin or other anti-platelet drug, smoking cessation or diabetes control.

I have always believed that patients should get all the information about their condition, explained in a way they can understand. Availability of patient records, especially lab and radiology reports, will increasingly oblige doctors to explain these results more carefully.

Dr. Keith Roach writes for North America Syndicate. Send letters to 628 Virginia Dr., Orlando, FL 32803 or email


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