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?
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.