Q. From the MRI report, what is your opinion regarding the heaviness of head?

Answered by
Dr. Aida Quka
and medically reviewed by Dr. Nithila A

Hello doctor,

My mother is currently taking treatment from a psychiatrist for depression. Her major symptoms are heaviness in the head, lower back pain, mood swings, feeling sad, and negative thoughts. Recently MRI and CT scan were done. CT scan was fine.

MRI indicates multiple small T2/FLAIR hyperintense foci without restricted diffusion are seen in bilateral centrum semiovale, the subcortical and deep white matter of bilateral frontal and left parietal lobe. No demonstrable signal alteration was seen in the corpus callosum at present. No evidence of restricted diffusion or blooming seen.

Features suggest the possibility of demyelinating etiology or pronounced microangiopathic changes. Please suggest what should be done? Either psychiatry treatment, or neurology treatment? Her main issue is the heaviness of head. She wakes up with negative thoughts, feeling like crying and suicidal behavior. She is currently on Ventab Xl, Mirnite, Clonotril, Olimelt, Lupirtin SR, and Sertee.

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Dr. Aida Quka



Welcome to icliniq.com.

I understand your concern and would explain that your mother's symptoms seem to be related to depression with psychotic signs. The lesions in MRI are suggestive of small vessel disease. I would recommend taking daily baby Aspirin 80 mg to help the progression of these changes.

In my opinion, her current therapy is quite complicated, and many interactions between drugs can worsen her situation. I would recommend stopping Mirnite (Mirtazapine) and Sertee (Sertraline) because they both interact with Ventab XL (Venlafaxine). Increasing the dose of Ventab XL may be necessary. Treatment of depression will help reduce the headache.

You should discuss with her psychiatrist on the above treatment option.

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