HomeAnswersNeurologymagnetic resonance imagingMRI shows sequela of lacunar type infarction with gliotic changes. Kindly explain.

Why does MRI shows sequela of lacunar type infarction with gliotic changes?


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Medically reviewed by

Dr. Nithila. A

Published At June 10, 2019
Reviewed AtDecember 26, 2023

Patient's Query

Hello doctor,

I am a 53-year-old male with 6'2" height and weight 220 lbs. My glycated haemoglobin (HbA1c) is 8.5, high triglycerides, vertigo, and some gait issues. I had a massive pulmonary embolism two years ago, not on any blood thinners, and sometimes I have high blood pressure. Contrast magnetic resonance imaging (MRI) shows a small focus of T2 prolongation present within the medial right cerebellum just posterolateral to the fourth ventricle measuring 5 mm which is also T1 hypointense and nonenhancing. This could represent sequela of an old lacunar type infarction with surrounding gliotic changes. Should I get the gamma glutamyl transferase (GGT) blood test done? What is the cause of this problem?

Answered by Dr. Aida Abaz Quka


Welcome to icliniq.com.

Magnetic resonance imaging (MRI) findings are compatible with an ischemic stroke in the brain. The stroke could be related to atherosclerosis and diabetes. HbA1c is high, indicative of diabetes. For this reason, I recommend physiotherapy and take daily baby Aspirin to help prevent a future stroke. It is also necessary performing a Doppler ultrasound of the carotid arteries or a carotid and vertebral artery angio computed tomography (CT) scan. It is also essential to check your blood lipid profile. I hope you will find this answer helpful. I remain at your disposal for any further questions whenever you need.

Patient's Query

Thank you doctor,

Can you write an order for the procedures you recommend and are there any lab tests like gamma glutamyl transferase (GGT) that will confirm stroke? Should I be on blood thinners if my D-Dimer is normal? I had massive pulmonary embolism 1.5 years ago, but vertigo started six months ago. When did this problem happen and is it still existing?

Answered by Dr. Aida Abaz Quka


Welcome back to icliniq.com.

It is a small stroke, indicative of small vessel disease, which is typically caused by diabetes and arterial hypertension. So, in my opinion, baby Aspirin is the blood thinner that you need. This blood thinner is different from those used in pulmonary embolism as it is an antiplatelet agent. Regarding tests, I would recommend is

1. Doppler ultrasound of the carotid arteries.

2. A blood lipid profile for dyslipidemia (abnormally elevated cholesterol and fats in the blood).

3. Cardiac ultrasound and a resting electrocardiogram (ECG).

4. An ambulatory 24 to 48 hour ECG monitoring for cardiac arrhythmia.

Regarding GGT (gamma-glutamyl transferase), it is a liver enzyme, which is used to diagnose fatty liver or biliary stones. It is not necessary in your case. D-Dimer is not specific for the brain, and it is not required. In the meantime I would recommend taking a daily baby Aspirin (80 to 100 mg), a Statin in case of dyslipidemia and Piracetam for the balance. I hope you will find this answer helpful.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Aida Abaz Quka
Dr. Aida Abaz Quka


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