Could a lightened area in a brain MRI be an infection or a tumor?

Q. Could a lightened area in a brain MRI be an infection or a tumor?

Answered by
Dr. Aida Abaz Quka
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 08, 2018 and last reviewed on: Aug 29, 2023

Hello doctor,

I had an magnetic resonance imaging (MRI) performed on my brain due to my visual perception being off and not seeing and understanding my location correctly while driving.I did hit someone and almost got into a larger accident. The right side of my head feels like there is a cyst or something there. My skull on the upper back right side would feel sore, bruised when touching it. It felt like a cyst, or something was inside the brain beyond the skull. After the MRI, it felt like a large bubble has got released from that area bursting into my skull. After the bubble burst, about an hour after the MRI, the bruising feeling in my skull started disappearing. There is a feeling like something is in my head in the upper back right side radiating up and down into my neck. On the right side of my neck, sometimes I feel a pinch or swelling but mostly feels like a lymph node is swollen. The MRI showed that I have a meningioma and localized frontal atrophy. The atrophy looks horrendous to me, and I found a lightened area where I have pain but it is not on the right but left side. My questions are: 1. Can you tell me whether a lightened area on an MRI could be an infection and not a tumor? As far as the atrophy is concerned, I have felt like my brain cannot create its energy for about 1 to 2 years. I was drinking a lot of sugar to provide energy but then started using supplements like acetyl carnitine which changes fat to fuel. I was under a lot of stress for several years and also was using a lot of anticholinergics like allergy medicine and antidepressants. 2. I read that the brain will cannibalize itself for Choline. I take Choline now, but do you think my brain shrunk due to stress, not enough Choline, low blood pressure (not enough nutrients)? Would acetyl carnitine which helps utilize fat for fuel cannibalize my brain for fuel if I do not have enough glucose or ketones? Currently, I am on Lexapro 20 mg, Wellbutrin 75 mg and Spironolactone 25 mg.



Welcome to I would like to review your magnetic resonance imaging (MRI) report for a more professional opinion directly. A hyperintense lesion could be related to low blood perfusion area or migraine headaches (if you have suffered before). The meningioma is a benign tumor, which grows slowly without causing obvious symptoms. In case of a frontal meningioma, it can lead to depression and memory problems. Regarding the brain atrophy, it could be related to different possible causes: Chronic hypertension, diabetes, dyslipidemia, a sedentary life, family history, etc. But, you should know that this is not a specific finding. As there are many persons with brain atrophy, who have normal cognitive function and well-preserved memory. So, as long as you do not have any short-term memory problems, there is nothing to worry about. I recommend consulting with a neurologist and performing some cognitive tests, just to be sure that everything is fine. It is also necessary following a healthy lifestyle: A healthy diet (Mediterranean diet, a low salt diet, be active and perform a lot of physical activity, avoid smoking or alcohol, etc.). I would also recommend continuing taking daily Aspirin.

Thank you doctor,

I am trying to consult a neurologist, but my doctor wrote me an order and the neurologist wants it faxed. I have been going back and forth to the offices. The magnetic resonance imaging (MRI) findings: No diffusion restriction in the brain. Along the right posterior aspect of the falx abutting the posterior aspect of the superior sagittal sinus, there is a homogeneously enhancing mass measuring 0.55 x 0.43 x 0.55 inch. It shows hypointense signal on T2-weighted imaging. No adjacent vasogenic edema within the brain. No other pathologic enhancement on postcontrast images. No midline shift. No ventricular dilatation. Localized atrophy along the frontal regions. No abnormal hyperintense T2 or FLAIR signal within the brain. Flow voids are intact. No abnormal susceptibility on the gradient echo sequence. The impression: Small right parafalcine meningioma abutting the superior sagittal sinus at the posterior aspect and measuring 0.55 x 0.43 x 0.55 inch. No acute infarct.



Welcome back to I reviewed carefully your uploaded images (attachment removed to protect patient identity) and the magnetic resonance imaging (MRI) report and would explain as follows: The meningioma is small and it does not lead to pressure into the brain area. But, it seems to be adjacent to the superior sagittal sinus and it may lead to increase the risk of sinus thrombosis. In case of an increase in dimensions, it may cause compression into this sinus. For this reason, I recommend consulting with a neurosurgeon and discuss surgery. A follow up every 6 to 12 months with brain MRI could be an option to wait and see for any possible progression of meningioma. I agree with the radiologist that there is prominent brain atrophy in the frontal lobes. Do you have any family history of dementia or Pick's disease? I recommend consulting with a neurologist and performing some tests to investigate for possible frontotemporal dementia. As you are taking Lexapro (Escitalopram) and Wellbutrin (Bupropion), I would like to explain that depression and anxiety can be the first signs of frontal lobe dysfunction and atrophy. For this reason, it is necessary consulting with a neurologist for a more careful. The probable causes include possible dementia, and depression. Investigation to be done is brain MRI. Differential diagnosis is fronto-temporal dementia.

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