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Magnetic Resonance Imaging: Clearly Reveals Brain and Spinal Disorders

The human nervous system, consisting of the brain, spine, neurons, neuroglia, and nerve fibers, forms a complex network of nerve cells. Disorders of the brain or central nervous system often manifest as headaches, dizziness, unsteady gait, and limb paralysis. This issue shares two real-life cases and their respective diagnostic and treatment methods.

Magnetic Resonance Imaging (MRI) can diagnose central nervous system issues (brain and spinal cord), identifying areas of insufficient blood supply in stroke patients, enabling doctors to understand the condition and provide appropriate treatment. An MRI scan of the brain can help identify the causes of symptoms such as vision problems, dizziness, epileptic seizures, chronic headaches, muscle weakness, numbness or tingling, changes in behavior or thinking, hearing loss, and speech difficulties.


Case One

Cerebral Aneurysm Rupture Leading to Leg Weakness

Two years ago, Ms. Chan, 45, had long suffered from lower back pain. One morning, she woke up with numbness and weakness in her right leg.

Despite seeing a family doctor, trying acupuncture, and chiropractic treatments for several weeks, the symptoms did not improve. Eventually, Ms. Chan sought help from a neurosurgeon. After a clinical evaluation, the doctor recommended a full central nervous system MRI scan to identify the cause. However, believing her symptoms were due to a spinal issue, she only agreed to a lumbar spine MRI.

The lumbar MRI revealed only degenerative spine disease, explaining her back pain but not the leg weakness. Later, Ms. Chan agreed to further MRI scans covering up to the cervical and thoracic spine, which also showed no abnormalities. Finally, she consented to the doctor's initial recommendation for a full central nervous system MRI, which included the brain and cerebral vessels. The brain MRI eventually revealed the cause: a congenital cerebral arteriovenous malformation aneurysm in her left brain had ruptured, causing a blood clot that pressed on the nerves controlling her right leg, leading to the numbness and weakness.

Subsequently, Ms. Chan underwent minimally invasive craniotomy. Using a navigation system and continuous brain function monitoring, the surgeon carefully removed the blood clot under a microscope, decompressed her brain, and excised the cerebral arteriovenous malformation aneurysm. Post-surgery, her right leg strength returned to normal, allowing her to walk normally. She later moved to Australia with her son, living an active life as usual.


Case Two

Severe Disc Herniation Misdiagnosed Twice as Hydrocephalus

Five years ago, Mr. Wang, 76, experienced unsteady gait, dizziness, frequent urination, and memory decline. He underwent a brain MRI at a private hospital and was informed of hydrocephalus. The doctor suggested ventriculoperitoneal shunt surgery to drain excess cerebrospinal fluid from the brain to the abdomen. Unwilling to incur expenses at a private hospital, he took the MRI report to a public hospital. After a consultation, the public hospital doctors agreed with the hydrocephalus diagnosis, and he underwent the shunt surgery. However, post-surgery, his symptoms worsened, becoming more severe than before. He was bedridden, experiencing excruciating headaches whenever he tried to sit up or stand.

Returning home post-surgery, with no improvement and even worsening symptoms, his family sought a second opinion from another private neurosurgeon. After reviewing the original MRI images, the doctor found no evidence of hydrocephalus. The doctor believed that the enlarged ventricles were due to mild brain atrophy related to aging, and the white patches around the ventricles were due to long-term cerebral microvascular ischemia, explaining his memory decline.

For the other symptoms, the doctor recommended a full spinal MRI scan to identify other common clinical causes. Finally, the MRI confirmed that his unsteady gait, dizziness, and frequent urination were due to severe spinal stenosis in both the cervical and lumbar regions, causing significant central nervous system compression. The doctor further explained that the unnecessary ventriculoperitoneal shunt was excessively draining cerebrospinal fluid from his brain to the abdomen, causing orthostatic headaches whenever he sat up or stood.

With the diagnosis clarified, the doctor performed three minimally invasive surgeries: two for "Minimally Invasive Laminectomy and Decompression" on his cervical and lumbar spine, and the third to block the previously implanted shunt to prevent unnecessary cerebrospinal fluid drainage and orthostatic headaches.

A day after the surgeries, the patient felt all symptoms had disappeared. He was delighted to walk around the ward with normal, steady, and agile gait, free from dizziness and orthostatic headaches, and his urinary frequency improved. He happily went home the next day. Five years later, after prolonged treatment for brain atrophy, his cognitive functions, memory, and analytical abilities returned to normal levels.

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