Brain Tumor or Vascular Malformation?

Patient

Q: So, here is my story. I had a horse back riding accident in August. I suffered a crushed maxilary and a severe concussion. I spent 2 nights in the hospital and was discharged without having any more scans or even a consult with a neurologist. Being a long time sufferer of migraines and after months more and more migraines I decided I should contact my neurologist. I had so many symptoms (trouble concentrating, lack of short term memory, and many more). He saw me right away and ordered a neurological phsyc exam and and MRI. He also changed around my migraine meds and put me on a maintance drug. He was very upset that he wasn't consulted while I was admitted. The MRI showed a 4mm abnormality. The radiologist said that it could either be a tumor or a vascular malformation or even an artifact. But later that day my nuerologist called me and said that it was a vascular malformation and wanted me to have another MRI in a 4 weeks. So I did. I was devasted my the results the radiologist gave me. He said that if clinical evaluation corrolated tumor would be the logical diagnoses. I know from all the research I have done that I have the symptoms of a tumor but my neurologist keeps telling me the same story: all the symptoms that I am having are from the head injury. It is just a vascular malformation and not to worry about it. I am second guessing this doc for the first time ever. He has been my doc since I was 16 that's 11 yrs. I am just afraid that he is missing something. Or brushing it off because of the head injury. 2nd opinion??? I have a name of a "good" doc at Johns Hopkins. But not sure if I should follow thru and get the second opinion or not. Pls someone give me some advise. I really need it. I am a mother of a 6 yr old and I want to be here when he grows up.

Doctor

A:    First of all it is important to confirm localization and risks of the vascular malformation with an angiogram and also determine that there is no other anomaly associated. The most common vascular malformations are the cavernous hemangiomas, these are congenital, intracranial vascular malformations; these abnormal vascular connections may tend to enlarge over the time. They can run in the family. Sometimes they do not produce any symptoms or may produce headaches, seizures or small local hemorrhages. Most cavernous hemangiomas may simply be followed up over time, but if they begin to cause symptoms or growing producing some kind of mass effect on the other structures, then, the surgical removal may be considered as a treatment option. In your case, the vascular malformation seems to be very small and it is not likely to be producing mass effect, so I recommend you at this time just keep follow up, but if you start to have any symptoms as persistent headaches (other than your migraines) or seizures you should get an immediate evaluation by a neurosurgeon. On the other hand, you had a Concussion, which is a brain injury that produces headache, altered levels of alertness and unconsciousness. Most of the time is the result of an important and significant blow to the head that shakes the brain inside the skull, which temporarily prevents the brain from working normally. Sometimes a person who has a more serious concussion, may develop new symptoms over time and feels worse than before the injury, this is “Post Concussive Syndrome”. It is important that over the time you start to show Post Concussive Symptoms, you call your doctor and get a thoroughly neurological evaluation. The post concussive symptoms include: difficulty to think, concentrate or remember; headaches or blurry vision; becoming angry or anxious for no reason; lack of interest in your usual activities, changes in your sex drive, dizziness, lightheadedness or unsteadiness that makes difficult for you to walk or standing. It is difficult to predict the outcome in terms of neurologic sequels, some people feel normal again in a few hours after a concussion while others have symptoms and sequels for weeks or months, it depends on each case in particular and also depends on the severity of the blow.

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