March 13, 2023 Brain Update ♪ “I Don’t Care Anymore” ♪ Ataxia and Leukoaraiosis

I’ve decided, after many unreturned phone calls to the neurosurgeon’s office, that “I Don’t Care Anymore” Phil Collins. Not sure what to think about being off balance without any vertigo; I nearly fell yesterday. Seeing as the problem is in a lobe of the brain not responsible for movement, and the densities on the MRI are not that impressive, perhaps they feel that as there is nothing for the surgeon to fix, there is nothing to discuss. The neurosurgeon’s office is being lax about referring me to a basic neurologist; however, I just left yet another message. Perhaps I’ll hear from them tomorrow.

[ March 14: Just heard from that office. 똥 ! (expletive in Korean) August is the first available, so why bother? ]

In the meantime, I should just focus on generally improving my health, but as “This life hasn’t turned out quite the way I want’d to be” Nickelback, I feel demotivated on many fronts.

I have a nagging feeling that I need to "Find a reason to get back in the game" Supernatural but I no longer feel that “It is never too late to be what you might have been.” George Elliot

N.B. I am addicted to collecting quotes, so I might as well use them!

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March 9, 2023 Brain Update

After consultation with a neurosurgeon's office last week, the above two diagnoses (one from my primary and one from the radiologist) are off the table. The neurosurgeon's office, after speaking to the doctor, said it was either an "Amyloid", stated to be "a density in the brain comprised of a positive protein", or a small "Cavernoma" described by them as "a density in the brain where there is a connection between arteries and veins." The United Kingdom National Health Service puts it this way: "a cluster of abnormal blood vessels, usually found in the brain and spinal cord". These densities are, according to the neurosurgeon, located in the left occipital lobe, which is responsible for interpreting information from the eyes. It seems that the MRI answered no questions about my stumbling, feeling off balance, or being accident prone and uncoordinated.

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February 24, 2023 Ataxia and Leukoaraiosis

[This post is quite disjointed; I found the subject matter of both Ataxia and Leukoaraiosis difficult to research. I am dissatisfied with my efforts to fully comprehend, interpret and write about what I have attempted to learn.]

I had an MRI taken February 15 because I have been stumbling, feeling off balance, accident prone, uncoordinated and have fallen a few times. My primary wrote "Ataxia" as the underlying diagnosis for the MRI.

So, what is Ataxia? Ataxia is a sign of several neurological disorders, which can develop over time or come on suddenly.

For more on Ataxia, scroll down to that section.

THE MRI

According to my primary, the MRI showed that I have capillaries all over my brain which are dead due to low blood flow. He also told me that the functioning capillaries will grow “branches” into those areas now deprived of blood, which is hopeful.

But here is what the radiologists' report said: "Mild to moderate Leukoaraiosis on the basis of chronic ischemic change." That last is a rabbit hole into which I did not go.

So, what is Leukoaraiosis? "Mild leukoaraiosis is a condition in which diseased blood vessels eventually cause small lesions or damage in the white matter of the brain."

LEUKOARAIOSIS

My research on this has taken hours, and is both confusing and scary. My freak-out or not will have to wait until I see the neurologist.

Leukoaraiosis, also known as "small vessel ischemia", is often referred to as unidentified bright objects on brain scans. It is common in the brains of people above the age of 60, although the severity of the condition varies from person to person.

Based on recent reports, leukoaraiosis is an important cause of disability, cognitive function impairment, gait disturbances, incontinence, dysarthria, and, most importantly, ischemic stroke.

"Leukoaraiosis can be a manifestation of a vascular process, but most likely not an end point of it. Leukoaraiosis itself has been found to be a risk factor for future strokes, for development of clinically relevant cerebrovascular disease, and for poor overall prognosis."

Epidemiologic studies have shown an association of leukoaraiosis with age, and several risk factors that are amenable to treatment, including smoking, hypertension, diabetes, homocysteinemia and hyperlipidemia.

Leukoaraiosis is also known as "white matter disease", which is an umbrella term for changes and damage to your brain’s white matter — the nerve fibers in your brain that connect different areas of your brain to each other and to your spinal cord like highways. White matter disease causes these areas to decline in their functionality. Prognosis varies from person to person.

One can also get white matter disease, also called "cerebral small vessel" or "microvascular disease", from aging and blood vessel changes in the brain’s white matter. It can be mild, moderate or severe.

One source stated that "Age-related white matter disease is progressive, meaning it can get worse. But you can take steps to stop it from spreading. Scientists think you might even be able to repair the damage, if you catch it early."

However, another source stated that "It is not possible to stop [white matter] disease progression, and it is typically fatal within 6 months to 4 years of symptom onset. However, some die only after several months, and some manage to survive for several decades."

YIKES!

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ATAXIA

Of course, Ataxia lead me down pages and pages of internet research. Even more pages after I had a carotid Doppler ultrasound, which the neurosurgeon said was about 50% occluded and needed no intervention, but one reference cited this as a cause: "conditions that disrupt the supply of blood to the brain such as a blood vessel blockage." Even at 50%, is that the case with me?

Other causes include medications (one of which I have taken for decades) and thyroid problems (which I have). Other citations: "Ataxia usually results from damage to the part of the brain that controls muscle coordination (cerebellum) or its connections." and "Ataxia is usually caused by damage to a part of the brain known as the cerebellum, but it can also be caused by damage to the spinal cord or other nerves." However, the MRI results did not indicate any interaction with the cerebellum. Perhaps it's time for imaging of my spinal cord...

While I have been given to understand that treating the underlying cause of Ataxia could slow its progression, I remain unclear as to whether this would stop it entirely or restore the parts of my brain that may have been damaged.

TYPES OF ATAXIA

Acquired Ataxia

This is where symptoms develop as the result of trauma, a stroke, a brain tumor, nutritional deficiencies, or other problems that damage the brain or nervous system. Acquired ataxias typically present acutely and progress rapidly from vascular, immune-mediated, infectious, and toxic causes. If ataxia develops due to an accident, surgery, or illness, some cases may stay the same or improve while others may get gradually worse over time and reduce life expectancy. In many cases, receiving prompt treatment for acquired ataxia can result in a good outcome and possibly reverse the condition.

Acquired Ataxia - Idiopathic Late Onset Cerebellar Ataxia

This is where the brain is progressively damaged over time for reasons that are unclear. This usually begins at around 50 years of age and gets slowly worse over time. Individuals with cerebellar disorders report difficulty with walking and balance, falls, dizziness, blurred or double vision, slurred speech, clumsiness, poor penmanship, knocking objects over when reaching for them, and tremors.

Sporadic Ataxia

Sporadic Ataxia occurs without any evidence that it was inherited from a family member. It can be difficult to diagnose. Other forms of Ataxia must be ruled out before a diagnosis of Sporadic Ataxia can be made. This disease is termed “neurodegenerative” because the nerve cells in the cerebellum gradually disappear over time without a known cause. Sporadic Ataxia can be either “pure cerebellar” if only the cerebellum is affected or cerebellar plus, if the Ataxia is accompanied by additional symptoms such a neuropathy, dementia, or weakness, rigidity, or spasticity of the muscles. Disability may be greater and progress more quickly with the cerebellar plus form of Sporadic Ataxia. In some people, the symptoms of Sporadic Ataxia are a prelude to the development of Multiple System Atrophy a rare, degenerative neurological disorder causing deterioration and shrinkage (atrophy) of portions of your brain (cerebellum, basal ganglia and brainstem) that affect internal body functions and motor control and affecting your body's involuntary (autonomic) functions. The autotomic nervous system is the part of the nervous system that supplies the internal organs, including blood vessels, stomach, intestine, liver, bladder, genitals, lungs, pupils, heart, and sweat, salivary and digestive glands. Treatment includes medications and lifestyle changes to help manage symptoms, but there is no cure. The condition progresses gradually and eventually leads to death.