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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18448
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My son had an MRI scan in May on his brain. The findings shown

Resolved Question:

My son had an MRI scan in May on his brain. The findings shown extensive abnormalities in quite a few areas but more so on the right side of the frontal lobe. The radiologist and neurologist were 70% sure it was CNS small vessel vasculitis but after an angiogram was clear they are now saying it's a mystery. Although I have read small vessel vasculitis does not show on angiograms. So I suppose my question is if it's not vasculitis what else could it be? And is there still a chance it could be small vessel shall I push for a biopsy?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.
Do you know which blood tests were done?
Customer: replied 1 year ago.
The report we had said that ESR (9), Renal function (normal) and auto antibodies including dsDNA and ANCA (negative) was done. Thank you.
Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information.

You are correct that an angiogram is usually negative in a child with small vessel vasculitis. Other conditions that could be present include a variety of brain or systemic inflammatory conditions or certain infections. It may be necessary to perform a biopsy, but since it is a surgical procedure, it is usually preferable to perform other evaluation first.

Aside from imaging, the first steps would involve detailed blood tests. In a child in whom vasculitis is suspected, extensive tests that may reflect an inflammatory disease would be reasonable. The ESR is one of these tests, but additional tests of inflammation include a C-reactive protein,complement, and immunoglobulin levels. I assume that a CBC and a general chemistry profile was also done, as these are usually done when the tests that you note have been done, but if not, these should be ordered. It is good that the test for auto antibodies have already been done.

Once extensive blood work has been done, then the next step would usually be a lumbar puncture, which also can look for evidence of inflammation with an increase in opening pressure, elevated white blood count, or elevated protein levels, while there is no evidence of infection.

If the diagnosis is still uncertain after blood tests, imaging tests, and a lumbar puncture, then it would be appropriate to ask the doctor to consider a biopsy.

If I can provide any further information, please let me know.
Expert:  Dr. D. Love replied 1 year ago.
Please let me know if any additional information would be helpful.
Customer: replied 1 year ago.
Thank you for the reply. I think they are trying to arrange a lumbar puncture for when he has another MRI scan in 4-6. They want to see if there's any changes and if what's happening is progressive. I think my main worry is not knowing and when I asked his doctor if it wasn't vasculitis what else could it be, he said it's a mystery as there doesn't seem to be any signs of it being anything else. I'm just worried as my cousin had a rare form of cancer at age 7 that was missed as there wasn't typical signs and she had no symptoms when she was diagnosed it was too far gone and she passed 6months after. With everything else going on with him he is a very complex little boy and it's hard to know if he is suffering with certain things as he doesn't complain about pain and because he has autism, ADHD and learning difficulties im worried some symptoms could be put down to those things and dismissed.
Expert:  Dr. D. Love replied 1 year ago.
Extensive changes in multiple locations throughout the brain would not be the way that cancer presents. If it is not vasculitis, the most likely conditions would be other inflammatory conditions or infections, and the evaluation noted above is the usual method by which these other conditions can be identified.
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