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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19320
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Dear Dr, Our mother was diagnosed with an Astrocytoma in

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Dear Dr,
Our mother was diagnosed with an Astrocytoma in 2010 and had an infarct in 2013.
Scans since 2013 show stable disease, fractionally lower edema (the most recent one being scans from Septemebr 2014).
Yet, neurologically, we have seen a lot of 'deterioration' in the last four/five months - considering these 'stable' reports.
Why would this be? We are baffled.
once a brain is compromised by disease and stroke, and even though these factors remain stable, does neurological deterioration continue?
Thanks you for your wisdom
Hello from JustAnswer. I will be glad to assist you today.

Let me address the general question first, then discuss her situation.

There are certain conditions that cause a single sudden loss of function of a portion of the brain, such as an infarct. In these conditions, once the acute episode has healed, there may or may not be residual neurologic deficits, but there would be no further deterioration in brain function if no further infarcts occur or other problems related to poor blood flow. Of course, someone that has had one infarct is at risk of having subsequent infarcts, and one of the management issues after an infarct is implementing interventions to reduce the risk of a subsequent infarct. However, no interventions will eliminate all the risk of a subsequent risk of an infarct. But, as long as there is no recurrent infarcts or other problems, there will not be any further deterioration of brain function.

Within this context, there are some problems that cannot be identified by an imaging study. For example, poor blood flow that is not sufficient to cause an infarct may not be readily identified on an imaging study. So, to say that someone is stable would require both an absence of symptoms along with an imaging study that is not progressing.

However, there are other problems that are typically progressive, even though the imaging study may not show progression. For example, an astrocytoma may penetrate into portions of the brain that cannot be readily identified on the MRI or even during surgery. This is particularly true of high grade astrocytomas. Consequently, even when there is no evident change in the brain on an imaging study, there may be progression of the infiltration of the astrocytoma into portions of the brain beyond the primary tumour. Even if the primary tumour has been removed, it is frequently difficult to be certain that there is no residual infiltration into surrounding brain tissue.

Therefore, in your mothers case, the deterioration in brain function over the last 4-5 months while the MRI is stable could be a sign that there is ongoing problems from poor blood supply that is not sufficient to cause another infarct or from progression of the astrocytoma infiltration into other portions of the brain.

If I can provide any clarification, please let me know.
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Customer: replied 3 years ago.

Thank you, ***** *****

Would a PET scan provide greater clarification on tumor activiy? We had this in July 2014 - followed by MRIs when a PET scan was not available.

Yes, a PET scan can provide greater clarification on tumour activity. An elevation of activity on PET scan is a sign of a higher grade tumour, and an increase in activity compared to prior PET scans is a sign that a lower grade tumour has transitioned to a higher grade tumour.

However, the PET scan also has a limitation of being able to identify the extent of infiltration of the astrocytoma into other portions of the brain. So, the PET scan does provide some information beyond the MRI that can be useful in certain situations, but it also may not identify the cause of the recent deterioration in brain function.
Customer: replied 3 years ago.

That's great. Thank you

So as a carer, is it fair to conclude that :

with neurological cases where there is complication of trauma from tumor and stroke and such, that in these cases sometimes it is hard to pin point triggers and that sometimes, we just cannot get definitive answers for the patient's condition?

Yes, that is correct.
Customer: replied 3 years ago.

Thank you, ***** *****

You are welcome. I hope that everything goes well.