Here's a patient with a complex history. The key question is the permanence of observable MRI changes.
Patient is a 59 year-old male, with obstructive sleep apnea, mild hypertension, mild elevated LDL and mild low HDL cholesterol levels. A recent brain MRI showed "minimal small vessel ischemic change seen in the deep periventricular white matter tracts"
Aside from the obvious need to exercise, lower blood pressure, and improve diet/cholesterol, could the observed changes be a result of low oxygen levels caused by untreated OSA? Patient has been using a CPAP for approx. 2 years. Would there have been improvement if this were the case?
Also, some literature shows such changes in neurologic Lyme borreliosis. Patient was treated numerous times (beginning 1988) with iv rocephin, claforan, and, lastly, vancomycin, which resolved symptoms in 1999.
Would any white matter changes be permanent, or would they disappear (heal?) over time?
Patient is a 59 year-old male, with obstructive sleep apnea, mild hypertension, mild elevated LDL and mild low HDL cholesterol levels. A recent brain MRI showed "minimal small vessel ischemic change seen in the deep periventricular white matter tracts"
Aside from the obvious need to exercise, lower blood pressure, and improve diet/cholesterol, could the observed changes be a result of low oxygen levels caused by untreated OSA? Patient has been using a CPAP for approx. 2 years. Would there have been improvement if this were the case?
Also, some literature shows such changes in neurologic Lyme borreliosis. Patient was treated numerous times (beginning 1988) with iv rocephin, claforan, and, lastly, vancomycin, which resolved symptoms in 1999.
Would any white matter changes be permanent, or would they disappear (heal?) over time?