DEAR DR. ROACH: I am concerned that my child has chronic traumatic encephalopathy after a serious concussion and several other head traumas. Can you tell me the current ideas for treatment? — K.L.R.
ANSWER: Chronic traumatic encephalopathy is a degenerative disease of the brain, described in boxers in 1928 (“punch-drunk” or “dementia pugilistica”), but recently there have been many reports of it in professional football and soccer players as well as in soldiers with repeated blast injuries. The pathology is related to but distinct from the pathology of Alzheimer’s disease, though both appear to relate to excess abnormal tau protein in the brain.
This is a condition that is just beginning to be studied. I can’t tell you how likely it is that your son may have it, even if I knew exactly how much trauma to the head your son received.
There have been recent reports of new drugs that may act on tau protein and that potentially could benefit people with CTE or Alzheimer’s disease. Some of these have shown promise in animal models. However, it is far too early for me to speculate further. There are no current treatments for the condition, but the symptoms, such as anxiety or depression, can be treated.
DEAR DR. ROACH: I would like your advice on a urinary tract infection. I was diagnosed with recurrent UTI. This is the third day of my medication, but it seems my symptoms haven’t improved much (maybe a little). Last time the symptoms left immediately after starting the medication. Do you think I should go back to my doctor now, or wait until I finish all medicine (10 days)? — S.L.
ANSWER: Urinary tract infections often get better quickly; however, you certainly should finish the medication, unless you are getting worse or having a side effect. Sometimes the medication that worked last time isn’t effective due to resistance in the bacteria. Sometimes there is a reason for recurrent infection or for the infection to not have cleared in the first place. A kidney stone, or a stricture (narrowing) in the urethra (the tube that carries urine out of the body) could be the cause of recurrent or persistent infection.
DEAR DR. ROACH: My son is 46 years old and has been having problems with ringing in the ears and his balance, and some problems with his vision. He had an MRI, and the doctor said that the scan showed a posterior fossa mega cisterna magna; the size was 23 by 45 by 35 mm. I have no idea what this is or what the prognosis might be. He is to see another doctor, but they have not been able to see him yet. Could you please tell us something about this kind of cyst? — Anon.
ANSWER: The cisterna magna is a normal space in the back of the brain, and it is filled with cerebrospinal fluid. In some people, they are larger than normal. In the vast majority of those cases, the mega cisterna magna has no correlation with the symptoms for which the MRI was obtained. One study showed no clinically significant neurological problems in people with incidentally found mega cisterna magnae. The neurologist your son probably will see will be able to take a look at his MRI scan and tell whether it is the likely case of an incidental finding of no consequence. MRI scans are so sensitive that we are finding many slight abnormalities that some people have, but that don’t affect their function.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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