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Old 06-30-2006, 12:54 PM   #1
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My MRI - Verbal Description of Mass - Aneurysm or Acoustic Neuroma?

Feelbad,

Thank you kindly for replying to my message. I appreciate your time.

The physician who interpreted my scans and wrote the report noted that there were several hyperintense foci on the FLAIR scans in the periventricular and subcortical areas. I can see these too... they are fairly obvious, there are maybe 10 of them, but "etiology is unknown." She offered some differential diagnoses, made no mention of the curious mass, which sticks out like a sore thumb to an amateur to me.

It's very visible on axial slides where my medulla begins, slightly to the the medulla's upper left. It is present on all axial slides at this level of the upper C-spine and brain, with all the types of weighting and sequencing (T1, T2, contrast, FLAIR, etc...).

On the upper c-spine axial slides it appears as a very bright, well-defined bulbous mass. It occupies the left sigmoid sinus area to the left of the clivus and upper-left of the medulla. On the uppermost axial slides before it goes off of the radar, it appears to have a fat sausage-like "tail" that points to the left, following the medulla. On some of the axial brain slides, the bulbous part it sort of looks somewhat coiled, like a snail shell? This shows up very well on the gadolinium contrast images.

On the right side, in the same area, I have looked very closely for a structure that even remotely resembles this. There is nothing -- just a dark, empty space. The only difference is seen in the gadolinium contrast images. With contrast, a similar structure appears on the right side, only it is MUCH smaller and not as bulbous or coiled in appearance.

I have an appointment with a neurologist on July 6. It seems like such a long wait! I also have another appointment with my primary physician on July 5. I might bring my MRI films along and point this thing out to him.

I wonder, how often do radiologists miss things such as this on MRIs? Kinda scary, in more ways than one.

 
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Old 07-02-2006, 09:55 PM   #2
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I did more research - adding more information

Okay, I did a ton of research on this.

The mass is located beneath behind the internal carotid artery, where the jugular should be. It follows the path of the jugular. In the lower images (closest to the base of my skull), the path of the internal carotid appears to be uncomprimised. On subsequent slices (moving upward into the cerebellum), the path of the carotid becomes obscured by the mass.

It is isointense and slightly hyperintense (relative to cerebellum tissue) on T1-weighted images with and without gadolinium contrast. On the FLAIR images, it is isointense. On T1 images with contrast, it is very hyperintense. Also with contrast, a similar structure appears on the opposite side, only its much, much smaller. It is not hypointense on any of the images.

Isointense - appearing about the same brightness.
Hyperintense - brighter than, or white
Hypointense - darker than, or appearing black

Based on the location and appearance in the different types of scans, I have three possible differential diagnoses:

Glomus Jugulare or Glomus Vagale (vascular sheath tumor)
Schwannoma (nerve sheath tumor)
Thrombosed Jugular Aneurysm (clotted aneurysm of the internal jugular

Glomus tumors appear on the different types of MRI scans as I described above - isointense or hyperintense on FLAIR and T1 images without contrast and very hyperintense on T1/T2 images with contrast. Aneurysms will usually appear hypointense on scans without contrast, unless they are clotted.

Also, based on my studies of anatomy in this area, looks like there is a high probability that the vagus nerve is compressed or irritated in some way. The vagus nerve has been linked to many other symptoms I have... dry, nonproductive cough, postural hypotension, depression, digestive problems, even reactive hypoglycemia (due to the vagus nerve's connection with the pancreas). It would explain SO MANY of my symptoms...

I will be showing these MRI films to my primary doc on July 5 and to a neurologist on July 6. Wish me luck...

 
Old 07-04-2006, 03:44 AM   #3
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Re: My MRI - Verbal Description of Mass - Aneurysm or Acoustic Neuroma?

If you have an appt on July 6, that's INCREDIBLY FAST to get in to see a neuro. You don't say when the MRI was done. Generally, people report waiting up to 3 months to get in, and I've heard of people having to wait 6 months. And that's in the U.S!

Don't stress a lot about the periventricular spots unless the neuro tells you to worry. Very common, and your neuro will know if they are in a worrisome area. The other "mass" you saw, leave the interpreting to the neuro. Of course, the neuro will need the films themselves. Your primary doc won't likely know much of value about it.

My neuro put the films up and went over them with me. You can ask to do that, too. I have a lot of the periventricular spots, too. They mean nothing significant in my particular instance.

(I had to wait almost 4 months to get in to see a neuro after developing a droopy eyelid and having an MRI. It went away before the appt and never came back).

Last edited by nowhere-child; 07-04-2006 at 03:48 AM.

 
Old 07-05-2006, 11:45 AM   #4
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Re: My MRI - Verbal Description of Mass - Aneurysm or Acoustic Neuroma?

Nowhere-child -- Thank you so much for replying.

My MRI was done on June 8. I received the interpreting physician's report on June 13. I discussed this with a friend who has MS, who advised me to schedule with her neurologist, Dr. Patricia F****, to just make sure everything is A.O.K.

I called her office to schedule the appointment on Thursday, June 15th. I would agree, I was able to get in a lot more quickly than I expected. I spoke with Dr. F.'s admin and/or nurse (not sure of her role) and she pretty much grilled me on every symptom with every part of my body. She asked about the MRI also. She told me that she would take this information to Dr. F. and let me know if we could schedule an appointment. The admin called me back the next day and we scheduled for July 6. Of course, I was asked to bring my films (not a CD).

I had an appointment with my GP today and brought my films. He was honest -- he did not know what the mass was but agreed that we needed to find out. He wanted to take my films to a radiologist friend of his who works down the street at an imaging facility (where they do MRI, MRA, ultrasound, CT, and the like), but said he wouldn't be able to get the films back to me until Friday. I told him my first appointment with Dr. F. was tomorrow but I could reschedule, but he handed the films back to me and told me to keep my appt with Dr. F. -- that she might know what the mass was.

This is a little scary.

 
Old 07-06-2006, 05:07 AM   #5
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Re: My MRI - Verbal Description of Mass - Aneurysm or Acoustic Neuroma?

Keep us posted on what it is, ok?

Best wishes.

 
Old 07-09-2006, 01:08 PM   #6
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Re: My MRI - Verbal Description of Mass - Aneurysm or Acoustic Neuroma?

Hi Again,

I was very disappointed with Dr. F, the neurologist. She barely looked at my MRI films. She first read the interpreting physician's report, then looked only at the sagittal T1 images and the axial FLAIR images.

Dr. F. put these two films on the backlight in the hallway and pointed out my brain anatomy (yeah, I already know what a pons is) and the lesions on the FLAIR images. To my relief, the lesions seen on the FLAIR images are not consistent with MS, according to Dr. F. She started to walk away, and I stopped her...

"Hey, can I ask you what this is?" I picked up a pen and pointed out the mass that was obvious to both myself and my GP.

She looked at it for two seconds and said, "It's part of your ear."

I asked, "Why is it on one side and not the other?"

Her reply: "Probably because the scan might be at a bit of an angle. Besides, the report didn't mention it, so it's nothing -- it's normal."

Hmph. If she would have taken the time to look at ALL of my films, she would have seen it on every one. Also, there is no structure in the ear that is 1cm in diameter and 3.5cm "tall" and appears hyperintense (isointense on FLAIR) -- and there is absolutely nothing that looks anything like it on any of the other films, with the exception of the contract-enhanced images. (With gadolinium contrast, a similar structure appears, only much smaller, which leads me to the conclusion that it's something vascular in the same area).

After all my research, I think I probably know more about the anatomy of the brain than some doctors!!!!

Anyhow, my films are now in the hands of my GP and they are being reviewed by more doctors. I will probably find something out sometime next week.

At any rate, Dr. F did a 5-minute neurological exam. She only noted some mild neuropathy in my feet and suspected that I have a B12 deficiency (I cannot fathom how that would be possible). Then she proceeded to prescribe numerous migraine medications and gave me a lecture about patient compliance, diet and exercise (she's preaching to the choir!!!!). I was P-I-You-Know-What!!!!!! Grrr!!!! I DO NOT WANT TO TAKE MORE DRUGS!!! I cannot stand it when doctors want to treat a SYMPTOM and not the PROBLEM! And I do not have MIGRAINES!!! :-P Argh.

Well, to her credit, at least she ordered extensive bloodwork. I'll be getting my blood drawn tomorrow. I have thyroid disease which is currently controlled by 1.5mg levothyroxine daily, so she's having my TSH checked too. (I was last tested in December and my TSH was 1.03.) I am also having the full CBC, chem workup, B12, and ANA. I've never had an ANA done, but I've always kind of suspected that I might have some kind of autoimmune thing going on, so it will be interesting to see how that turns out.

*Deep Breaths*

Last edited by ArtsyAthlete; 07-09-2006 at 01:13 PM.

 
Old 07-10-2006, 08:41 AM   #7
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Re: My MRI - Verbal Description of Mass - Aneurysm or Acoustic Neuroma?

I kind of have to believe that if it's clearly obvious on the films as you say, someone would have mentioned it if it were abnormal. The radiologist or the neurosurgeon...you would just have to think if it's huge and something of concern, they would have noticed.
Especially in this CYA society of ours.

Please keep updating on what you find. Certainly I see why you're worried! Best of luck!

 
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