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Old 03-10-2010, 06:43 PM   #1
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Spinal AVM MRI results

Last week I had MRI's done on my brain, cervical, thoracic, and lumbar spine.
Here are the results.

Brain- with and without contrast
Findings: There is mucosal thickening involving bilateral maxillary sinuses, ethmoid air cells, sphenoid sinuses. There is a 1 cm small mucous retention cyst within the right sphenoid sinus. Bilateral intraorbital contents are normal. There is lower lying of cerebellar tonsils.

Intracranially, the ventricular size and cisternal spaces are normal. There is no mass effect or midline shift. There is no hydrocephalus.

The FLAIR images demonstrate two small high T2 signal foci within the left anterior frontal lobe, one surrounding the frontal horn of the left lateral ventricle and another one within the left frontal lobe subcortical white matter. In addition, on sagittal view, there is high linear T2 signal along inferior margin of the corpus callosum. These findings are non specific.

There is no signal loss on susceptibility weighted image to suggest intracranial hemorrhage.

There is no increased diffusion to suggest acute infarct.

There is no abnormal enhancement on post contrast images within brain parenchyma. There is no meningeal enhancement.

Impression:
1. Two small discrete hight T2 signal foci within the left frontal lobe white matter as described above. In addition, there is linear high T2 signal along the inferior margin of the corpus callosum. These findings are non specific and of uncertain etiology. Possible causes include a demyelinating process, hypertension, or other inflammatory etiologies. However, these findings are not diagnostic of any particular etiology. It is uncertain whether these findings are related to patient's current symptoms.
2.No abnormal enhancement within brain parenchyma. No acute infarct, mass effect or hydrocephalus.
3. Paranasal sinus disease as described above.
4. Low lying cerebellar tonsils. Please refer to cervical spine MRI on same day for further evaluation.

Cervical Spine- with and without contrast

Findings:
The visualized portion of the brain demonstrates low lying cerebellar tonsils extending 4 mm below the foramen magnum, suggesting ectopia, but not meeting criteria for frank tonsillar herniation. (on a personal note, I thought I read that Chiari Malformation guidelines were 3-5 mm below? Could I possibly have that?)

There are seven cervical vertebral bodies noted in slightly reversed curvature which might be caused by position or spasm. There is a 2 mm posterior subluxation of C5 on C6 vertebral body. The bone marrow signal is normal. There are degenerative changes throughout the cervical spine, evidenced by narrowed disk space, facet and uncovertebral joint hypertrophy.

At C3-4 there is small posterior disk protrusion without spinal canal stenosis. There is no neural foraminal narrowing.

At C4-5 there is small posterior disk protrusion. There is no spinal canal stenosis or neural foraminal narrowing.

At C5-6 there is disk osteophyte complex extension posteriourly. The spinal canal is measuring around .9 cm, mildly narrowed. There is right side mild neural foraminal narrowing due to uncovertebral joint hypertrophy. The left neural foramen is patent.

The spinal cord does not demonstrate abnormal signal. There is no abnormal enhancement involving the spinal cord. However, there are multiple linear enhancing serpiginous structures noted along the surface of the lower cervical/upper thoracic spinal cord, posteriorly more than anteriorly.

Impression:
1. Increased amount of serpiginous enhancing structures along the surface of the lower cervical/upper thoracic spinal cord, likely represent prominent vasculature. This is an unusual finding, and could be caused by vascular congestion or possible spinal arteriovenous fistula or malformation. Thoracic and lumbar spine MR wigh and without contrast would be helpful for further evaluation. Further workup is recommended.
2. No spinal canal stenosis or neural formaminal narrowing. No abnormal signal within spinal cord.
3. Mild degenerative change of the cervical spine.
4. Cerebellar tonsillar ectopia.

Thoracic Spine- Normal

Lumbar Spine-
Very mild degenerative disc disease at the L5-S1 level with a small disc bulge. No significant spinal stenosis or neural foraminal encroachment throughout the lumbar spine. There is not abnormal enhancement throughout the lumbar spine.

So, having written all of that, what do you guys/gals think?
I often have lots of pain, swelling, and sore to the touch right underneath my head. Its where my brain sits on my neck. I think now after reading all of the MRI reports and educating myself, this may be due to the low lying cerebellar tonsils??

I am now awaiting a phone call to tell me when my spinal angiogram is to look at the possible spinal AVM. In the mean time, my neurologist has me taking 25 mg of nortriptylin once a day at bedtime. My Dr has given my hydrocodone 5-500 and told me to take 1-2 every 8 hours as needed for pain. The nortriptylin does help with the burning, tingling, and some of the pain. The vicodin, I believe, I am building a tolerance to. I have been taking them for about 8 months and they are not working as effectively as they did before. I take 6 a day (2 at a time) and it usually lasts for about 2 hours. Then I suffer through until its time to take it again!! I have heard of pain management clinics that help with my type of pain. I think my Dr is kinda getting a little weird about giving me the narcotic pain meds as I don't think he fully understands what is wrong with my neck. I stopped in and told him about possibly having a spinal AVM and he said he didn't know why that would cause so much pain. I really felt like a big dummy!! I really didn't have an answer other than, I don't know either, BUT I KNOW THAT I HURT EVERDAY!! So I guess I was wondering if any of you thought that my 'conditions' were warranted for pain management. Thank you in advance for all of your input!!~

I am so grateful to have a place like this to come and ask questions and be heard. Thank you all for your caring!!~
Tasha

 
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Old 03-12-2010, 09:47 AM   #2
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Re: Spinal AVM MRI results

i have not forgotten about you hon. unfortunetly my time on this stupid PC has been very limited so i have not been able to respond here, but i WILL, probably tomorrow? its just too in depth to do a simple type of response thing here and i do want you to get the best type of info. so i will be back in the morning to give you my thoughts here, K? again ,i know you are waiting and i am really sorry i just cannot get thru this right now. i hope you understand hon. just hang in there and i will be back,K? marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 03-12-2010, 12:13 PM   #3
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Re: Spinal AVM MRI results

Marcia,
Hey, I do totally understand being busy! Are you kidding? You mean you aren't sitting around waiting for worry warts like me to post? I'm shocked..... I look forward to hearing from you tomorrow!! Have a wonderful Friday!!
Tasha

 
Old 03-13-2010, 10:18 AM   #4
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Re: Spinal AVM MRI results

don't EVER lose that good sense of humor hon, its what has gotten me thru sooo freaking much crap in my life along the way.

the one thing that you just absolutely NEED right now and could also obtain one thru where you are going for the angio too is a good knowledgable and EXPERIENCED type of neurosurgeon. an NS really does need to take a good hard look at your films. they don't pay too much attention to what any mere radiologist states about certain findings and want to do their own much more knowledgable 'read' of your films themselves. this is also kind of a "second" read of your films too which is always a good thing. you will just be getting an opinion from someone who actually knows the inner structures of anything like the brain and the spinal cord sooo much better only becasue they go in those places like on a daily basis? vs a mere rad who just 'looks' at films and kind of gives their overall 'impression' of what they 'feel' may or may not even be a real finding? while a primary doc will pretty much use any scan as a way to tell who to send you to as far as a specialist will place much more wieght upon the rad report, most really good NSs may not even give it a look at all. thats how much emphasis any good NS really has for a rad read of any hardfilm. so some of what has been actually stated up there that 'he or she' found, may or may not even be real solid findings here either, so DO also keep that in mind?

the one thing that i thought of as soon as the tonsils were mentioned as being too low was also a possible chiari too. i do not know alot about them(just know how they tend to look upon film and present) but there are some people up in the brain boards way up from here at the top who do have them and have posted about them if you want to pop up there? the only thing i DO really know about them is that they just do tend to place a bit more pressure upon that spinal areas since those tonsils should actually be more within the skull area and not dropped down that far. but it is not alot from what is stated by the way of true measurement. but this is one of the very important things that needs that NSs opinion too?

i have to say i am curious as hell to actually know just what this rad thinks he is actually seeing within the frontal lobe areas(and the rest of the true 'brain' descriptions overall?)? it appears from what he is saying there, that tho he sees 'something"? he cannot even begin to really define it? that too is another NS thing to look over. it could just be a something or a nothing. i am wondering if this simply could be what i mentioned before a hemangioma? this is what i had in my cord area? they can be very small but are only venous fed and within the brain are not too overly problematic compared to the AVMs and the fistula crap? but all ofthe overall brain descriptions just really DO need the expertise of a good NS to really know anything,ortr perhaps a much deeper type oif a scan called a three T or 3 tesla scan? they had to do this on my brain when i had an aneurysm since i have a kidney disease,i have to decline contrast? there is a nasty icky med i can take like when i have to have my angios to make it afe for my kidneys,but i did not want to go there is there was another beter scan without contrast. but for you,the contrat qwould ber fine. this type of a scan just uses 3 times the amount of real magnetism than a regular MRI can and does get much clearer in depth pics than any even contrasted regular MRI possibly could. this would be something depending upon what the NS would actually just already know with HIS overall knowledge when he sees those hardfilms himself? its just a really good way of getting a much better MRI type of scan for certain findings,espescially when in the brain area? there are just many little things that can be hidden from view in there since it just has so many structures?

as far as the rest of the report goes? for now i am only going to hit what is within the more significant appearing areas,K? or we could be here all freaking day, lol. while it does appear that you have absolutely NOTHING IN that actual spinal cord which trust me is a really wonderful thing here, it does mention something that i have never ever heard of or seen in any rad report that i have had or seen posted here so i used my handy tabers medical dictionary to see what the freaking heck this is?

it mentions what is called on the report as 'serpignous enhancing structures" that appear to be "running" upon the surface of the c and t spin areas of the cord? when i looked up that serpingi thing, all it states is that it has to do with something that is 'creeping'? like creeping up or downward type of thing? really strange wording there,ya know? but this IS what he is decribing as some type of vascular malformation, thus your possible AVM? and this just IS what really NEEDS that anigio to really define. they will only be able to see light up tho from anything arterial, not venous. tho on another date once that contrast has fully passed thru you they can do what is called an MRV? this ONLY would look ator 'light up' anything contrasted that is venous fed not arterial. but they may be able to just ascertain that difference with the angio in seeing it,then looking at what actually lights up and does not once they shoot that dye up there? that is something the neuroradiologist would do for you at the angio appt.

so basically hon its kind of a wait and see thing here til you can find out for certain just what this particular vascular malformation actually just is and what treatment options are avaliable to minimize any danger if this is mostly arterial, of bleeds. what i am actually wondering here just knowing how any given venous fed lesion would bleed vs an arterial one(an ooze vs what would be heavy or pumping bleeds becasue of the higher pressure?)? if what that 'creeping' finding actually is this thing just could be majorly venous and is having little bleeds within itself not to the outside at this point which WOULD espescially is these are happening more towards the bottom(or just being drawn there) but inside itself, just gravity even being a player here at all, it WOULD tend to appear like it would be 'creeping" downward in a way? you know what i am trying to say with that? i just am trying to make some sense out of that word he used that means something IS creeping or appears to be?? just a very different type of wording there.

but i do have to fly here right now since i just noticed i went over my noon stop since i have an appt today. but DO ask your neuro about referring you to a good pain clinic tasha, seriously. my pain clinic is where i finally was able to actually obtain any good releif using not only meds but the different modalities they just can offer you there that you cannot really get any place else. just considering this really insane finding and the other parts that are creating any real pain, you just DO need some better more knowledgable pain people to help you deal with all of this crap right now. this is all they DO at any pain clinic every single day,help people deal with their particular pain proceses. i personally think it really is needed. talk to your neuro since i am sure he will be more than happy to not have to keep rxing narcotics, lol. they don't like that, go figure. i will be back hon, marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 03-16-2010, 08:15 AM   #5
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Tashaisinpain HB User
Re: Spinal AVM MRI results

Thank you so very much for your response!! And I did take your advice and post on the brain board. It was suggested that I may have a B12 deficiency. Something to look into.....
I also kind of had a little meltdown as I am at my wits end!! Just getting tired of waiting, ya know? I kinda feel like I am flying blind, so to speak. I have not been equipped and now I am expected to have everything figured out on my own and that really sucks!! Just like with the whole brain lighting up thingy....On the MRI, it wasn't even warranted for any conversation, but really, I feel like whoever wrote the report didn't discuss it because he didn't know what the hell it was!! So what, since he doesn't know what it is then we just ignore it altogether? Talk about goofy.....

I'm just frustrated and in pain and confused and grouchy and all the other crappy words used to describe just plain confusion........

Thanks for listening.....

 
Old 03-16-2010, 09:15 AM   #6
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Re: Spinal AVM MRI results

Can you also tell me what to look for as far as a bleed goes? What symptoms should I be on the lookout for that would indicate I had a rupture? I know as of like 2 days ago, my newest symptoms is that my ears are contantly ringing.....kind of like when you are in a quiet room and you hear that buzzing sound. Only mine is happening whether its quiet or not. Since none of the Drs are telling me anything, I should at least ask someone who has gone thru this already.

Thanks for your time....
Tasha

 
Old 03-18-2010, 06:54 AM   #7
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Re: Spinal AVM MRI results

hey hon. i did post up on the brain board the other day after i saw you did post there too. did ya read that? have they called you yet or did you try calling them about the angio?

the thing here is it was not actually the radiologists real "job' to actually 'know' about every finding in any MRI film(he merely explained a possible 'finding'),that real explanation just should come from the neurologist in your case, and HE dropped the ball on you here. the "specialists' are the ones who we are supposed to be able to count on here. the rad only looks and gives what she or he actually 'sees' and that of course depends only upon 'their" own level of real knowledge.

this is why you simply DO seriously need a good actual neurosurgeon and NOT a mere neurologist for this. basic neuros really don't know anywhere as near as much as most NSs just do since they are the ones who actually go into brains and spinal cords, ya know?

as far as any real 'bleeds' go? well some you wont even have a freaking clue, and some you may. alot also depends more on just what this particular malformation actually consists of? either venous, arterial or a bit of both since they DO bleed very very differently. i would just be making certain at this point to be writing down ANY actual odd feelings or any changes like this one along with the date it happened on too? this WILL help the NS who you will be seeing know a bit more since certain sensations or feelings or neuro changes just can mean alot of different things, or what is even being affected? considering that you just DO have a bit lower tonsils up in the brainstem area there also sitting on your spinal column and cord a bit differently, it could also be hitting the nerves there in some way? you really wont know alot here til they can simply get things moving ya know? just keep track of what your current symptoms are and what has popped in already that you have there and try to generalize the time frame of every single "onset" if you can remember when? i just kept a notebook with all my crap in in and also wrote down ANY actual real good questions i would think of like as soon as i thought of the good question? otherwise i would forget about that dang question later? then this will be your little notebook of stuff that you can simply bring with you when you see the NS that hopefully will be thru the very same place as where you will be getting that angio too? like i said before hon,the teaching hospitals are just going to be YOUR very best bet in really finding 'solid' answers. other NSs unless they happen to actually specialize in vascular malformations will just NOT have that good experienced level of knowledge that you need right now. this was MY biggest issue when i had my angioma in my cord? just finding the NS who actually did just HAVE the most all over experience with what i had.

tasha, can you go up to your 'my settings" thing here at the top of the page and change the settings to actually allow PMs to be sent? they do have the private messenging feature here? its pretty simple to actually do. then i can give you some better specifics here. i was going to send you one but when i popped onto your username. it shows that you have not enabled the PM feature so i cannot do this the way you have it right now. if you click on MY username here, it does show what the PM thing is? maybe you could try hitting mine and it will be able to set up that way too? i don't really know. but it should state when you hit my name, 'send feelbad a private message"? try both ways and see if you can get this set up, it really would help in describing certain things to you in the PM way, thats all. its just a nifty little feature.

like i mentioned on the brain board to you, you are going to HAVE to be your OWN advocate here and start getting a bit more demanding if people are simply not doing their jobs for you right now, and along the way here. if they still have not called you about that angio hon, call them(whoever was supposed to actually set this up in the first place, the neuros office maybe?), and keep calling til someone gets their act together. you just NEED that angio done before anything else can get rolling here. but just see about that PM set up. its all done thru that 'my settings" area up there on the top of the page here?

i gotta fly here as i have a pain clinic appt early this afternoon and it does take me a bit to get 'me' together, lol. but DO keep me posted hon. marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

Last edited by feelbad; 03-18-2010 at 06:56 AM. Reason: dang spastic fingers!

 
Old 05-12-2010, 02:35 PM   #8
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Re: Spinal AVM MRI results

Quote:
Originally Posted by Tashaisinpain View Post
Last week I had MRI's done on my brain, cervical, thoracic, and lumbar spine.
Here are the results.

Brain- with and without contrast
Findings: There is mucosal thickening involving bilateral maxillary sinuses, ethmoid air cells, sphenoid sinuses. There is a 1 cm small mucous retention cyst within the right sphenoid sinus. Bilateral intraorbital contents are normal. There is lower lying of cerebellar tonsils.

Intracranially, the ventricular size and cisternal spaces are normal. There is no mass effect or midline shift. There is no hydrocephalus.

The FLAIR images demonstrate two small high T2 signal foci within the left anterior frontal lobe, one surrounding the frontal horn of the left lateral ventricle and another one within the left frontal lobe subcortical white matter. In addition, on sagittal view, there is high linear T2 signal along inferior margin of the corpus callosum. These findings are non specific.

There is no signal loss on susceptibility weighted image to suggest intracranial hemorrhage.

There is no increased diffusion to suggest acute infarct.

There is no abnormal enhancement on post contrast images within brain parenchyma. There is no meningeal enhancement.

Impression:
1. Two small discrete hight T2 signal foci within the left frontal lobe white matter as described above. In addition, there is linear high T2 signal along the inferior margin of the corpus callosum. These findings are non specific and of uncertain etiology. Possible causes include a demyelinating process, hypertension, or other inflammatory etiologies. However, these findings are not diagnostic of any particular etiology. It is uncertain whether these findings are related to patient's current symptoms.
2.No abnormal enhancement within brain parenchyma. No acute infarct, mass effect or hydrocephalus.
3. Paranasal sinus disease as described above.
4. Low lying cerebellar tonsils. Please refer to cervical spine MRI on same day for further evaluation.

Cervical Spine- with and without contrast

Findings:
The visualized portion of the brain demonstrates low lying cerebellar tonsils extending 4 mm below the foramen magnum, suggesting ectopia, but not meeting criteria for frank tonsillar herniation. (on a personal note, I thought I read that Chiari Malformation guidelines were 3-5 mm below? Could I possibly have that?)

There are seven cervical vertebral bodies noted in slightly reversed curvature which might be caused by position or spasm. There is a 2 mm posterior subluxation of C5 on C6 vertebral body. The bone marrow signal is normal. There are degenerative changes throughout the cervical spine, evidenced by narrowed disk space, facet and uncovertebral joint hypertrophy.

At C3-4 there is small posterior disk protrusion without spinal canal stenosis. There is no neural foraminal narrowing.

At C4-5 there is small posterior disk protrusion. There is no spinal canal stenosis or neural foraminal narrowing.

At C5-6 there is disk osteophyte complex extension posteriourly. The spinal canal is measuring around .9 cm, mildly narrowed. There is right side mild neural foraminal narrowing due to uncovertebral joint hypertrophy. The left neural foramen is patent.

The spinal cord does not demonstrate abnormal signal. There is no abnormal enhancement involving the spinal cord. However, there are multiple linear enhancing serpiginous structures noted along the surface of the lower cervical/upper thoracic spinal cord, posteriorly more than anteriorly.

Impression:
1. Increased amount of serpiginous enhancing structures along the surface of the lower cervical/upper thoracic spinal cord, likely represent prominent vasculature. This is an unusual finding, and could be caused by vascular congestion or possible spinal arteriovenous fistula or malformation. Thoracic and lumbar spine MR wigh and without contrast would be helpful for further evaluation. Further workup is recommended.
2. No spinal canal stenosis or neural formaminal narrowing. No abnormal signal within spinal cord.
3. Mild degenerative change of the cervical spine.
4. Cerebellar tonsillar ectopia.

Thoracic Spine- Normal

Lumbar Spine-
Very mild degenerative disc disease at the L5-S1 level with a small disc bulge. No significant spinal stenosis or neural foraminal encroachment throughout the lumbar spine. There is not abnormal enhancement throughout the lumbar spine.

So, having written all of that, what do you guys/gals think?
I often have lots of pain, swelling, and sore to the touch right underneath my head. Its where my brain sits on my neck. I think now after reading all of the MRI reports and educating myself, this may be due to the low lying cerebellar tonsils??

I am now awaiting a phone call to tell me when my spinal angiogram is to look at the possible spinal AVM. In the mean time, my neurologist has me taking 25 mg of nortriptylin once a day at bedtime. My Dr has given my hydrocodone 5-500 and told me to take 1-2 every 8 hours as needed for pain. The nortriptylin does help with the burning, tingling, and some of the pain. The vicodin, I believe, I am building a tolerance to. I have been taking them for about 8 months and they are not working as effectively as they did before. I take 6 a day (2 at a time) and it usually lasts for about 2 hours. Then I suffer through until its time to take it again!! I have heard of pain management clinics that help with my type of pain. I think my Dr is kinda getting a little weird about giving me the narcotic pain meds as I don't think he fully understands what is wrong with my neck. I stopped in and told him about possibly having a spinal AVM and he said he didn't know why that would cause so much pain. I really felt like a big dummy!! I really didn't have an answer other than, I don't know either, BUT I KNOW THAT I HURT EVERDAY!! So I guess I was wondering if any of you thought that my 'conditions' were warranted for pain management. Thank you in advance for all of your input!!~

I am so grateful to have a place like this to come and ask questions and be heard. Thank you all for your caring!!~
Tasha

 
Old 05-12-2010, 02:36 PM   #9
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Re: Spinal AVM MRI results

Dear Tasha, Get a bandage and wrap up your head and ears to relieve the pain. Shona

 
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