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Old 10-05-2012, 08:31 PM   #1
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Please help with MRI report

Hi I'm a new poster and I'm hoping someone may be able to help. I've recently been diagnosed with Chiari Malformation Type 1 after having a full brain MRI Scan and will soon see a Neurosurgeon which is good. I do have most, if not all, of the symptoms that that come with this diagnosis.

I was also sent for a two in one spinal MRI of the Cervical and Lumbar spines, which actually turned out I think to be the entire spine if I'm reading the results properly.

Here's the MRI results:

Spine Cervical

MRI of Cervical Spine from skull base to the T7 has been imaged.

Herniation of the cerebellar tonsils below the foraman magnum (8mm) with obliteration of the cisterna magna.
There is very mild compression of the lower brainstem without signal changes. There is no associated syringomyelia. Normal size of the forth ventricle.
Straightening of the normal cervical lordosis. Very mild degenerative changes throughout the cervical spine without spinal cord or nerve root involvement. Normal cervical cord.
Conclusion:
Chiari 1 Malformation without associated syringomyelia.


Spine Lumbar
MRI of Lumbar Spine – for T8/T9 to the Sacrum has been imaged
S shaped Thoracolumbar Scoliosis with left sided lumbar convexity.
There are mild to moderate degenerative changes throughout the lumbar spine with desiccation, loss of height and mild symmetric bulging of the discs.
These changes are more pronounced at L3/L4.
Normal conus medullaris and causda equina. No spinal canal stenosis. No foraminal stenosis.
Conclusion:
Thoracolumbar Scoliosis.
Mild to moderate degenerative changes throughout lumbar spine.
No cord or nerve root involvement.
There is no evidence of neural tube closure defects.


Is there anything on these reports that I should be worried about?

I'm concerned with the mention of scoliosis, as an adult is this something I'm stuck with; and what sort of symptoms could it cause, if any?

Also the brain MRI results say that the cerebellar tonsils are asymmetrically inferiorly extruded in the foramen magnum, 9.7mm on the right side and 5.1 on the left side; this is quite a bit different to the spine results so which one is correct?

Thank you for reading such a lengthy first post and for any advice or explanations.

tirrannaei

PS: what does 'with obliteration of the cisterna magna' actually mean? Is this normal or something to do with Chiari?

Last edited by tirrannaei; 10-05-2012 at 08:36 PM. Reason: Added question

 
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Old 10-06-2012, 11:40 AM   #2
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Re: Please help with MRI report

Brain MRI - "" the cerebellar tonsils are asymmetrically inferiorly extruded in the foramen magnum, 9.7mm on the right side and 5.1 on the left side""

Spinal MRI - "" Herniation of the cerebellar tonsils below the foraman magnum (8mm) ""

Maybe I'm missing something, but I don't see the contradiction. The two MRI's seem to be basically in agreement.

"" what does 'with obliteration of the cisterna magna' actually mean? Is this normal or something to do with Chiari? ""

I read this as the radiologist saying the two are connected. It makes sense, as Chiari is an extrusion of cerebellar tissue, and the cisterna magna lies below the cerebellum. If you look at images, you can see that Chiari might or might not involve the cisterna magna.

One of the big problems associated with Chiari is that the cerebellar extrusion may block the foramen and prevent the normal flow of cerebrospinal fluid. Among other bad effects, this obstructed flow can create unhealthy pressure differentials which allow the growth of syrinxes in the cervical spinal cord. Your lack of syringomyelia would seem to make it less likely that the CSF is so obstructed.

Let me warn you that I'm going out on a limb here and am certainly "out of my league", as it were. The neurologists and neurosurgeons are the ones you want to hear from.

I'd certainly like to hear what the neurosurgeon has to say, if you're willing to take the trouble...

Last edited by WebDozer; 10-06-2012 at 11:44 AM.

 
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Old 10-06-2012, 03:08 PM   #3
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Re: Please help with MRI report

Quote:
Originally Posted by WebDozer View Post
Brain MRI - "" the cerebellar tonsils are asymmetrically inferiorly extruded in the foramen magnum, 9.7mm on the right side and 5.1 on the left side""

Spinal MRI - "" Herniation of the cerebellar tonsils below the foraman magnum (8mm) ""

Maybe I'm missing something, but I don't see the contradiction. The two MRI's seem to be basically in agreement.

Hi, thanks for taking the time to have a look at my post. No you're not missing anything, I just think it was me reading it wrong. I think what confused me is that one mentions the different lengths on the left and right while the other doesn't.

"" what does 'with obliteration of the cisterna magna' actually mean? Is this normal or something to do with Chiari? ""

I read this as the radiologist saying the two are connected. It makes sense, as Chiari is an extrusion of cerebellar tissue, and the cisterna magna lies below the cerebellum. If you look at images, you can see that Chiari might or might not involve the cisterna magna.

I've had another look at some MRIs online and can see what you mean, I think it was the word 'obliteration' that made me nervous. it sounded quite scary.

One of the big problems associated with Chiari is that the cerebellar extrusion may block the foramen and prevent the normal flow of cerebrospinal fluid. Among other bad effects, this obstructed flow can create unhealthy pressure differentials which allow the growth of syrinxes in the cervical spinal cord. Your lack of syringomyelia would seem to make it less likely that the CSF is so obstructed.

This is what really confused me as the MRI of the brain (which I stupidly forgot to mention in my OP) shows 'Enlarged sella turcica with severe thinning of the pituitary gland (empty sella) and enlarged optic nerve sheaths suggesting intracranial pressure, which is what I've been told is hydrocephalus. I also have all the symptoms of both chiari and hydrocephalus so I was surprised that there was no syringomyelia found as the Neuro thought there might be. None of the MRIs were done with contrast so we don't know yet if the CSF is being blocked.

Let me warn you that I'm going out on a limb here and am certainly "out of my league", as it were. The neurologists and neurosurgeons are the ones you want to hear from.

I'd certainly like to hear what the neurosurgeon has to say, if you're willing to take the trouble...
I'll definitely report back when I see the Neurosurgeon.

The first Neurosurgeon I saw was a quick appointment to just review and briefly explain what chiari and hydrocephalus can cause but he didn't explain much of anything to be honest. He did though refer me on to a specialist centre, as it was another Dr who ordered the MRI (he was looking for possible MS) but I won't see again. The neurosurgeon didn't have access to the spine MRIs as they were taken because my rheumatologist was looking for arthritis of the spine.

Thank you again for your help, it's very much appreciated.

 
Old 10-06-2012, 03:39 PM   #4
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Re: Please help with MRI report

<< I've had another look at some MRIs online and can see what you mean, I think it was the word 'obliteration' that made me nervous. it sounded quite scary. >>

I'd assume - just to be cautious - that he meant for the word to be scary. Since the caverna is a cavity, if it's obliterated then that means it's completely filled up, and I'd assume that what's filling it is cerebellar material. So you have this material not only dropping down through the foramen, but also filling the caverna. Once again, just trying to apply logic to something I know VERY little about. If you see it differently, you are likely to be right.

As for the syringomyelia, I don't know that a CSF blockage NECESSARILY will cause syrinxes. Given the apparent cranial overpressure - attributed to a buildup of CSF - a blockage seems more likely.

Just speculating here, but I wonder if Chiari can be caused by overpressure - by a blockage of CSF - SOMEWHERE ELSE, and not in the foramen. That is, the buildup of CSF is pressuring the entire brain, and the cerebellum is the only part that has anywhere to go (down the foramen and into the caverna).

I certainly wish you the best. Not much you can do until you see the neurosurgeon, so no reason to dwell on it, although I know that's easier said than done.

Last edited by WebDozer; 10-06-2012 at 03:40 PM.

 
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