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1068422 tn?1293684253

MRI - Questions

Hi...

I have some questions in regard to a spinal MRI with and without contrast.
This will be rather lengthy so get a cup of coffee!  I hope someone understands what all this means.  I have not have my follow up with my Neurologist yet, it will be several more weeks.  They did call and requested that I take 2 Tramodols every four hours.  I have not been complaining about my pain.  I have just been sucking it up.  I guess they did not like that.  They did not explain anything however.  Here is the list.

Cervical Spine:
Negative for acute bone marrow edema.  The heights of the cervical verebral bodies are quite well maintained.  The disc heights are intact. Negative for syrinx. The cervical cord is unremarkable. Negative for Arnold Chiari Malformation. There is no abnormal enhancement with contrast material.

At C1-C2, the relationships are well maintained. At C2-C3 there is no signifcant compromise. At C-3-C4, there is minimal right exit foraminal narrowing, more markedon the left. At C6-C7, there is mild left exit formaminal narrowing. At C-7-T1, there is mild left exit foraminal narrowing.

Impression:
1. At C3-C4, There is minimal right exit foraminal narrowing.
2. At C5-C6, there is mild bi-lateral exit foraminal narrowing, more marked on the left.
3. At C-6-C7, There is minimal left exit foraminal narrowing
4. At C7-T1, There is mild left exit foraminal narrowing.
Negative for disc herniation at any level studied. Negative for significant disc/osteophyte complex.

Lumbar Spine:

The vertabral body heights and marrow signal are within normal limits.

At L1-2, L3-4 and L5, the disc heights are maintained. There is normal disc hydration. Mild facet joint and ligamentum flavum hypertropy is noted at the L3-4 and L4-L5 levels without significant lateral recess or formaminal narrowing. No nerve root impingement is evident.

At L5-S1, there is preservation of the disc height, but diffuse disc desiccation. There is broad-based posterior disc bulging without evidence of focal disc herniation or central spinal stenosis. Minimal facet joint and ligamentum flavom hypertropy are noted without significant lateral recess or forminal narrowing. No nerve root impingement is seen. Incidental note of a Tarlov cyst at the S2 level on the left. The marrow signal within the sacrum is unremarkable. The visualized portions of the S1 joints appear normal.

Impressions:
1. Mild degenerative disc disease at L5-S1. No disc herniation, spinal stenosis or nerve root impingement.
2. Mild lower lumbar facet joint DJD and ligamentum flavum hypertrophy without significant lateral recess narrowing or foraminal narrowing.

The end.

okay..so why did they make such a big deal out of this. Yes, I do have pain but I thought everyone does?
As a side note, I have a neurogenic bladder (ISC) and neurological problems..that is "why" I am seeing a Neuro.
legalgirl
6 Responses
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1068422 tn?1293684253
Hi again!
Yes I have to agree with you the past couple of years have been pretty bad. I would love to have the chance to rewrite the past few years of my history! If I am not mistaken it would have something to do with hiking in to my favorite fishing hole and camping for a year!

The Rheumy I saw...was a quack (my opinion) but I have to give him a kuddo for getting me heading towards the right people. When I arrived in his office my left hip had been in what I call the cramp from ...well you know what I mean! The hip comes on when it wants and it is sudden.  It can last from a week or two to months.  This particular time I had, had it for over two months. By this time my entire body was exhausted and I had muscle cramps all over from compensating for the hip. So when he touched me I hurt.  He immeadiately diagnosed fibromyalgia.  He claimed that Klonopin would cure it.  He sent me home with it and I got so much worse.  When I went back for a follow-up is when I had the seizure.  Needless, to say after he told me I do not have osteopenia I knew he was crazy.

I think the Neuro thought I might have it because it was on the medical record from the goof ball.

Immeadiately after I saw a new Neuro for the first time. She was very concerned with the seizures because they were out of control. It has taken us a year to find the right medications due to allergies and sensativities. I was just given my drivers lisence back and now after this SSEP nightmare I have lost it again for another year. I have to admit I am pretty ticked about that.

Thank you for the link to the Tarlov Association.  I am still a little confused about what can be done about it.  Sounds like not to many Doctors want to do anything with it or do not know how.

Thanks for the heads up on the Tramadol.  I take it from your response that it might induce seizures.  Maybe that is why I am having so many jerk type of seizure now.  I thought it was the effects of the SSEP.

I decided yesterday to quit being a baby and let the nurou do the lumbar puncture.  I went down and requested a copy of my brain MRI that was done a year ago and I kind of understand her point now after doing some research.  I am a little confused though why there was no sign of lesions if I have MS on my spinal MRI.

Anyway, Thank you so much for all of the information and encouragement.  I have been in need of both.  Your knowledge is appreciated!

Susie
Helpful - 0
Avatar universal
Sounds like you’ve been through holy h*ll. I had to think a little bit about your posts before I replied. I agree with Helen in the sense that there’s has to be more than 1 thing at work here. How would you rate the competence of the Doctors you’ve been seeing, because some of their actions are questionable at best?

Did they give you a tender points test when they decided you had Fibromyalgia, and why didn’t they send you to Pain Management? There isn’t a cure for it, but they generally do treat the symptoms. I think its great you didn’t buy into that diagnosis.

And increased reflexes can be due to: Corticospinal tract disease, hyperthyroidism, anxiety and many other things, and why in world would they prescribe you Naproxen, it’s an NSAID generally used for fever and inflammation?

I think some of your upper extremity pain could be of cervical origin, just because the MRI says mild/minimal doesn’t necessarily mean it is. I know this from personal experience. The Tarlov cyst finding is something I think you should really look into, because the symptoms it can produce are very similar to what you’re going through.

If you get frustrated with your Doctors, you might want to consider looking for a good Teaching Hospital, there are Neurology Departments within these hospitals that live for cases like yours, and this is also where some of the best minds can be found.

One more thing, if you are predisposed to having seizures, I don’t think it’s a good idea to be taking Tramadol. I could be wrong, but please check it out with your Doctor. There are plenty of other pain-killers they can give you.

Take Care


Here’s a link to a Tarlov cyst site:

http://www.tarlovcystfoundation.org/TarlovCystInformation.asp

Helpful - 0
1068422 tn?1293684253
Helen,

Hi...Thank you for responding!  I appreciate it.

My neurologist has been working so hard to try to figure everything out.  I have to give her a lot of credit!

Her first priority has been to find the right medication and dosage to control my seizures.  We have been working on that for over a year.  I think we have finally got that under control!!

Over the past year she has seen different issues when I have arrived in her office.  Some I was not aware of and others I knew.  She has tested me for Lyme, Lupus, Myasthenia Gravis and to be honest..I am not sure what else.  I know I am paying payroll for all of the local doctor offices and hospitals.

Not sure if I said something or not...But she became suspious of MS early on.  I believe she was trying to "rule" everything else out first.  Then, I got H1N1 and spent 10 days in the hospital. While I was there I had a quack that believed I had lung and bladder cancer.  He claimed he had done testing and it proved I would be dead before Christmas.  Keep in mind he made this claim on December 1.  What a horrible Christmas we all had this year. Needless to say, I could not see a urologist until January.  She is also a cancer specialist.  She proved that I "do not" have bladder cancer.  However, she found other benign issues.  She made an appoitment with a neuro urologist for three months later.  In the mean time I was seeing a pulmonologist for the "lung cancer".  He did not believe I had it..He thought it was left over from the H1N1.  Two weeks ago, I found out that my lungs are perfect on a follow-up with x-ray!!

In the mean time my neuro backed everything off..she was waiting to see how things went and trying to let me recover mentally from all the chaos and terror.
I saw her three months ago and she kept saying MS. She wanted to do a spinal tap and I said no out of fear..so she scheduled an SSEP and an MRI of my spine because I have severe hyperreflexia.

I have always had basic lower back pain..sometimes worse than others but nothing I felt was horrible. My neck has always been stiff and does not like to go towards my chest.
One week after the MRI a fill-in Neuro called here all excited and hyper.  She wanted me on pain pills asap.  She wanted 2x4 a day.  I took 3 a day and felt pretty good.  I started cooking again and cleaning the house.  My fear became...what is this?  Are we going to go off track again? Chasing something else?

Then they did the SSEP....Oh geez what a nightmare.  My right side showed hyperreflexia.  The left side went crazy and started a grand mal seizure, right there is front of everyone.  That was the most painful experience.  I thought my body was on fire.

After the SSEP, I developed severe pain in my neck, shoulders and lower back.  I went up to 2 pills every six hours.  My diagnosis of the SSEP: I think I got hurt during the seizure.
I am now using heating pads which seem to help.

I have not received the results of the SSEP.  They will not be in for another week.  I have not seen or spoken to my Neuro since my last appointment three months ago.
I wrote to this forum because my diagnosis of the MRI was .....so what?  I did not see anything that bad.  But hey, what do I know!  The Tarlov cyst does have me intriqued as I have had pain there for years.

I guess...I am just sick of being sick and sicker of tests and wondering.  I think given time to calm my body down after the "fish out of water" experience during the SSEP that the pain will calm down.  

I want to thank you all for responding and confirming my toughts on the MRI...I am just not sure what the fill-in thought; she saw?

Oh...I scoped out the web page you suggested.
My hip pain only extends to just above the knee...more on the thigh and comes and goes at will.  I usually have a month maybe two or three of no pain at all.  Then I pull the cain back out.

Thanks so much,
Susie
Helpful - 0
1295655 tn?1272467246
As you have a whole bunch of problems it could be that there is more than 1 reason behind them. What happened to the MS diagnosis?
With regards to your MRI scan, Kalvin says it all.  However your lower spine results show nothing that could give rise to any of the symptoms you have. Neurologists don't look at the pelvic area as all nerve pain and problems stem from disc impingment in the spine. NOT TRUE ! ! You tube Dr's George Best and Aaron Filler for an explanation on piriformis syndrome (PS) and pudendal nerve entrapment. Your problem with stairs, pain in the butt, pelvis and 'paying' for activity for a couple of days so ring true with a PS diagnosis. I have it and would advise you to google symptoms to see if you can see any similarities.
I don't have your upper body issues at all and like you I am not an avid fan of medication but I have had to succumb. Not being able to sleep properly gives you more problems so it's a balance really.Hopefully you will be able to stop taking tablets when your diagnosis is sorted and your problems can be resolved. If you are strong enough to suck up the pain (I can identify) you will be strong enough to become 'un hooked' if necessary.
One med for seizures, Gabapentin, can also be used to help nerve pain, ask your doctor about it. It is often prescribed with an anti depressant, which really just give you an extra coping mechanism.
I now take them all including tramadol, and although still in pain it is just more managable.
Read your last post again and would def check out PS the heavy leg thing. . having to lift to climb stairs, get into the car etc could be PS.
Take care
Helpful - 0
1068422 tn?1293684253
Hi...

Thanks for responding!

The cause of all of this goes back to when I was fifteen and ejected from a jeep at a high rate of speed. I lived in a little town and the care I received was poor (just to be nice).

Four years ago, I started getting intense pain in my left hip.  I was dragging my leg and unable to think.  I saw a Doctor who gave me a total of five cortizone shots into the hip.  The first one lasted a week and the others even less time.  The doctor finally said do not come back for these, they are not helping.  I started seeing a massage therapist who said my entire body was spastic.  She never made any improvements.

I use to fish, garden, hike, quilt, garage sale and go-go-go. For a long time I continued to do them.  For awhile (sucking it up) then with an analgesic (Tylenol, advil, doans, asprin) and then another, eventually I just quit taking them.  In the past two years, I gave up all of my hobbies.


Last year things became very bad.  I got to where I could not climb the stairs without picking up my left leg with my right or just draging it up, while I hanged onto the wall.  I went in to see my Primary who know's me..She flipped out and sent me to a rhuematologist.  He took one look at me and said...you have Fibromyalgia.  I had never heard of it..He explained it and I thought..no way..He took me off my mirapex added Klonopin (miserable) and sent me packing.

The pain began to worsen and at one point, I was crying and begging my doctor to help me.  She said it is just fibro and you will have to adjust and get use to the pain. By this time my ability to urinate was almost gone..I thought well maybe that has something to do with all of that?  So, I began to suck it up even more.

Before long, I was walking with a cane  (off and on) and getting worse by the day.  I had a follow up appointment with the Rheumy who thought I might need an anti-depressent.  He touched my left leg rather strongly and I had an immeadiate Grand-mal seizure...Afterwards when I was kind of with it..he said we should leave and maybe go to a hospital.  He said he could not help me.

My primary flipped again and sent me to (a) my Neurologist (she is pretty great)!  She did an MRI and said I have old damage to my temporal lobe.  I told her about the pain and she said I have fibro.  I told her no, I dont.  I was put on seizure meds and appointments were lined up.  I started having worse problems and then she got worried as she watched me go down hill. So we started a massive search.  I am so sick of tests, I could scream.

In the meantime, I got H1N1 and ended up in the hospital fighting for my life for ten days.  I got "caught" on my ability to urinate and they sent me to a urologist.  More tests.  They found that I have a neurogenic bladder and it was much worse than they thought.  I only have 40% functunality of my bladder.  So now I cath.

In the mean time My Neuro was leaning towards a diagnosis of MS.  So she sent me in for an MRI of my spine. Reason for MS was so many syptoms and sometimes they were worse than others.  I never brought up pain as I did not want to hear about fibromyalgia again. So I sucked it up some more. I also had three dymelating spots in my head? She had also tested my leg reflexes and I almost kicked her in the face.  She was blown away by that.  I have no idea what the relavence is as my reflexes have been that way for a long time. I had also developed severe tremors in my hands.

By this time, I quit shopping.  If I went I would "pay for it" for two to three days. Basically, My life has just stopped. My husband wants to sell our beautiful home as he worries about the stairs. Side note: I began having memory and speech difficulties as well as swallowing. Numbness in my arms, legs and pelvis, face pain under my eye, going towards my nose and heading for my upper teeth ...sometimes running towards my right ear.  I see a dentist all the time and he says I am good. Vision has become a problem with constant sparkles and blurred vision. Migraines that alomst never stop. A bunch of other stuff too..but it is time quit whining. So off to get an MRI I went....By the way...I tried to not whine to my neuro.

Anyway...My Nuros office called (Dr. on call) and she was excited and put me on Naproxen.  I ate before.... all the stuff she said.  I could not sleep unless I was sitting up and my stomach burned like fire.  She took me off that and switched me to Tramadol.

The fill-in...sent me in for an SSEP.  That was a NIGHTMARE. That was the most painful experience of my life.  I swear I could feel every volt travel at "Burning" speed throughout my body.  I wanted to scream but did not.  Then he moved to the left side..My reflexes kicked in and boom..I had a full-blown seizure in his office.  I am a little ticked because I was doing good with what I call the "jerks" and seizures... they were also letting me drive again (1 year no driving).

So..Now I am waiting for the results of the SSEP.  I am also waiting to see what my Neuro says about the MRI.  I see her next month.

In the mean time...I only take half the dose of tramadol as I am afriad I might get hooked.  That's all I need. However, after the SSEP "experience" I have had to take the reccomended dose as I cannot sleep, sit, or walk without the pain being much worse.

I have pain in my neck, shoulders, upper back, both feet, left leg and especially the butt and hip.  Pain in my right wrist and arm to elbow. Numbness everywhere including my pelvis and pain in the pelvis bone. I have serious pain in my lower back and tailbone area.  I dont know...I keep thinking I just need to fight through the pain.  When I get that idea and do it...Man, I get so bad I starting getting dumb thoughts..Until I think about those I love and how precious life really is.

Thanks for responding.  Sorry this is so long.  I emitted a bunch trying to not bore you so bad.

Thanks,
Susie (legalgirl)



Helpful - 0
Avatar universal
The Neurologist is going to love you, a patient that doesn't complain. That's a rarity.  

Here's my thoughts on your reports.

Cervical Spine
You have minimal/mild foraminal stenosis pretty much from C3-T1. The type of symptoms you would get from this would be possible neck and facial pain, headaches,upper back and shoulder pain possibly traveling down your arm into your hand with tingling and maybe some numbness. I have no idea what type of pain your experiencing, and it could very well be that your condition is not serious enough to produce any of these symptoms, because every level is either minimal or mild. If you are experiencing some of these symptoms, they can probably be resolved by conservative treatments.

Lumbar Spine
You might be getting some discogenic back pain out of your disc bulge at L5-S1 but aside from that I don't see anything that's that bad..

This Incidental note of a Tarlov cyst at the S2 level on the left correlates with your neurogenic bladder problem, It can also cause a lot of pain in your back and legs. But it might not be related at all, what other neurological problems do you have?

And yes, we all have pain, but some of us complain a little more than others.

Take Care

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