Brainstem looks crooked?

Question

This MRI was done in 2013. According to the Radiologist, it was "unremarkable" I have a Neuro appointment next week, and just received my 2013 scan to give to her. I was reviewing it, and noticed this weird looking brainstem. Does it look strange to anyone else? I am going to point this out to her due to increasing symptoms over the last 3 years.

selmaS · Answer

lol.....cute....

Not surprising Drs do not know about the MRI's and implanted metals, as we all have found out there is much about Chiari and related conditions they do not know....

 WOW all that has to be done, ,but the fact is it can be done,,,,,thanks again for sharing this in-sighted info.

The_beat_goes_on · Answer

There are some doctors who don't know they're safe ... my GP included.   I forgot to mention that older pacemaker / icd implants do make MRI impossible.  Medtronic brought us the first MRI safe pacemaker and now I think they are the norm from all the big makers, which is awesome considering our medical advances and the benefit of MRI (especially as we age)  ... but not available to those needing a replacement pacemaker / ICD.  It's the leads, too, which are kind of barbed into your heart and dangerous to remove.  Before my first one, after having a cardiac implant ... it was the biggest hassle.  they had to xray everything and make sure the serial numbers on the leads and device matched my card, and were safe.  I do sometimes feel like ... static electricity, but usually just once or twice in the beginning.  Things can heat up, too, I can only use a 2.0 tesla MRI machine ... and not all hospitals will even do it.  With my implant they have to have a crash cart and medtronic rep there to put my device in a special mri MODE, and then back when it's finished ... and with the shunts ... also have to reprogram those after each scan.

My niece asked me if I was a robot.  Pretty much! ;P

selmaS · Answer

Thanks for the info....I was not aware of that as some have said they could no longer have a MRI due to implanted metals....so confusing.

 Thanks again.

The_beat_goes_on · Answer

they can do an mri with most fixed or implanted metal ... I think the only exceptions / contraindications are maybe aneurysm clips and shrapnel?  you just have to tell them what you have and where so they can note artifact ... I have some PFM crowns on molars, an mri safe pacemaker, and two shunts and the artifact is almost like ... sunbeam-ish? But maybe different metals cause different artifacts ... I found this :

http://www.medicinaoral.com/pubmed/medoralv14_i6_p278.pdf

and it looks like metal braces cause signal loss ... so maybe. Good luck with your new scans! let us know what you find out!

selmaS · Answer

Oh ok...and they still did a MRI? I thought they couldn't do it if you had any metal.....hmmm....even still I do not think an artifact would cause the look you have in the above MRI picture....

orchidfae · Answer

I had full metal on the bottom, and ceramic with metal wires on the top teeth. Metal bands went around my molars also. I will make sure I get all the reports and disk for sure!

selmaS · Answer

When you go for these tests....request you get copies of the MRI's on disk and a copy of the report sent to you.....

 Until more testing is done there is no way to know what is going on....

 May I ask what kind of braces did you have that could have caused an artifact on your last MRI?

orchidfae · Answer

So, I had an online Neuro look at it a few days before my appointment today. He said to him it looked like vertebral artery compression of the Medulla, and to get an MRA. My Neuro today didn't look at it, but said maybe it was artifact from the braces I had at the time. She ordered these tests for next week:

MRA Carotids Neck WO Contrast
MRA Head Routine WO Contrast
MRI Cervical Spine WO W Contrast
MRI Head WO W Constrast
MRI Thoracic Spine WO W Contrast

She officially diagnosed me with Intractable Hemiplegic Migraine with aura without Status Migrainosus and Hemifacial Spasm. She made sure I understood that I wasn't to take Imitrex with the kind of migraine I have. Raised the dose of Amitriptyline and added Fioricet for my abortive. 

Mentioned some symptoms I had sounded like MS Hug, but wants to rule things out, and first on list is lots of bloodwork and the scans, then we will go from there. Next appointment with her is in October.

selmaS · Answer

Something I found out when getting MRI reports....the radiologists most of the time may report an " all clear" if what they were told to look for they do not notice....that is not to say something may be there and not being mentioned.....and some will go above and beyond looking and report every little thing they notice....and then on the flip side many NS's do not read the reports prepared by the radiologist and like to give an opinion themselves as to what they feel is going on.....so, you have to get a few opinions , educate yourself to know when you have the right Dr for you.....

The_beat_goes_on · Answer

Do you have the report?  does it mention artifact or anything?  did you ask your primary what they thought?   Primary doctors can be a great sounding board.

orchidfae · Answer

Hi Selma, I looked at my scan again, and it is shown from the view that looks from the top of skull down. This MRI was taken in 2013 and Radiologist told my primary that this was totally clear, absolutely nothing abnormal. My first neuro appointment is this Thursday, so hopefully I have a chance to get her opinion on it. I wonder if it was misread

selmaS · Answer

Well with anything compressing the brain stem like that no wonder you have migraines.....but they have a source...what ever that item is.....

 Do point this out to your Dr if it is not mentioned to you.....and then please let us know what you find out

orchidfae · Answer

Only other diagnosis at this point is Hemiplegic Migraine. Having some other symptoms, pins and needles, pain with the weakness on my left side limbs, it goes on. So this naturally worried me to see what looked like something going through

orchidfae · Answer

Saw it in other scans that showed this view. On the sideview I don't see anything like this. Should I point this out to my Neuro?

selmaS · Answer

Hi orchidfae and welcome to the Chiari forum.

 I too see something as it should not be.....but I am not sure what it is as I am not a medical professional and not use to looking at this particular view.

 Some possibilities are a retroflexed odontoid and baslaar invagnation....again not being use to this view I am not sure what it might be.....but compression of the brain stem is not good regardless of what it is.

 Do you have a Chiari specialist helping you? Do you have a Chiari DX as well?...Any other related conditions?

lasel22 · Answer

To my untrained eye, this mri does look strange. It seems like something is pushing into the brainstem from the right side (probably actually your left, but the right side of the mri itself). My images did not look anything like that. Do the other views, axial or sagittal, show that strange black thing poking into the brainstem?