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MRI of the brain report came back
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MRI of the brain report came back

Well I have no idea what all this stuff means.  Most of it, I gather, implies there is diminished CSF flow, but they were unable to give 100% accurate results.  So I am going to post the results here and would love any and every opinion of what you read.  I know Dr. Heffez will thoroughly explain all this May 5th, but I want to have an idea of what is going on NOW---LOL--

Here it is:

Normal flow void is
noted within the imaged intracranial vascularity.

As mentioned above, flow analysis with specific measurements of CSF flow
velocity and duration of flow during systole and diastole could not be
performed. The sagittal phase contrast images were obtained using velocity
encoding parameters of 3, 5 and 10 cm per second. Limited analysis of these
sagittal images demonstrate no obvious asymmetric flow jets however, there
is suggestion of slightly diminished flow just posterior and inferior to the
cerebellar tonsils as compared to flow demonstrated within the subarachnoid
space ventral to the medulla and ventral to the upper cervical cord. This
particular depiction suggests probable decreased velocity at least dorsal to
the upper cervical cord and, again, below the cerebellar tonsils below the
foramen magnum. This particular finding can be seen in association with
altered flow dynamics below the foramen magnum in patient's a Chiari I
malformation. Obviously, sensitivity is diminished without benefit of
ability to perform specific velocity measurements as described above.

IMPRESSION:

1. Chiari I malformation with tonsillar ectopia as outlined above.
Inferior cerebellar tonsils project below the foramen magnum approximately 7
mm. There is minimal crowding of the posterior fossa.

2. Very limited CSF flow analysis because of lack of software necessary to
perform specific CSF flow velocity and waveform analysis. Gated phase
contrast images obtained in the sagittal projection, however, suggest
diminished flow related signal dorsal to the upper cervical cord as well as
below and dorsal to the inferior cerebellar tonsils. This pattern can be
seen in association with altered flow dynamics (particularly during systole)
below the foramen magnum in Chiari I patient's.
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1265199_tn?1271877477
Sorry, I forgot the first part of the report!  Here is what was listed BEFORE what I posted above:

MRI OF THE BRAIN WITHOUT GADOLINIUM 4/16/2010:

HISTORY: Spina bifida with hydrocephalus.

Multiplanar noncontrast T1- and T2-weighted whole brain images were
obtained. FLAIR axial and diffusion-weighted axial whole brain images were
also obtained as well as gradient echo T2-weighted axial images. Phase
contrast sagittal MR images of the brain were also obtained to depict CSF
flow.

FINDINGS:

Unfortunately, software is unavailable to specifically performed CSF
velocity measurements or to ascertain CSF flow waveforms during systole and
diastole.

Sagittal images demonstrate tonsillar ectopia. Inferior cerebellar tonsils
extend below the level of the foramen magnum approximately 7 mm. There is
suggestion of perhaps mild crowding of the posterior fossa. There is no
evidence of compression of the inferior cerebellar vermis or the cerebellar
tonsils, however. There is no evidence of kinking or displacement of the
brainstem. Prepontine cistern as well as CSF space ventral to the medulla
appears grossly normal.

There is no evidence of associated hydrocephalus and no syrinx is identified
within the cervical cord at least to the level of the inferior endplate of
C3.
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1179332_tn?1297482590
Ok, I have taken medical terminology in the past so I will give this my best shot..

So I think it is saying that you have normal flow within your brain brain vessels but that they have noticed diminished flow around the area of the herniated tonsills. They are comparing the flow at the posterior (back) or your skull to the area at the front (ventral) of you skull probably at the foramen magnum region. It's alot of medical jumble but what it is saying is that they have seen a decreased flow around the CM1 formation compared to your flow on the other side..

I would think that confirms that Chiari is causing your problems, even though they say it it is slight and there is no asymmetric (not the same on both sides) flow jets...I think the fact that they picked it up without the neccessary software..that there is something there. I would think that Dr. H will agree.

For info: the subarachnoid space is the space inbetween the 2nd (arachnoid) and 3rd (pia mater) layers of your brain and that is where the CSF flows. Also, they are seeing more of a diminished flow during your systole (contraction phase) of your heartbeat which would make sense as that is when the blood is being pushed through. Also, they are saying there is minimal crowding at the back of your skull (the posterior fossa is a depression at the back of the skull (near the base) where the cerebellum sits).

I can get into more if you like, just let me know what else you want to know. In any event it definitely warrants further investigation.

Good luck on the 5th
Carolyn
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1179332_tn?1297482590
Ok I just read the rest...pretty much says the same thing. Other than, they are saying that they can't actually see any crowding of the tonsills but they still think it could be blocking the CSF flow to a slight degree. Also, seeing as they don't have the right equipment to actually pick up the velocity, again, they still see something. No syrinx up to C3 but that doesn't rule it out as many have had it lower than that. So it is good that you will be having a work up with DR. H..I'm sure he will do all the necessary tests. At the very least this test gives you some validation that there is something going on.

Take care!
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1265199_tn?1271877477
Thank you so much as your explanation I could actually undertand!  I was also sorta thinking along the same lines as you stated regarding they still see something, even w/o proper software and the syrinx can happen below C3.

And yes, if you have further analogies, then by all means share your knowledge :)  Plus it will help others with similar findings :)

THANKS
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1179332_tn?1297482590
LOL..that's the thing with medical terminology...when your first look at paragraphs like that, your head starts to spin. But that is what they teach you, to break it down, and then it is a lot easier to understand :)

Any word or anything else you would like to know, feel free to ask!
Carolyn
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1041839_tn?1278685446
I agree with carolyn's analysis. Good job! Also, i wanted to let you know that dr. Heffez will explain everything to you! On mine the slice he kept going back to was the one that looks like you were inside the skull and coming out through the foramen magnum. Thats where my blockage is and showed up the best. He would explain part of it then look at me first, then my husband to make sure we understood. He even broke it down and compared it to a water hose for my husband lol Anyway just wanted you to know he is very easy to talk to and very thorough, and gives you plenty of time to ask questions. He spent almost an hour and a half with us! If you have any questions just let me know! Blessings ~ Shannon
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1236570_tn?1276742125
I can help you break down some of the terminology also. I'll just give you the meaning of some of the words, I don't want to "interpret" the report though. I'll leave that up to the NS.

SAGITTAL  - is kind of like a long ways slice up and down. Like the typical MRI picture we often see that has the profile of you forehead, nose, lips and chin
VENTRAL - the front of the body (the belly)
DORSAL - the back of the body (like a dorsal fin of a shark)
POSTERIOR - behind (this usually refers to a structure and not necessarily to the body)
INFERIOR - underneath (this be in reference to a structure OR in relation to the whole body, meaning toward the feet
CEREBELLAR VERMIS - a structure within the midline of the cerebellum
MEDULLA - Part of the brain stem that is located just in front of the cerebellum
PONTINE CISTERN - A space located in front of the Pons (which is part of the brain stem that sits on top of the medulla

It's all latin word part. Like Carolyn said just break everything down into word parts. Any other specific questions feel free to ask.
Hope this helps a little.
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1265199_tn?1271877477
You have all been very informative and very helpful.  I am very confident in my choice of Dr.Heffez and so look forward to my appt w/him.
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