New, trying to understand MRI findings

[sdhill76]

Long story short, I started getting neck pains and headaches about a year ago. Went to PCP, had xray of neck, and was told I had the neck of a 60 y/o lady (I'm 32). So he diagnosed me with osteoarthritis, gave me 6 day round of steriods and pain meds.  It was a short term fix. Several months later pain returned and several more months later my stubborn butt went back to PCP. This time he referred me to an orthopedist.  They did another 6 day round of steroid, more pain meds, and had me go through physical therapy. Again, short-term fix.  So, per orthopedist request, I went back in mid Sept. to have an MRI of the cervical spine. Here were the results:

FINDINGS:  Sagittal images demonstrate mild cerebellar tonsillar ectopia with possible mild crowding of structures of the foramen magnum. In addition, a prominent CSF space is present posteriorly in the midline (image #6 of each sagittal series) which may represent either a mega cisterna magna, congenital variant or arachnoid cyst. The cervical cord is unremarkable. Mild anterior end plate spurring is present at C4-5, C5-6, and C6-7. There is no evidence of fracture, listhesis or destructive bony lesion.

Axial images were obtained from the bottom of C2 to the top of T1. There is no evidence of disk herniation or central or neural foraminal stenosis.

IMPRESSION:  
1.)  Early, mild disk changes at C4-5, C5-6, and C6-7. No evidence of disk herniation or central or neural foraminal stenosis
2.)  Mild cerebellar tonsillar ectopia with possible mild crowding of structures at foramen magnum potentially indicating the Chiari malformation. Prominent CSF space in posterior midline of posterior fossa which may indicate a mega cisterna magna, congenital variant or arachnoid cyst. Further assessment with complete MRI of the brain should be considered if not already obtained.

Now, having showed me the "dip" in my head on my MRI, the orthopedist said she couldn't tell me much more since this was only a scan of my neck, and she referred me to a neurologist.
Well, that particular neurologist she referred me to did not take my insurance, but they in turned pointed me to someone who did.
ONE DAY later, I'm seeing this neurologist.  In less than 15 minutes, after putting me on the spot and asking me a bunch of yes or no questions, and spending a few minutes to look at my MRI, he came back and told me he completely disagreed with the radiology report, and said to me, "You probably have a very small brain injury consistent with your head trauma 4 years ago, so small that only way we would see it would be to slice open your brain, which we won't do.  Your head trauma probably knocked this (he points to the back of the head) a little out of place and is what's causing the headaches.  You need to stop taking the pain medication and I want to put you on Topamax. Come back in 3 weeks and we see how you are doing."

That was one week ago.  Today, I finally got the Topamax (my ins needed preapproval), I took the first dose this morning, and I will not take another pill: the side effects were horrible!

I will admit, I do not fully understand the MRI report. But, the neurologist, in my opinion, was very rude, and I want a second opinion.  I mean, what is "Prominent CSF space" and "potentially indicating the Chiari malformation"???
Are these something that can only successfully be answered with the MRI of the brain? And how can that neurologist completely disagree with the MRI?

Just don't get it :(
~sonia
(sorry so long)

[lu7997]

I was in a car wreck and my pcp dx chiari but my NL felt as though it was post trama and nothing to worry about my herniation is only 4mm but my symptoms are bad.  He put me on Topamax and blew me off.  The side effects of the med are so much like the symptoms I was having it was hard to tell where one started and the other one ended so I stopped the med and aside from my original complaints doing better without it.  I sent all my images and reports to a CM specialist and hopefully I can get some better answers from him.  I suggest you do the same.  Most of the consolations are free and you would at least get a better idea where to start.


hope this helps Ange : )

[sdhill76]

Thanks for the welcome! And for your insight.
Whether or not I have the malformation, I agree, that NL (is that neurologist?) I saw was not interested in "me".  I understand sometimes it's trial and error with doctors and treatments (try treatment A, if that doesn't work, then on to B, etc.), but for him to just decide to put me on a powerful drug after just 15mins with me, that I have problems with!

Good news is that I did find a NL on my ins plan that, after reading his profile, seems to care about his patients and is a dr that has "...longstanding interest in neuroimaging techniques of MRI and CT."  I don't know if he (or any of the other docs in the practice) has knowledge in Chiari malformations, but two things stood out:
1) The receptionist that returned my call this morning said that he is VERY meticulous with his patients and that I should expect my first visit to be at least 45mins and could even run over into someone else's appt because he REALLY wants to get to know his patients.
2) His interests in neuroimaging techniques makes me feel like he'll at least want to do more scans (as the radiologist recommended).

I've got an appointment with this new NL in 4 1/2 weeks.  And I feel more confident going into this.

And, I've started keeping a pain journal so hopefully (if I stick to it)  I'll have a comprehensive month long report of my pains!

Wish me luck!!!
~sonia

[selmaS]

Hi and Welcome to the chairi forum.

Sonia, many of us get conflicting reports when we see a NS and not one that is a chiari specialist.....

I can not speculate on what ur dr meant by the  prominent CSF space or potentially indicating chiari......All I can say is I feel u were with the wrong dr for u and this condition.

If I were to assume, the term mild could mean that ur herniation is under 5mm and that is y the term potenially chiari is being used...too many look at the size of the herniation to determine ifit is chiari, when it is chiari if the skull is too small and misshapened....it also mentioned overcrowding, so that could mean a CSF blockage....not sure if that is what is meant by prominent CSF space....

First off a NL will dx and then u go to a NS...so find a chiari specialist and let them read ur MRI's....

Hang in there Sonia!!
"selma"