How are you? I'm sorry I haven't been on in awhile.. I have been waiting for my appointment with The Chiari Institute in NY which is scheduled for March 10 & 11th. In the mean time they requested I have a CINE MRI... I live in MA so to cut costs I had it performed here.. I just picked up the report and I am very confused by it...
It reads the following:
There is a borderline low lying cerebellar tonsil on the right extending below the foramen magnum 6 mm. (previously reported 8 mm) On the left, the cerebellar tonsil is within normal limits??? There is mild crowding of the posterior fossa structures without significant compromise of the foramen magnum. CSF pulsations are noted around the foramen magnum.
Incidental note is made of a T1 and T2 hyperintense focus at midline in the posterior nasopharynx measuring 6 mm in diameter.
Borderline low lying RIGHT cerebellar tonsil. The left cerebellar tonsil is unremarkable. There is no significant compromise of the foramen magnum. This does not completely meet criteria for a Chiari 1 malformation. Incidental tornwaldt cyst.
So I have had at least 4 MRI's of my brain and not one has said only my right cerebellar tonsil is low lying. Has anyone ever heard of this? Will this take away my DX of Chiari? I have all of these symptoms and finally thought I was on the road to answers no I don't know what to think.
Does anyone have any feedback? It would be greatly appreciated.
I know it is not uncommon for them to asymetric. I dont know how they treat that. I had one person tell me that they might average them? Not sure! I am assuming they have seen your scans already at TCI? I dont believe they agree to see anyone they dont think they can help. Do keep in mind that the size of the herniation is not important it is whether there is csf blockage or crowding.
I also had the thornwaldt cyst... that is crazy. I went to the ENT to make sure and it was nothing to be concerned about unless it grows...which usually doesnt happen according to the ENT that I saw. I also think alot depends on the views and who is doing the measuring. So try not to worry.
Hi Krista....no worries...I had one tonsil at 6mm and the other at 4mm...it is possible for the herniation to be asymmetrical and not bilateral.
Keep in mind this report is the opinion of the radiologist and most NS's will look at the MRI's and make their own decisions ....
Chiari is the malformation of the skull....the herniation is the result of the malformation and lack of space....the Drs at TCI may not find u a surgical candidate if u do not have CSF obstruction and or overcrowding.
This states u do have crowding, and pulsations of the CSF.....the pulsations of CSF is an indication that ur CSF is moving with the BP...showing there is some restriction to normal flow.
This along with ur symptoms and ur quality of life is what ur drs will use to determine if in fact they feel the benefits of surgery out weight the risks.
I'm surprised they didn't mention whether your CSF flow was normal or not considering that is the point of a CINE MRI for chiari. I would call and see if you can get some explanation from the radiologist because it is indeed odd that this is so different than 3 other MRIs. Also, I'm pretty sure having any herniation of the tonsils at all meets criteria for Chiari even if it isn't a classic case. People do often have one side of the tonsils that is herniated differently than the other.
Anyway I wouldn't worry about it because at the Chiari institute I'm sure they'll want to see the film for themselves and they'll know how to interpret them correctly.
Thanks so much for taking the time to respond to my post. You guys make a good point... In order for me to even get the appointment with the Chiari Institute I had to mail them all of my reports and discs. They have seen my past images... I am just so nervous about this appointment and then to read this report.. It just added. I'm not sure what TCI will say or if they can even offer me help but I'm desperate to feel better. Have any of you gone to TCI?
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