Problems with neck

I first posted a note on the forum on March 26, 2004. The Doctor responded on March 28, 2004. This question is a continuation of the March 2004 note with additional information added. If the two notes could be connected that would be great.

I had an MRI of the brain. The results are as follows:
1. There is a 5mm lacunar infarct adjacent to the frontal horn of the right lateral ventricle.
2. Incidentally noted is some fluid in the right mastoid air cells.

What would cause this in the brain? I do not have high blood pressure and my sugar levels are great. Does this have anything to do with my neck and facial paresthesia?

I still am having all of the symptoms of my first note. In frustration I am now seeing a acupuncturist. He said that there is a lot of inflammation at the site of the cervical protrusion and at the C1 & C2 level. I am guessing that all of the inflammation in the neck is causing my facial paresthesia. I also continue to have difficulty swallowing when the neck muscles tighten. What do you think? Also, what are possible causes of the inflammation in my neck? While the acupuncture is helping with fatigue for a day or so my main symptoms are not going away. Are there any tests to check for inflammation? How does the inflammation effect the nerves and muscle tightening?
Any additional information would be helpful and appreciated.

Thank you so much for your time. I have tried unsuccessfuly to get on to the Neurology Forum.

[Kevin Pho, MD]

To answer your questions:
1) A lacunar infarct are small deep cerebral infarcts located mainly in the basal ganglia and thalamus but also in the brain stem, internal and external capsules and periventricular white matter. They are most likely due to atherosclerotic occlusion of perforating branches, and less likely due to small emboli.  It may be possible that your symptoms can be related to these.

2) "Inflammation of the neck" is a vague description.  Simple muscle strains or muscle spasms can cause inflammation of the neck.  Various rheumatological disorders can also cause this.  There are some small studies suggesting that acupuncture may help - but there are not enough studies to give consensus recommendations.  Tests to check for inflammation can be an ESR (sedimentation rate) as well as a C-reactive protein.  Both are blood tests.

3) Inflammation may be related to muscle spasm and tightening.  This can subsequently compress and irritate nerves, giving some of the symptoms you describe.  A referral to a neurosurgeon can be helpful in seeing if any type of nerve compression is present.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b