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MRI Question - What Am I Looking At?
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MRI Question - What Am I Looking At?

I have recently been DX with symptomatic Chiari Malformation (6.8mm herniation) with a small syrinx at the level of the C2 vertebrae.  I am in the process of waiting to meet a neurosurgeon to discuss my options.  in the meantime, I went for a thoracic/lumbar MRI to rule out additional issues lower in the spine, such as Tethered Cord or another syrinx.  Here is the MRI report:

MRI: INTERMEDIATE SPINE 2 ADJ.SEG.4 OR MORE SEQU.

Findings: Examination is slightly limited - secondary patient motion. From C7-T1 to L3-L4 there is no disk protrusion, spinal stenosis or significant foraminal narrowing. At L4-L5 there is a disk bulge with no focal disk protrusion. Borderline degree of central spinal stenosis. No significant foraminal narrowing. There are mild changes of the facet joints. At L5-S1 there is a disk bulge with no focal disk protrusion or spinal stenosis. No significant foraminal narrowing. Suspect bilateral spondylolysis with no anterolisthesis. Alignment of the thoracic and lumbar spine is normal. There is mild anterior wedging of T7 vertebral body of approximate 10% loss of height. Vertebral body heights otherwise well maintained. Signal intensity spinal cord is normal. Conus is normal in appearance terminating at the level L1. Note is made of a small hemangioma in the T10 vertebral body level measuring up to 1.2 cm.

Impression: Mild degenerative changes in the lower lumbar spine with no focal disk protrusion, spinal stenosis or significant foraminal narrowing. Mild chronic anterior compression fracture of T7. Bilateral spondylolysis with no anterolisthesis at L5-S1. Conus is normal in appearance terminating at the level of L1.

One thing that is not accounted for in the report but appears in the images on the CD are worrying me; these two shapes: http://i39.tinypic.com/2yopohd.jpg

Should I be worried about these two shapes?  What could they be? I'm just surprised that there is no mention at all of them in the report.

Many thanks in advance!
Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I am unable to access the link you posted. I would suggest that you discuss your concerns with the ordering physician. Many times there are benign variants that may be seen on neuroimaging. Also, if there is an abnormality, it can be distinguished on the various sequences that are obtained with the MRI.

When do you follow up with the neurosurgeon? Do you have symptoms currently (i.e., how and why was the Chiari discovered)?

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

2 Comments
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Avatar_f_tn
Hi again,

Have you tried copying and pasting the link in question to a new tab or browser window?  It works fine on my end, hmmm...

Here, I uploaded it again to my profile on here, here is a link to this one: http://s3.amazonaws.com/medhelp_images/user_photos/269926?1335628556 - If the above link doesn't work, simply click on my profile and click on the image tagged "Photo For Neurology Forum Question - April 2012"

Although I don't know what they two shadows could be, I do think that if they were something terrible, someone somewhere would have noticed, or so I'd like to think! I'm mainly asking because the syrinx on my first two MRIs was missed, so when I saw those two unaccounted-for shadows, I wondered if they had missed something again... :)

I am still waiting for a consultation with the neurosurgeon I was referred to; I'm in Canada and wait times can be very long. I have several intolerable symptoms currently, and everything started about 16 months ago (extreme pain in the head, neck, shoulders and right arm and hand and upper body weakness was the first of the symptoms, rapidly followed by; loss of signal in the right hand and arm as confirmed by an EMG and Nerve Conduction; nausea, vertigo and pain in the back of the head and neck when bending my head back, forward and doing any exertional activities; vision problems; ringing and pain in the ears; headaches made worse or brought on by sneezing, straining, coughing loudly, and singing; intolerance to loud noises; loss of some feeling in the feet; clumsiness, memory and brain fog issues; occasional speech issues; constant tightness in the throat and intermitent numb patch at the back of the tongue and mouth; difficutly maintaining a normal body temperature and occasional profuse sweating) so after much testing, the Chiari and small syrinx at C2 was declared the culprit.  

Thanks again for your help, and let me know if you figure out what the shadows are in the above-linked picture!

Em
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