MRI Result - What does it mean?
by kooki, Oct 12, 2006
I've been having slight ringing in ears and intermittent headache for the last couple months.   The headache or feeling of heaviness would go away without my taking any medication.  I would simply lie down and rest for a couple hours and the headache would go away. I would usually get the headache or heavy feeling when I'm stressed out or nervous or having anxiety.     What does it mean "major intracranial vascular flow voids are present?" What is FLAIR signal?  Result of MRI is below.  Would appreciate help in interpreting it.  Thank you

MRI Findings:
" There is no intra or extraaxial fluid collection.  No midline shift or mass effect.  No focal parenchymal abnormality.  No evidence of intracranial hemorrhage.  Post-Gadolinium, there are no enhancing masses.  No hydrocephalus.  The major intracranial vascular flow voids are present.  There is abnormal signal on diffusion-weighted imaging.  There are scattered punctate foci of increased FLAIR signal in the periventricular white matter which is nonspecific.  None of these lesions show enhancement.  There is no abnormality of the paranasal sinuses or mastoid air cells.

"No acute intracranial abnormality.
No enhancing mass
Diffuse punctate areas of nonehancing increased FLAIR signal.  This is nospecific and may represent small vessel ischemic disease.  The distribution is not typical for multiple sclerosis, however, this cannot be entirely excluded. "
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Member Comments (17)
by Demiguise, Oct 13, 2006
I can try to help you in a minimal way. Don't read films but
can assist w/ report info. There is no T1 or T2 mentioned nor
specific lobes of brain. In general, it looks like a pretty gd
report radiologist did. Many are quick scan/sloppy. Your post
reads like they were trying to find things Dr didn't request.
Mri's are read by signals/spins/echoes/light/density/flairs/etc.
I can just tell you what yours kinda' means. Re: 'major flow
voids present', means the main flow vessels in your brain are
seen as `great & flowing well w/ clarity'. No back-up/blockage.
If the word present wasn't there, may mean hard to see/visually
difficult poss. do to a disease. FLAIR is a technique to attempt
to clarify an area. T1 is first test pattern for scan. T2 is 2nd
to go back to ck T1 signal of focus. T2 can separate solid from
a water retaining spot like fat/water/edema in tissue. This
technique is FLAIR. My guess is the punctate is just fat-spots
w/ alot of fluid retained in the white matter part of brain. The
lesions didn't enhance. When they switch to FLAIR read, it turns
things now dark & they then TRY to enhance. None enhanced so I
think these are old spots of stress to tissue from perhaps the
hdaches or? I had a routine mri w/ a 1.3cm spot & after Flair,
it was determined scar tissue. I had a bleeding vessel at one
time that did damage & sealed. It was a ischemic stroke or
attack. Probably very old & I never felt it. We decided that it
was probably from a death in family w/ long term migraine from  grief 10 yrs ago may have been cause. I also have scattered
punctate (fatty spots). *Most end report w/ 'cannot be excluded
or ruled out' to cover their buns. Everyone now days that has
hdaches or mri spots think they have MS. MS is usually dx'd
when things are bilateral + clinical. If you get MS 8 yrs from
now, this is a disclaimer & dropped in Neuro's lap. *Aspirin or
many pain meds cause ear-ringing & also hdache swelling. Hope
I was able to help & not confuse. Gd-luck.
by kooki, Oct 15, 2006
Thanks so much for taking time to reply to my post.  Yeah, I've been taking aspirin/ibuprofen quite often the last two months.  And, started to experience slight buzzing/ringing in my ears about the 1st of October.  I haven't been taking aspirin anymore so I hope it goes away over time.  

THanks again.
by kooki, Oct 15, 2006
I started having anxiety/nervousness attack early this year when an internist did an ekg on me and told me that I had enlargement of heart.  I was sent to get 2D echocardiogram which came back all normal.   I went to a cardiologist and showed her the ekg result that was done at internist office.  Turned out, my cardiologist said that my ekg was misinterpreted.  Ekg did not indicate enlargement of heart at all.     Every now and then, I would get anxiety and could feel blood rushing to my head.   I was also quite nervous during the MRI, and the noise of the machine made my nervousness even worst.   Could this be the reason why "diffuse punctate of nonenhancing increased FLAIR signal" detected during the mri procedure?

My primary doc referred to a neurologist.  I requested the hospital to have all images in a CD to take to a neurologist when I see him a month from now.
by Demiguise, Oct 15, 2006
Most reg MD's have a daily job of non-complicated illness so
when they get a report w/ scattered foci, they don't have time
to do or repeat clinical exam for transmission (hammer knee/
pin-*****/scrape foot) basics, that Neuro should do. Hopefully
Neuro will look at films or faxed report from referral. You
have a rt & left brain & ea. has 4 lobes. The scattered means
just that. It forms no significant pattern nor large enough to
justify measurement. There are several MRI types of units but
they all do the same. Ea. will hum/bang/clank/rapid fire/hammer
& techs no if it's your 1st & watch you while locking head in.
Stress/anxiety shows on face. Usually you 'say' your nervous.
Once in they should talk to you. They are actually scanning at
that time w/ a signal. The 1st noise is a test signal to ck for
nerve response to adjust machine signal. You can talk back/hit
stress button if intolerance happens. They know you have neuron
activity elevating if you are anxious. You can ask for more air
on some, to deep breathe-relax. They can even see a seizure abt
to happen & stop testing. They see more stress than what you
felt. There's difference between annoyed & panic on signals.
The tech is usually doing the operations while the Radiologist
is viewing the monitor for details. They instrust tech to go
back/repeat. They showed non-enhancing FLAIR. No fluid collect.
The punctates are old & mri didn't cause it. More than 1 attempt was made to enhance. Foci is very small, some micro!
You have more than 1 brain layer & they ck'd subcortex. I know
by the read. Periventricular AREA is near ventricles where CSF
is. Its area + clinical, Dr wants to let Neurologist deal
with. Can't remember post but I have a 1.3cm ischemic area on
left brain & was found just incidently. That's a 1/2" of scar
tissue. Way bigger than foci. I'm a non-stress person. I get do
upset, so mine goes back to probably 10 yrs when I cried for a
week over a death. A migraine followed for 1 week & then zip.
Chronic stress can be measured w/ a Cortisol blood test. 1 am
& 1 pm on same day. Unless you have something clinical, I think
Neuro will be ck'g you just to rule out something.Hydrocephalus
(water on top of brain) was even ruled out to ck compression.
If you worry/stress alot, this may be time to alter life some.
Breathe/yoga/walk/read. Our brain cells die daily. A healthy 80
will have lots of white matter on MRI but if not in certain
places, will have excellent memory. Stress needs to be heavy-duty. Maybe you were affected severely over the heart mis-dx's.
I hope things turn out well for you. Have a cookie kooki!
by kooki, Oct 15, 2006
Thank you again for your explanation.   Yeah, I was affected much  by the misdiagnosis of internist early this year.  I was hyperventilating for a good 10 days til I got the result back.    That was the first time I felt pain in my left shoulder, neck, head and upper chest.  My heart was racing.  I was given stress echo test by cardiologist which she said was normal (no blockage).   Every now and then, I now would feel pain on upper chest and shoulder whenever stress out.  I didn't feel any pain when I was stressed out prior to misdiagnosis.  Even my cardiologist was baffled how that Internist came up with enlarged heart on ekg.  

I'm doing yoga now and my new primary doc just put me on buspirone (anti-anxiety) for a month therapy.  

by Demiguise, Oct 16, 2006
I think you nailed the problem & the fix. Sounds terrific.
I do yoga stretching/breathing for some muscle pain & I now
sleep better. Learning to balance on some stupid big ball also
for something called 'core'. It's not as easy as it looks!
by sultryskies, Oct 16, 2006
I am 35f...many ms symptoms..mri is clear..told a bit of arthritis in my neck...I know this is not the diagnosis...legs are body does not stop moving when I am at rest...I have face twitches, my right pupil is malfunctioning in dim light, have had optic neuritis, spasticity, tremors, sweats, weakness, sleep problems, depression, pain pain pain all over...been put on baclofen and have been pain free for weeks now and have had pain for as long as I could remember...I walk everywhere and do not I am now able to use my legs...I can touch my fingers to the floor..have not been able to do it for years...optic neuritis occured in 1992...had a hell of a time since and never nailed it and now my mri is blank...ARRRRRRRRRRRGGGGGGGGGGGGGGHHHHHHHHHh...any suppport out there?....thanks for listening
by Demiguise, Oct 17, 2006
With all you've dealt with, I can tell you're motivated & have a gd attitude. The walking even w/ discomfort is necessary to
brain function & spine msg'g. With zip on mri, stay positive
since you found your magic pill, Baclofen. I posted somewhere
on board, I like the old dinosaur rx's. Baclofen is one of them.
It's used alot for myoclonus problems, (spastic muscles & spasm-
nerve conduction). Rapid ear-pops/clicks/jerks/throat pull/
leg cramps/spine injuries & MS. It got you mobile enough to stay
toned & it's cheap. It's not much for pain but use it or lose it. Everyone fights the old drugs. Never been a recall on that one! Nothing on brain mri usually means not ms. You may want to
scroll up to post by Oregon 24 on 10/17 & read my 10/17. Go to
google I mentioned abt benign fasciculations. I don't think you
have MS or ALS but it's a gd explanation site for movement
disorders. The cervical spine can have a small spur or disc
problem that can cause many painful movements & including the
cause of head-pressure & eye motion. The entry at skull base
has an area called 'the bundle'. If it swells, it becomes a
jammed pipe & brain msg crosses w/ spine msgs. Stay taking
what you know works. Gd-luck.
by brucie, Aug 02, 2007
Can someone help me understan my MRI reading?