Neurology Exam Question

[Eiresquid11]

I was diagnosed with Chiari I Malformation and Syringomyelia, back in October 2009.  The cerebellar tonsils are herniated 14 mm and the syrinx spans from C6-T3 and is 8 mm in diameter.  I have been going to a  neurologist every 3 months since then and would always have a very standard exam.  This time, he also tested the sensory system by using objects to sense the way temperature and pain were effecting me.  I felt more pain in the knee than the foot and it was much colder at the knee than the foot.

I don't know if this is a good thing or not.  After explaining my symptoms to my NL and after performing the exam (the worst being my headaches), he is sending me for 3 more MRIs - Brain, Head and Carotid.  Can someone explain to me why he is doing this?  I would have asked him, except he only mentioned the brain MRI to me.  It wasn't until I was getting forms for the MRI and MRAs that I was made aware of the head and carotid exams.

Thanks,
Erin

[Eiresquid11]

Thank you so much for your response.  I have gone for my MRIs and am waiting on the neurologist to call me back with the results.

What I can tell you is that my symptoms are not one sided.  I experience the headaches, neck pains, stabbing pains in the back and chest area on both sides, as well as the blurred vision.

I know that the brain MRI was to check the stability of the Chiari.  I am not sure what the MRA of the head is for.  I am not even sure what that can detect.  The same can be said for the MRA of the carotid.  I am assuming from your response that the MRA of the carotid is to ensure that there is no blockage in the carotid that is causing the headaches or other symptoms.

My neurologist did not order another cervical MRI yet.  Can any of the three MRIs that were ordered check the cervical for the syrinx?

I will make sure to ask him all these questions and then some, such as why I was placed in verapamil for the headaches.  I know that it can help to prevent headaches but it is also used for high blood pressure and cholesterol.  I have neither of those and want to ensure that taking this medicine every day won't cause my blood pressure to drop too low.

Also, I need to know the effects of taking alcohol with this pill.  If I am going to be taking it every day for an unforeseen amount of time, I would like to know if I can have a glass of wine at dinner or if I can enjoy a night out once in a while.

Anyway, I am rambling!  Thank you so much for your time.  I really appreciate your responding to my question and helping me out!

Kindly,
Erin

[Christopher R Newey, DO]

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.

Syringomyelia is a chronic progressive disorder of the spinal cord. It usually presents with painless weakness and wasting of muscles of the hands and arms and also with segmental sensory loss. The sensory loss is usually of the pain and temperature variants sparing sensation of joint position and vibration. The symptoms are classically described as being in a "cape like distribution". If the syrinx enlarges, the posterior spinal cord may be involved which will then cause changes with joint position and vibration in the feet. I wouldn't expect the feet to be the first involved given the anatomical organization of the sensory tract in the spinal cord. Given the headaches, your neurologist is probably wanting to ensure that the Chari is stable and not causing any conditions such as hydrocephalus. If the symptoms you are experiencing are one sided, your neurologist may also be working you up for stroke. I am not saying you have had a stroke, but this is in the differential in patients with unilateral symptoms. The cervical MRI is to evaluate your syrinx further.

I would suggest that you contact your neurologist to ask him/her specifically why he/she ordered the exams.

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