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HELP with MRI of Cervical Spine Findings
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HELP with MRI of Cervical Spine Findings

My husband is a 39 yr old male with neck/back pain headaches and blackouts. A MRI was done and we have been told he has a bulging disc and physical therapy has been ordered. We have since gotten the clinical notes and need help interpreting it, the following is what it states:
There is normal alignment of all cervical vertebrae. There is loss of intervertebral disc space height and signal intensity at the C5-6 intervertebral disc space. The sagittal images show an area of abnormal signal intensity within the cervical spinal cord in the thoracic region. The examination was not tailored for evaluation of the thoracic region but this is suspicious for a syrinx or and area of myelomalacia. The cerebeller tonsils are above the foramen magnum. There are no areas of pathological signal intensity within the bone marrow of the vertebral bodies to suggest an acute fracture or neoplasm.
At C5-6 there is a shallow central disc protrusion
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620923_tn?1413427272

  Hi...I have to ask what symptoms ur DH is having...and if he was also given a MRI of the brain  as well? It sounds like they only did an MRI of the cervical spine. Low lying tonsils do not have to lie below the foramen magnum to be of concern.

The other question I have  is did ur DH suffer an injury to his thoracic area?...it is not normal for a syrinx to form here even with injury as our rib cage protects this area...and is usually a sign of a CSF obstruction.

  I am really curious as to the symptoms that prompted this MRI.

     "selma"

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On Aug 30th he started having major dizzy spells and started blacking out. He was admitted to the hospital that afternoon and released the following evening with a diagnosis of syncope. When he followed up with his family doctor he had continuing symptoms and had started having memory loss, blurred vision, seizure like symptoms, as well as depth perception issues. His neck also pops alot and it causes blackouts as well, plus he has severe headaches at the base of the skull constantly. The physician decided to send him to a neurologist and an ent. The ent did a ct scan but has found nothing significant. The neurologist did an eeg and a brain mri 1st, the eeg was normal and the only thing found in the 1st mri was a cyst in the nasal cavity which the ent then prescribed medicine for. I have not gotten the clinical notes on the first mri as I didn't know I could until I was trying to get a letter from them to supply his employer with more documentation about what is going on.
We do not recall any specific injuries to that region, although there was a couple car wrecks many years ago that may have done something and he not know it, as well as abuse by his first wife.
Origionally it seems as though they were basically testing everything to try to find the problem, he even was seeing a cardiologist who saw him at the hospital and she has cleared him with no abnormal findings.
It has been weekly appointments to one doctor or another since the onset and this is the first true results we have gotten saying they have found something. But one main concern is that he has a sister who has digenerative disc disease and has already had back surgery and will be having neck surgery in january to fix 3 discs that are messed up there.

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620923_tn?1413427272

  Hi...sorry, but I am going to ask a few more questions.....first, u said black outs, did he pass did he feel it coming on, or was he aware he was falling but couldn't react?

Also does he bruise easy and is he slow to heal....

  Sorry I have so many questions.
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It's fine that you have so many questions, ask away, I try to give as much info as I can but I know that I do not always give complete enough information.
He does not bruise easily or take long time to heal.
When the first occurence of blackout happened he felt little dizzy and told a co-worker he was talking to, the co-worker caught him before he hit the ground. They brought him home and later the same day it happened several times with me and he still does not recall passing out or anything that happened during the time of the event. On that date his eyes remained open but there was no response from him, I caught him on these occurences so there was no trauma at that time either. I called EMS and they transported him to the hospital for the stay which i described above.
He does not feel the blackouts coming and most are for short periods of time. Others happen and he doesn't recall even getting up off the couch or out the bed but finds himself in the floor when he comes to. I have been at work when the longer spells occur but from the best we can figure, due to text messages he has made around these, he has been out for a hour or more. When I am home I am able to immediatly try to get a response and talk to him to bring him back quickly so they don't last very long when I am home.
Most of the dizzyness has abated at this point. Neck and back pops frequently. At a young age he was told after dislocating his hip that his hips were deteriorating and they did not believe he would be walking at this point in his life, but thankfully he can still do so and although they cause pain as well it is something he handles.
It's all this new stuff that concerns us the most. This may have been more info than you needed but figured it best to give as much background as I could possibly think of. Feel free to ask any other questions you may have. We really appreciate anything you can tell us to help us to understand what is going on.
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620923_tn?1413427272

  The reason I was asking about his black outs is there is passing out and something called a drop attack....when u pass out u know that is what happened...u feel dizzy and may even get a "snow" effect as u go out...so u can 't control it but U know what it is....

A drop attack, u r standing one minute the next u r mid fall and aware u r falling...(when u pass out u do not come too until after u hit the ground)....but can not react, or speak....it is like there is a light switch on ur spine and someone flicked it off and on and u go out for only a few seconds...but ur brain is not able to send the signals as to stand....

this happens as a result of a CSF obstruction.

The dislocations cold be Ehlers-Danlos...not all with EDS will have easy bruising or be slow to heal but they are typical...the fact he is hypermobile and has joints that dislocate is a good indication he should be tested for EDS.

The time his eyes were open but no response, did he have a recollection of what happened?

It sounds like he is passing out is he was able to be caught by a co-worker...which is better then it being drop attacks...but, it could also be a little of each.

Also from ur description that he may be out for hours when alone, and u can talk him back, I wonder if it is a seizure of some sort.

Did he ever have an EEG?

   "selma"
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Yes the EEG came back normal. The neurologist has/had suspicion of clonic seizures but I don't know if she still thinks that after the "normal" eeg. When the episodes occured and his eyes were open he does not know anything of what occured only what I tell him occured. He just thought he was dizzy, amd was little upset with me for calling an ambulance.
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620923_tn?1413427272

  The best I can suggest is to get copies of all the tests and try another NL or NS for another opinion.....

I am perplexed...but not a medical professional....so really not sure what else to tell u except was he checked for POTS?
Postural orthostatic tachycardia syndrome (POTS, also postural tachycardia syndrome) is a condition of dysautonomia, more specifically orthostatic intolerance, in which a change from the supine position to an upright position causes an abnormally large increase in heart rate, called tachycardia. Several studies show a decrease in cerebral blood flow with systolic and diastolic cerebral blood flow (CBF) velocity decreased 44% and 60%, respectively. Patients with POTS have problems maintaining homeostasis when changing position, i.e. moving from one chair to another or reaching above their heads. Many patients also experience symptoms when stationary or even while lying down.
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I appreciate all the information you have given us. I'm not totally sure what all was tested for, do know that with all that the cardiologist did that she found nothing at all and she covered alot of testing. He starts physical therapy on tuesday and we hope for some good results. He returns to the neurologist on the 28th so I will try to keep post for what they say and how things go. The neurologist is well liked by all doctors we have seen and has a really good reputation. I know that things take time to complete and this started at the end of august and we started going to neurologist mid to late september. If she doesn't have answers in next couple months I will then look into another doctor.

My biggest concern was the statement in the findings that I wasnt sure what that would mean:The examination was not tailored for evaluation of the thoracic region but this is suspicious for a syrinx or and area of myelomalacia

I will be at the appointment on the 28th and will make sure I get as mch info as I can
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620923_tn?1413427272

  U were right to have concerns as I said the thoracic area is the most protected area of the spine and unlikely for an injury to cause a syrinx there, the other possible cause is a CSF obstruction.....this is y I asked all the questions I did, and wonder  about a brain MRI and Chiari.....even tho the cerebral tonsils are reported above the foramen magnum, I wonder if it  is causing an obstruction, or if he has a retroflexed odontoid....both would cause overcrowding and an issue.
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