I would appreciate some help interpreting my brain MRI report (it’s many months until my next neurologist appointment).
1. How common is it to have a vein impinging on the root of the trigeminal nerve? Is the “indentation” significant?
2. Based on the report, what would you say are my chances of having trigeminal neuralgia? (I have daily episodes of extreme discomfort, localised around my head area)
3. What could the “gliosis” indicate?
Clinical History: Left trigeminal neuralgia?
Technique: A multiplanar and multisequence protocol was performed with gadolinium.
Report: There is a small vessel extending across the superior-medial margin of the preganglionic left trigeminal nerve at the point about 5 mm from the root entry zone. Regional margin of the nerve is indented. This does not appear to represent the superior cerebellar artery which is located in a more rostral position. The nerve demonstrates even low signal, Meckel's caves/trigeminal cisterns are intact bilaterally. Parasellar and cavernous sinus regions are clear. Pterygopalatine fossae are intact bilaterally. Maxillary and sphenoid sinuses are normally pneumatised. Cerebello-pontine cisterns are clear. Inflammatory change is not evident in the mastoids. Vertebral and basilar arteries are patent.
Midbrain, pons and meduíla together with the cerebellum define normally,
Ventricular system is midline in position and of normal dimensions. Normal grey-white matter differentiation is evident in the cerebral hemispheres. A small focus of subcortical hyperintensity is demonstrated towards the anterior margin of the left insula. This would represent an area of nonspecific gliosis, no evidence of abnormal diffusion or enhancement. Basal ganglia define normally.
Conclusion: A small vessel indents the margin of the preganglionic left trigeminal nerve as it courses along the superior-medial margin of the nerve. Left trigeminal nerve is of normal signal. Parasellar and cavernous sinus regions are clear. Maxillary and sphenoid sinuses are normally pneumatised. Brainstem and cerebellum define normally.
Ventricular system is of normal dimensions, and is midline in position.
Small subcortical focus of hyperintensity is present towards the anterior margin of the left insula, this would represent a small focus of nonspecific gliosis.”
I'm not a doctor. So I don't feel qualified to answer your questions. Community leaders are just patients themselves.
You may want to post your question in the Neurology community or check out the experts section where you may get an answer from a doctor.
From my own experience with TN, MRIs are used to rule out other problems such as Multiple Sclerosis or a brain tumor causing pain. Was this MRI a thin slice MRI or "Trigeminal Neuralgia protocol"? If so, it is a diagnostic where they are looking for blood vessels or veins pressing on the nerve.
My un-expert reading is that they may have found a compression. This would make you a candidate for an MVD - Microvascular Decompression. A surgery that could help alleviate your pain.
Can you call the doctor that ordered the MRI and have them explain it? Sometimes you have to be your own patient advocate and demand service from these docs. If they ordered the MRI they should have the courtesy to follow up with the results in a more timely manner, especially since you are dealing with such pain.
Hoping you get some answers from qualified people and relief from your pain.
Please come back and share your experiences. Your story may help someone else in the community
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