CINE MRI result- interpretation?

[Eliza616]

I had a full spine MRI and a CINE MRI. Good news, no syrinx. And per the NS, there is no need for concern on the "borderline" position of the tonsils. (note - prior MRI said 5mm) I would just like an opinion here before I can truly relax.  Note that the CINE MRI was without contrast and lasted less than 15 minutes.  

Preliminary sagittal T2 weighted image demonstrates the right cerebellar tonsil proximally 4mm below the foramen magnum, the left slightly less. Several millimeters of cerebrospinal flid signal are present ventral to the cervicomedullary junction. Tube spinal fluid signal ispresent dorsal to the tonsils in near midline at the foramen magnum. There is no basilar impression. The clivus measures approximately 4cm in length in the basioccipit approximately 3.4 cm, the lateral relatively short dimension. Twining's line measures 8.5 cm, a relatively short dimension from the tuberculum sella to the internal occipital protuberance at the torcula. The transverse dimension at the transverse-sigmoid junction  is approximately 11.6 cm out however, demonstrating a relatively wide posterior fossa.

The ventricles are normal in size and position. No stones of brain signal abnormality are detected. Multiple foci are present in cerebral hemisphere white matter, nonspecific in appearance. None are seen in the brainstem or posterior fossa. Pituitary fossa and optic nerve sheaths are unremarkable. No major arterial or venoocclusive change is noted.

Cine MRI flow study demonstrates CSF signal pulsation ventral to the cervicomedullary junction, but none dorsal to the tonsils at the opisthion-c1 region.

Impression:
1. Borderline position of the cerebellar tonsils without definite crowding, and with relatively short basiocciput. Nonspecific white matter changes may be seen with ischemia, post inflammation, demyelination.
2. CSF flow signal ventral to the cervicomedullary junction, but none dorsal to the tonsils at the opisthion.

End of report....

The three spine MRI reports are too lengthy, and probably not important enough to provide in detail. Basically, I have degenerative changes in both the cervical and lumbar areas, but without spinal cord impingement. The thoracic spine was normal except for a small root sleeve cyst at T11-12 which was not even mentioned in the impressions, so must be insignificant.

I am not concerned about the nonspecific white matter changes. I am looking for confirmation that this doesn't sound like CM.

Thank you for any feedback you are willing to provide.

[selmaS]

  It is best if ur experience was not a good one with a Dr to not mention them by name on here, but u can send me a PM if u wish.....I like to have an idea of where these Drs that are not helping are so I do not have them on the list......and that goes for clinics as well.

Not sure if it is a clinic if they will let u see a diff Dr at this point....they tend to respect the other Drs opinions....u may need to go outside that clinic for another opinion or to get the CINE MRI.

As for monitoring, a Dr should be monitoring u....and MRI's are only required if u develop new symptoms or current ones worsen.

[Eliza616]

Selma,

Thank you for your great answers, as always. I went to a Chiari clinic whch is on the list, but the Dr. I saw is not the one listed- bad decision not to insist. I don't know if it is appropriate to say where I went or who I saw on this forum, but I agree with your conclusion.

I would not opt for surgery at this point, anyway. Topamax has controlled my headaches /dizzy episodes reasonably well for about 7-8 years; prior to Topamax, I just wanted my head cut off and would have had surgery in a heartbeat. Now, I would not have surgery as long as there is no syrinx. I just want to know if I need to monitor the condition- such as have another MRI in a couple of years to see if anything has changed. According to this NS.,I have absolutely nothing to be concerned about related to this "borderline herniation."

Can I ask another NS. in the same clinic to look at the CINE (the one recommended by numerous people on this forum)?

I am so tired of being treated like a crazy person. I don't think I can endure another rude or condescending Dr.  

Thanks.

[selmaS]

  Chiari is Chiari bcuz of a mallformed skull and not the size of herniation or restriction of CSF flow which urs does have....and so many Drs do not realize it is the back portion of blocked CSF flow that affects those with Chiari.

IS this Dr a true Chiari specialist?

The white matter can be lesions which can develop from severe HA's.....so if u have Chiari and have Chiari HA's u may have some of this as well.

Not sure why they call this borderline except for the herniation size...as so many look to that to determine if u have borderline or mild Chiari....and it is severe if u have a herniation of 13mm's...HOWEVER some with a 3 or 4mm herniation can have much more dire symptoms then someone with a 13 mm one...it is all a matter of width of the tonsils and CSF obstruction...and if it is posterior (dorsal)  that is enuff to cause an issue.

U may want to take ur MRI's and reports to another Dr for an opinion and review.