Neck Pain, Dizziness, Headache, Unsteadyness, MRA, MRI

[verseman]

I just had an MRI of my cervical, as I've had a lack of range of motion and frequent pain. It revealed slight herniation at c-5,c-6 1-2mm.

• Is that a lot?

I had an MRA of my circle of Willis to look for issues with my vertebral artery- I've been having vertigo and loss of balance, pain in back of head and headache, cranial pain Tingling of hands and feet, itchy feelings. The exam was done without comparison.

Findings were:

No stenosis, occlusion, or aneurysmal involvement of the distal vertebral arteries, the basilar artery, P1,P2, and P3 segment of the posterior cerebral arteries, the A1 and A2 segments of the anterior cerebral arteries, and M1,M2, and proximal M3 segments of the middle cerebral arteries.
IMPRESSION: Normal MRI of the circle of Willis.

• Is this the right area to be focusing on for my symptoms? why did they not capture lower portion of vertebral artery such as V4 (intradural), V3 (c-2 to dura), V2 (foraminal) and V1(pre-foraminal)?
It would seem appropriate to have an MRA of the lower segments since I get shooting pain up neck and get sensations of unsteadiness if I turn my neck, or close my eyes in the shower. If I walk into a darkened space, I start to feel unsteady...this never happened before 6 months ago.

• What exam do I need to request to make sure I'm getting correct amount of CFS flow?
• What do my symptoms sound like?

I still have noise in my left ear and decreased hearing, I've read where cervicogenic issues can affect vestibular communication.

• What can I do for cervicogenic dizziness?
• I also showed a slight 5mm cerebellar tonsillar ectopia (horizontal) could this be what’s causing these TRANSIENT symptoms with Cranial pain, cranial pressure?

[verseman]

I'm sorry. Let me be a little more clearer. I've gone down the road of Meniere's disease. The symptoms are different. I have the hearing loss and transient vertigo but much more that Meniere's doesn't. I have severe neck pain, I have a shooting liquid feeling that goes up my neck to my head after sitting and driving for 30-45 min. when I stand up and get out of the car. Is is blood? or is it CSF? I also have unsteadiness (6 months) esp when in the shower with closed eyes. or walking into a darkened room.

I will ask again. Do I need to get a better MRA of my Vertebral Artery? segments v1- v4

I have pain in the back of skull often. I have a cerebellar tonsillar ectopia, or chiari, but they say it's minimal. 5mm.. my MRI was horizontal and I've been told you get a better MRI with vertical.

Can neck problems like herniated disc can lead to malfunction of the vestibular nerves? and cause cervicogenic dizziness?

Can anyone help?

[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.

As you know, dizziness can have many causes. Vertigo, or "room-spinning dizziness," can be caused by several different types of inner ear problems and less commonly from central nervous system diseases. Cervical disease (such as a herniated disc in the cervical (neck) region or arthritis of the spine) can cause vertigo, though this is not common. More often, the dizziness is not room-spinning per se but rather a wooziness or sort of light-headed dizziness. I will refer to this as cervicogenic dizziness. This notion of cervicogenic dizziness is not accepted by all medical practioners, it is controversial, as it is not well researched, difficult to diagnose, and difficult to conduct research on. However, it may be diagnosed in someone with neck pathology and dizziness in which no other cause is found. Therefore, it is a diagnosis of exclusion, after inner-ear and brain problems are excluded.

Patients with dizziness due to neck pathology (cervicogenic dizziness) often complain of dizziness that is worse with particular head movements and when the head is maintained in one specific posture for prolonged periods. Neck pain and a headache in the occipital region (the back of the head above the neck) may be associated with the dizziness. The dizziness may last minutes to hours after assuming certain head positions.

Other causes of vertigo can include inner ear problems, of which there are a variety including Menniere's disease (which is marked by episodes of vertigo, ear-ringing (tinnitus) and hearing loss), Benign positional vertigo (BPPV) which is marked by episodes of vertigo brought on by head movement, brain tumors (this would be apparent on MRI), certain toxic drugs (specific medications), neuropathy, and certain infections.

The area that is typically imaged on an MRA will depend on the order that is placed. A separate order is needed to image the neck vasculature. If this was not ordered, it would not have been performed. If your MRI brain is normal (which I am not sure if you had this done), CSF flow abnormality would be less likely. If you are concerned about CSF flow abnormality from the low-lying cerebellar tonsils (i.e., Chiari malformation), a CINE flow MR would be useful. (FYI: Chiari malformation is an abnormal extension of the cerebellar tonsils (a structure in the posterior brain) through a hole in the skull called the foramen magnum. It is often asymptomatic or may present with headache, cranial nerve problems, sleep apnea, or hearing/vestibular problems. One associated feature with chiari’s is its association with syringomyelia, which is dilatation of the central canal in the spinal cord).

I suggest you follow up with a neurologist.

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