Questions about MRI findings and continuing dizziness, head

[jwesho]

On June 6th, I had a severe dizzy spell that brought me to my knees, and lasted a week.    I saw my PCP and he did cardio work thinking it might be cardiac related.  All was negative.  We then went the neuro route.  I had a CT scan - negative, then my first MRI: Impression - There is a cystic mass seen in the left cerebrum that may represent an arachnoid cyst extending from the fissure for the middle cerebral artery versus an epidermoid cyst. It's 10.4mm transverse x 7mm in craniocaudal diameter x 10.4mm in AP diameter.

My second opinion:  Neurosurgeon - very sharp.
    He dismissed the severity of this and ordered another MRI in 3 months.  The results are as follows: There is a 12mm(was 10.4) focus of cerebral spinal fluid signal intensity in the left putamen. There is a linear structure coursing through this. this has the appearance of a prominent parivascular space. A similar, though smaller appearing density is seen in the region of the right putamen measuring approximatly 6 mm in size, No abnormal areas of intercranial enhancement are seen. Impression - Prominent parivascular space is demonstrated in the basal ganglia,left larger than right, otherwise negative.

My NS says he thinks it's congenital and recommended a follow up in a year.I've since been referred to an ENT for dizziness, but am still having head and neck pain .

Can you explain to me what is going on and should I be worried about the diagnosis from the MRI's?  ENT doc thinks I've got a crystallized balance nerve. He's got me on xanax, but I'm still getting somewhat dizzy.  Thanks for the help.

[PaulaB79]

I have been having a lot of issues over the past 6 months...diagnosed with hypotension, then had a lot of digestive issues leading to the removal of my gall bladder about 3 months of physical therapy for myofacial muscle spasms between my shoulder blades and a lot of lower back problems, now I am having severe headaches radiating from my forehead to the back of my neck. I have been having irregular periods more frequent ones, I have had a few instances of incontinence so my PCP ordered an MRI but everything came back normal. I just don't what to  do! I am always tired I am 30 years old I am at a healthy weight I am just running out of patience seeing a nueroligist is an option but what would they be looking for?

[Larry333]

A related discussion, Fainting and fall, cause? was started.

[edinburgh]

I have had severe head and neck pain for a year now.  No obvious cause of onset of pain.  Through mouth X-Ray indicates: Cervical Spine - Marginal spurring and reduced disc height consostent with disc degeneration and uncoverdbral joint OA at C6/7.  Also osteorthritic changes are noted at the facet joints particularly the upper C spine at C2-3 and C3-4
Facet hypertrophy and spurring appears to narrow some of the intervertebral foramina particularly on the right side at C3-4. C3-5 and C6-7.  No fracture or other abnormality seen.

CT of the Head: Cortical sulci and syri have a normal appearance.  Gray matter white matter differentiation is normal Ventricular system, basal cisterns, and basal ganglia are unremarkable.  Nor intracranial hemorage or masses are identified.  Impression: Normal

MRI of C-Spine:  At c3-4, there are some early degenerative changes.  I do not see any focal disc protrusions or compromise of the central canal.  At C4-5 again early degenerative changes with early disc osteophyte complex.  There may be very slight encroachment on the exit foramen on the right side, however this is felt to be mnimal.  I do nt see any focal protrusion of the disc or significant central canal compromise.  St C5-6 again ther are degenerative changes with a small, broad-based, central protrusion of the disc.  It does just contact the cord but there is no real mass effect or signal change identified.  Ther is a little narrowing of the ecit foramen on the left.  C7-T1, again no focal protrusion of the disc or central canal compromise.  I gether from the requisition that the patient does not have any radicular fndings.  There is some straightening of the cervical lordosis.  The cord signal and contour appear to be within normal limits.

1st. Physio Therapist said he found instability in C1-2 area.  Told to wear collar 24 hours per day till MRI which took 3 months to get.  Neck extremely inflamed and took physio 3 months to brig imfalmation under control.  Range of motion was 10% after MRI.  Three months later range of motion 27%.  

I have had two spinal injections:  1 into C5-6 did nothing to help.  Later into C2/3 gave me significan releif from head pain. Neck pain presisted.  

About to undergo nerve block at right 2/3.  My question is how can we see exactly what is happening at C1 and C2?  Woul appreciate any information you can give me on that and on how my condition is being treated and if treatment will give me a normal active life again?

[kwag]

If I were you I'd see a chiropractor and work on that neck of yours.

[jwesho]

Also,   I've saw my ENT again and told him about the recurrent dizziness or floating (still says it's recurrent viral neuritis or BPV).  Also told him about the recurrent headaches and neck pain.  The last severe episode is when I kept a neck and headache for two weeks, 24-7.    I've since saw my NS's  nurse practitioner who gave me midrin for the headaches.  Doesn't do much, the pain seems to stem from the upper portions of my neck.   I go back to see my NS on 1/3/05.  

I guess I'm curious to see if you think my MRI results are significant, is it treatable in the locations I gave you, and what are your ideas on the causes of the neck and headaches.  I know it's impossible to diagnose w/o the MRI pics, but I do have a couple I can email.

Thanks for all of the help.

JH

[CCF-Neuro-M.D.-CS]

Without looking at the MRI I cannot form an opinion about the possible causes or treatments. A second opinion with another neurosurgeon would be reasonable to help dort out this issue.

Regarding the dizziness, the initial spell could have been due to benign positional vertigo or a viral infection of the inner ear. If you are continuing to have spells, and you also report neck pain, then it would be reasonable to have a MRI of the cervical spine (neck). There is a condition called cervicogenic dizziness. In this condition, pressure within the upper cervical cord, typically from degenerative changes, or a problem with the muscles of the neck can cause dizziness. A consultation with a neuro-otologist (dizzy doctor) would be helpful. If you are in the area our specialist is Neil Cherian. Good luck.