Brief Answer:
The provided images are not enough.

Detailed Answer:
I read your question carefully and I would like to try and help you.

Looking at those images though I am afraid that not much can be said. It is only 7 slices. An MRI exam has hundreds of images inside. They examine the brain using different techniques, or sequences as they are called, some sequences are better for certain tissue and conditions, some sequences for others.

The images you provide on the other hand do not comprise even a full sequence, they provide a view of less than a fourth of your brain matter and at a very low resolution at that.

So if I have to express an opinion based only on those images I can say only that there is no finding such as tumor stroke, inflammation etc in those images to explain those headaches, but I can not guarantee there is not something in the rest of the exam.

The best way to send me the full exam, without compromising quality, would be to open the CD/DVD, find a folder called Dicom, it contains all the images. Put that folder in a zip file, upload it on some file sharing service like for example Dropbox and provide the link in your next follow-up question. That way I can view all the images.

Looking forward to hearing from you again.

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Brief Answer:
Read below.

Detailed Answer:
Thank you for providing all the images.

Now regarding the headache I do not see any lesion to justify it. By that I don't mean to say that you do not have a headache, but that it is most probably a primary headache (such as migraine, tension type headache etc) and not a headache caused by a lesion increasing the pressure inside the skull such as tumor, stroke etc.
There is one abnormal finding in the the right temporal lobe though. You can see it in this link where I indicated it with an arrow. Now as I said it is not the direct cause of your headaches as it's small, doesn't compress anything, doesn't have associated swelling. Probably it may be just a remnant of some old lesion, like from a trauma, old infection etc, sort of like an old scar in the brain. However to safely say that perhaps a more complete MRI would be advisable as this one has only the most basic sequences, one which includes contrast administration might reveal something more.

I remain at your disposal for other questions.

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Brief Answer:
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Detailed Answer:
Thank you for the additional contrast exam. I took some time to answer both because I was at work and also because I wanted to take some time to consider the possible differential diagnosis as it is not a straightforward case. I wish you had let me know the MRI report as well in order to compare opinions with radiologists. Also please tell me if there is some other symptom apart from the headaches in the last 3 months.

The good news is the fact that there is no enhancement from contrast. That is against some threatening conditions which would have needed urgent treatment like some malignant tumors, active infection or active inflammation.

However I am still not able to exclude one type of tumor, a very slowly growing tumor, called low grade astrocytoma. It typically appears at your age. Apart from that some rare types of inflammation like sarcoidosis are still possible, but unlikely because usually they enhance after contrast and involve different areas.

So I believe a consult with a neurosurgeon will be needed in order to consider a biopsy of the lesion. As I said before it is not the cause of your headaches with its limited size, it has been found by coincidence and it might be considered lucky having been able to find it at such an early stage which (if confirmed to be the case by biopsy) would increase chances of treatment success.

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Brief Answer:
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Detailed Answer:
Hello again and thank you for the reports. I thought about you yesterday wondering if perhaps I was too radical in my diagnosis and scared you away.

The first report doesn't present any discrepancy, it doesn't reach any conclusion, basically says what I did after viewing the first MRI, that there is an abnormality, that the MRI wasn't complete and that another one with contrast is needed.

The second one speaks of enlarged perivascular spaces or Wichov-Robin spaces as they are also called. These are some fluid filled spaces around blood vessels, present in all people but normally small, under 5 mm. In some rare cases they can be larger than normal, the radiologist believes this to be your case, an enlarged perivascular space of 1.5 cm.

What do I think of that....it was a possibility which I had considered on Monday and I was somewhat torn before answering. The reason I didn't go with that diagnosis is first because these perivascular space is thought to have the same intensity with cerebrospinal fluid in all sequences. In your MRI it was the same in all but the T1 sequence where it looked to me as of a higher intensity. The second reason is the location. These enlarged perivascular spaces are usually found in other regions of the brain, usually deeper in what are called the basal ganglia (I am aware it may sound confusing, hope I am making sense to you, if not never mind and jump to the conclusion, I'm just resuming my thoughts).

It is these two atypical factors which made me sway towards the diagnosis I suggested. I think it is a plausible possibility but between this harmless issue which doesn't require any treatment or follow-up and the lesion I suggested I believed it more prudent to suggest the one which requires attention.
So to answer your last question, yes I would be in favor of another opinion, and even if that is in favor of the perivascular space I would still suggest a control MRI in 6-12 months.

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