Brief Answer:
Radiology seems to state that there is no significant change from before

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am an adult neurologist from XXXXXXX Ohio. In looking over the radiology report I believe I'm reading it slightly differently than you are.

It states that you have "relatively less flow posteriorly" and "...the appearance is not significantly changed from previously." In addition there is no blockage to flow as per the report checking with the contrasted flow sequences. It's of no XXXXXXX that you would have less flow posteriorly than anteriorly because of the Chiari the back part of the brainstem is more significantly "scrunched" with less room to give than in front. Even after decompression you can still have much less "relatively" speaking of a posterior than anterior flow of CSF....but again, the important 2nd half of the radiology read is that it is "....not significantly changed from previously"...meaning that in comparison to your studies of 2013 the radiologist felt that the flow was the same now as it was then...

As far as the pain in your spine....it is possible that there could be an obstruction in flow that the MRI study currently fails to show...it's not a perfect study of course....whether or not an MRI of the spine would show anything more is hard to say. When they get an MRI of the brain and do flow study sequences with MR they usually go at least down to the cervicomedullary junction which is where the neck meets the spinal column. If it looked up to that point I doubt that things would be happening farther down of importance.

Therefore, I believe the area of interest still remains in the brain. However, what you will want to find out is whether or not they actual did a FLOW STUDY using Phase contrast (PC) imaging MR or CSF flow studies using a magnitude measurement technique which could miss things that the PC study could pick up.

So what I would ask for in your case from either the radiologist or your neurologist is to send you for a:

1. Phase Contrast MRI of the brain
2. Include CSF velocity studies with CARDIAC GATING techniques. This means that the MRI images subtract out the movement artifact created in the fluid sequences caused by the heart beating. Special techniques can actually subtract out the NOISE of the heart beats in terms of what other perturbations they cause in fluid flow dynamics.

The other advantage of a PC MRI study is that there could be what's referred to as a SYRINX in the spinal cord and that could also be responsible for pain in the neck or shoulders. Got any numbness or tingling anywhere that you didn't have before?

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.

Also, if there are no other questions or comments, can I ask that you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments and questions to me in the future at:

bit.ly/drdariushsaghafi and I would be honored to answer you very quickly and if you wish, continue this interesting discussion.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 60 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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