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What Does This MRI Report Indicate?
Question: I have been having bad headaches for the past 4 weeks. I feel that my head in under a lot of pressure and when I move it to the left or right it hurts a bit more. I have recently, over the past two weeks, had pain behind of my eyes also. Approximately 5 days ago, I lost my vision for approximately 30 seconds and I seem to have lost a little bit of my periphery vision. It also hurts when I look to the extreme left/right/up/down. During this period I have been feeling tired and lethargic also. 3 days ago, I felt so lightheaded and fainted for approximately 40 seconds. After struggling with all of these issues, I have decided to go see a neurosurgeon. An MRI was performed, and I need a second opinion on the diagnosis: Empty Sella, tortuous optic nerves and prominent perineurual CSF sleeve, likelihood of idiopathic intracranial hypertension.
Brief Answer:
Fundus examination/MR venography/Lumbar puncture
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I understand your concerns well and I shall try to address them in the best possible way.
Your clinical history and MRI reports are favoring Idiopathic intracranial hypertension.Next,
1) You should get a funduscopic examination done by an ophthalmologist for papilledema.
2)Lumbar puncture should be done to look out for raised intracranial pressure and response to therapeutic removal of CSF should be observed.In case of raised intracranial hypertension, headache should improve with large volume(therapeutic) removal of CSF.
3)MRV(MR Venography) should be done to rule out venous thrombosis in brain.
Hope that you must be having some further questions.I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD.DM(Neurology)
Fundus examination/MR venography/Lumbar puncture
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I understand your concerns well and I shall try to address them in the best possible way.
Your clinical history and MRI reports are favoring Idiopathic intracranial hypertension.Next,
1) You should get a funduscopic examination done by an ophthalmologist for papilledema.
2)Lumbar puncture should be done to look out for raised intracranial pressure and response to therapeutic removal of CSF should be observed.In case of raised intracranial hypertension, headache should improve with large volume(therapeutic) removal of CSF.
3)MRV(MR Venography) should be done to rule out venous thrombosis in brain.
Hope that you must be having some further questions.I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD.DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr.-
More so than the headache, it's the feeling of lightheadedness that troubles me the most and my on-going sensitive to loud noises and bright lights, and pain behind of my eyes.
Many thanks for responding so quickly! Here are some quick responses to your questions above:
1. No fever? No fever.
2. No nausea or vomiting? I have felt nauseous during this period.
3. Is there neck tightness/pain? No.
4. Are these headaches nearly constant? No they come and go at different times in the day.
5. Are you more sensitive to noise than lights? Yes I am more sensitive to noise and lights of recent.
6. In the past few weeks, along w these headaches do you feel dizzy, lightheaded?? Yes, this is my biggest problem. I nearly collapsed a few days ago, because I felt lightheaded. I think this is one of my primary problems along with PAIN behind the EYES.
We did an endocrine profile to test pituitary function, here are the results:
PM Cortisol: 2.48 (2.3 - 11.9)
AM Cortisol: 6.51 (6.2 - 19.4)
Testosterone: 4.03 (2.8 - 8)
Prolactin: 6.02 (4.6 - 21.4)
T3: 2.98 (2 - 4.4)
TSH: 1.44 (.27 - 4.2)
T4: 1.50 ( 1.04 - 1.65)
Antinuclear Antibodies: Negative
RA Factor: Negative
ESR: 10 (0-9)
WBC: 7.76 (4-10)
Platelets: 338
Haemoglobin: 15.8
I have also attached a few other MRI pics.
Additional questions:
1- Have you reviewed the actual MRI's and not the report? What are you thoughts?
2- DO you suspect IIH? if so, why?
3- Do you see any lesions or cause for concerns?
4- Do you actually see a tortuous optic nerve? If so, what are are causes?
I wanted you to provide an independent view, and not necessarily base your response on the MRI report.
More so than the headache, it's the feeling of lightheadedness that troubles me the most and my on-going sensitive to loud noises and bright lights, and pain behind of my eyes.
Many thanks for responding so quickly! Here are some quick responses to your questions above:
1. No fever? No fever.
2. No nausea or vomiting? I have felt nauseous during this period.
3. Is there neck tightness/pain? No.
4. Are these headaches nearly constant? No they come and go at different times in the day.
5. Are you more sensitive to noise than lights? Yes I am more sensitive to noise and lights of recent.
6. In the past few weeks, along w these headaches do you feel dizzy, lightheaded?? Yes, this is my biggest problem. I nearly collapsed a few days ago, because I felt lightheaded. I think this is one of my primary problems along with PAIN behind the EYES.
We did an endocrine profile to test pituitary function, here are the results:
PM Cortisol: 2.48 (2.3 - 11.9)
AM Cortisol: 6.51 (6.2 - 19.4)
Testosterone: 4.03 (2.8 - 8)
Prolactin: 6.02 (4.6 - 21.4)
T3: 2.98 (2 - 4.4)
TSH: 1.44 (.27 - 4.2)
T4: 1.50 ( 1.04 - 1.65)
Antinuclear Antibodies: Negative
RA Factor: Negative
ESR: 10 (0-9)
WBC: 7.76 (4-10)
Platelets: 338
Haemoglobin: 15.8
I have also attached a few other MRI pics.
Additional questions:
1- Have you reviewed the actual MRI's and not the report? What are you thoughts?
2- DO you suspect IIH? if so, why?
3- Do you see any lesions or cause for concerns?
4- Do you actually see a tortuous optic nerve? If so, what are are causes?
I wanted you to provide an independent view, and not necessarily base your response on the MRI report.
Brief Answer:
Please upload the MRI CD.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up and providing further details.My suggestions are based mainly on the MRI report because MRI sections you have uploaded are not enough,to comment upon 'tortuous optic nerve' and 'empty sella'.
Please find answers to your questions here:
1)I have seen through actual MRI's as well but as mentioned above,the sections are not adequate to analyze the findings.I suggest you to please upload the entire MRI CD as a zipped file on google drive and share the link here.I shall view your MRI with my default dicom viewer.
2)Based on MRI report and clinical history,IIH is a close possibility.Transient visual obscurations,with slight peripheral vision loss,are indicative of the same.MRI findings substantiate the suspicion. Funduscopic examination for papilledema will further help in the diagnosis.
3 and 4)I would be better able to comment upon the lesions and optic nerve after looking at the whole MRI.
I shall be waiting for your follow-up with MRI CD, as requested.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Please upload the MRI CD.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up and providing further details.My suggestions are based mainly on the MRI report because MRI sections you have uploaded are not enough,to comment upon 'tortuous optic nerve' and 'empty sella'.
Please find answers to your questions here:
1)I have seen through actual MRI's as well but as mentioned above,the sections are not adequate to analyze the findings.I suggest you to please upload the entire MRI CD as a zipped file on google drive and share the link here.I shall view your MRI with my default dicom viewer.
2)Based on MRI report and clinical history,IIH is a close possibility.Transient visual obscurations,with slight peripheral vision loss,are indicative of the same.MRI findings substantiate the suspicion. Funduscopic examination for papilledema will further help in the diagnosis.
3 and 4)I would be better able to comment upon the lesions and optic nerve after looking at the whole MRI.
I shall be waiting for your follow-up with MRI CD, as requested.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I need your email address to share the google file with you
Brief Answer:
Please share the link here itself.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
Providing email addresses to the users are against the forum's rules.Please share the google drive link here itself in the space for the query.That's the way it goes.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Please share the link here itself.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
Providing email addresses to the users are against the forum's rules.Please share the google drive link here itself in the space for the query.That's the way it goes.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Please see link below:
https://drive.google.com/file/d/0B0hTLnojqoLbakZ6OVg4OXhlVVU/view?usp=sharing
https://drive.google.com/file/d/0B0hTLnojqoLbakZ6OVg4OXhlVVU/view?usp=sharing
Brief Answer:
Empty sella is visible.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
I have gone through your MRI study in detail.
The finding of empty sella appears to be correct.
Optic nerve on left side is definitely tortuous while its not that much on right side.
I suggest you to get a funduscopic evaluation done to rule out papilledema and at the same time,please get admitted in a neurology facility for observation of response to large volume CSF removal.
We can't label it to be a primary headache(like migraine) unless we rule out IIH in this case.
Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Empty sella is visible.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
I have gone through your MRI study in detail.
The finding of empty sella appears to be correct.
Optic nerve on left side is definitely tortuous while its not that much on right side.
I suggest you to get a funduscopic evaluation done to rule out papilledema and at the same time,please get admitted in a neurology facility for observation of response to large volume CSF removal.
We can't label it to be a primary headache(like migraine) unless we rule out IIH in this case.
Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1- Thanks Dr., you did not comment on lesions, blood leakage, brain swelling, etc. Anything out of the ordinary?
2-Also, would these finding all be incidental? Are these issues congenital?
3- Finally, do you know of a good neurological clinic in Bangalore?
2-Also, would these finding all be incidental? Are these issues congenital?
3- Finally, do you know of a good neurological clinic in Bangalore?
Brief Answer:
NIMHANS at XXXXXXX
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
There are some small FLAIR hyperintensities in the midbrain and around posterior horns of lateral ventricles,which may be of doubtful significance.What did the reporting radiologist say about these?
Apart from this,there is no blood leakage,brain swelling or any other structural abnormality(except as mentioned in the previous answer).
Findings can be incidental.However,with the current history,these should be taken in clinical correlation of IIH. Rare cases may have congenital empty sella.Likewise for tortuous optic nerve.
Neurology department at NIMHANS holds great neurologists.You can visit the place.
If you have some further questions,I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
NIMHANS at XXXXXXX
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
There are some small FLAIR hyperintensities in the midbrain and around posterior horns of lateral ventricles,which may be of doubtful significance.What did the reporting radiologist say about these?
Apart from this,there is no blood leakage,brain swelling or any other structural abnormality(except as mentioned in the previous answer).
Findings can be incidental.However,with the current history,these should be taken in clinical correlation of IIH. Rare cases may have congenital empty sella.Likewise for tortuous optic nerve.
Neurology department at NIMHANS holds great neurologists.You can visit the place.
If you have some further questions,I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello, thanks for the reply doctor. The radiologist did not comment on any FLAIR hypersensitivities in the midbrain. Is that something I should ask him?
Brief Answer:
Yes,you may.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
They appear to be small.If the reporting radiologist did not mention,possibly,they were not significant according to him.
Besides,there is no harm in having his viewpoint on it.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Yes,you may.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
They appear to be small.If the reporting radiologist did not mention,possibly,they were not significant according to him.
Besides,there is no harm in having his viewpoint on it.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok thanks Dr. I will ask the reporting radiologist. I also have another radiologist on this website helping to provide a second opinion and will also ask him.
I had a fundoscopy done yesterday and papiledema was ruled out. No other major findings found...what next?
I had a fundoscopy done yesterday and papiledema was ruled out. No other major findings found...what next?
Brief Answer:
Lumbar puncture for CSF pressure.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
Next,Lumbar puncture can be done for estimation of CSF pressure.This will help to know if raised intracranial pressure is present.In the process,you will need a short hospital stay.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Lumbar puncture for CSF pressure.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
Next,Lumbar puncture can be done for estimation of CSF pressure.This will help to know if raised intracranial pressure is present.In the process,you will need a short hospital stay.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Dr. it was helpful.
I am curious to know, however, if we are missing anything here. As I reported, I had a fall 3 months ago, could my symptoms be related to that? (i.e. concussion ?). Could a mild concussion be the cause? or Meningitis?
Best-
I am curious to know, however, if we are missing anything here. As I reported, I had a fall 3 months ago, could my symptoms be related to that? (i.e. concussion ?). Could a mild concussion be the cause? or Meningitis?
Best-
Brief Answer:
Unlikely due to concussion or meningitis.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
No.There are no chances of concussion or meningitis causing any of these changes.Be assured on that front.
Hope that I have answered your query.If you have some further questions,you are most welcome in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Unlikely due to concussion or meningitis.
Detailed Answer:
Hi XXXXXXX XXXXXXX
Thanks for being in follow-up.
No.There are no chances of concussion or meningitis causing any of these changes.Be assured on that front.
Hope that I have answered your query.If you have some further questions,you are most welcome in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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