Brief Answer:
Hyperintensities on T2 Flair, inflammation. Many things possible

Detailed Answer:
Hello XXXXXXX Thanks for coming to HealthCareMagic. I'm sorry you feel the service in this case was poor. Unfortunately getting a doctor who can read these kinds of things takes time, especially at this time of night. I'm one of the Consultant Neuro Critical Care specialists who works directly for HCM. I'd like to try and discuss this imaging result with you if you don't mind.

Lets understand what a T2 FLAIR image is first, then we can better understand what hyperintensities on this sequence of the MRI means.

The full expansion of the term FLAIR is "Fluid Attenuated Inversion Recovery". This is a very technical term which boils down to this.. if you see hyperinstensities on FLAIR imaging that means that there is a buildup of LOW density fluid.. either water or Cerebrospinal Fluid or inflammatory fluid.. in the region that is being examined.

At first blush.. there could be a number of causes for a finding like this. In the very elderly.. it's considered a normal part of aging. As the brain ages.. small areas of the grey matter are slowly lost.. leading to flair intensities. In a 27 year old such as yourself.. the more likely explanation is that it is due to movement or an artefact on imaging. In other words, it would be a harmless mistake on the part of the imaging apparatus. Not really a disease at all. But this interpretation is at first blush as I said.

I could better interpret this finding if you could tell me a little about your medical history. For instance, WHY was the MRI done in the first place? What symptoms have you been facing and for how long? Do you have any chronic health issues that you have been facing?

The more information you give me, the more useful I can be to you. So please let me know the circumstances surrounding the MRI and why it was done.

I look forward to your reply.

Vinay

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Brief Answer:
Right sided headache and right sided nasal blockage may be related!

Detailed Answer:
Hi there XXXXXXX thanks for following up!

You've given me a very important piece of information here. The fact that you have noticed frequent right sided nasal (nose) blockages with right sided headaches is an important correlation. Many a time, blocked sinuses are the causes of frequent headaches. We must explore this further! I will explain how in a moment.

But first, I really must ask again.. why did your doctor get this MRI of the brain done? What were they looking for? Had I been your doctor, knowing what you have just told me in advance, I would have asked for a CT of the Paranasal sinuses.

I am assuming that your doctor ordered the MRI to rule out any brain abnormality which might be causing your headaches. In which case, we can ignore the FLAIR hyperintensities as artefactual. They should be ignored.

Back to the nasal blockage though? How often does this happen? Do you know if you are allergic to anything in your environment? Do you take any antihistamine medication (eg Nasal sprays like Flonase or tablets like Allegra or cetrizine).

If my hunch is correct, chronic blockage of your sinuses may be causing your headaches. In which case, a short course of an antihistamine should bring your headaches under control. There are alot of 'IFs' in that though.. So I need information. Tell me about your medical history. Take your time and give me all the details you can. I am more than happy to go through it in detail!

Looking forward to your reply!

Vin

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Brief Answer:
MRI ruled out brain issues, leaves Migraines and Allergies as possibilities

Detailed Answer:
Ok XXXXXXX Now I think we are beginning to form a plan of attack here. In my opinion, the two most likely causes of your headaches are

1) Sinus INFLAMMATION secondary to a possible allergy
2) Migraine Headaches.. secondary to.. well anything.. (we don't always know what causes migraines..).


The reason I put Sinus inflammation first is because the correlation between the occasional nasal blockages and the headaches is quite literally a text book example of sinus inflammation, especially inflammation in the frontal and ethmoidal sinuses (ie the sinuses in your forehead and around your eyes).

The reason I have put migraines as a possibility (a distant second) is that migraines have a tendency to be one sided and present in the way you are mentioning.

Now, my reasoning is not as important as how to attack this problem though:

Hence, I want to thoroughly and completely rule out that your sinuses are causing this problem in your case though. To do this. You will need to take a REGULAR and medium term course of the following medications.

1) Tab. Allegra 120mg once in the morning for 1 month
2) Fluticasone Nasal spray, one spray in each nostril.. twice daily for 1 month.

This should bring WHATEVER inflammation you MAY have in your sinuses under control. If this does not succeed in solving your headaches.. then we will have to discuss the possibilities of migraines and the management of those.

But for now, lets attack the sinus possibility first. The medications I have recommended are very safe and effective and have virtually NO side effects when used for such short terms (just a 1 month trial). But they ARE prescription medications.. so you will need to discuss their use with your local doctor and get a prescription for the same.

I hope this plan of action is agreeable to you. Let me know how it works for you.

Vinay

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