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What could cause pain at back of brain stem,head and lower neck despite normal MRI result and can it be Sinusitis?

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ENT Specialist
Practicing since : 1998
Answered : 660 Questions
I have had a MRI done very recently and it states that the trigeminal nerve, 7th & 8th cranial nerve complexes and the abducens nerve and otherwise normal in the cisternal portions. Conclusion: there is no suggestion of a brain parenchymal abnorality. In particular no focus of gliosis or oedema. On the limited imaging through the posterior ofssa, the trigeminal nerve is normal in the cisternal portion and within Meckel's cave.. 7th & 8th cranial nerve complexes are also normal within their cisternal portions with no inflammation seen within the mastoid air cells. The abducens nerve is also grossly normal in its cisternal portion. Noted however is sinusitis involving the maximallary sinuses, worse in the left and mild in the right maxillary sinus? the source of the facial pain. No suggestion of a mass seen within the curtaneous tissue of the cheek or orbits to implicate infraorbital nerve pathology on the limited imaging of the facial cutaneous region. No intracranial pathology. On cervical spine there are minor disc bulges seen of the cervical spine at the c5/6 and the C7T1 level abutting the tecal sac mildly anteriorly. There however remains capacious central canal. No cord signal abnormality seen to suggest evidence of myelomalacia cord oedema. craniocervical junction is normal. Minor disc desiccation seen throughout all the cervical discs. No annular fissures/tears seen of the cervical discs. Their conclusion: Minor disc desiccation see through the cervical levels. Minor disc bulges seen at the lower cervical levels as described abutting the tecal sac anteriorly at the above described levels. There is however no resultant central canal, lateral recess or foraminal compromise. No cord signal abnormality to suggest myelomalacia or focus of demyelination. No impingement seen of the cervical nerve roots to suggest cervical radiculopathy. The vertebral arteries show normal flow voids. I am still getting some pain up the back of the brain stem, and up to the top of the head, I also get pain in the lower neck as well.. My neck feels tired at times. I have been to an ENT doctor who said my left sinuses must be drained as the XXXXXXX sinus is blocked, the right partially. I also get firing sensations and burning around the mouth and right eye, occasionally the whole face and back burns. The Neurologist said there is nothing wrong with me neurotically and it is muscular. At times i have a waving sensation to the front of my face also when I look down. A lot of the muscular symptoms seem to have settled down and this is the left over. I know the pain is diminishing but what do you think is the cause can be? My husband helped me up and my the back of my neck seemed to be pushed up and the back, I also had a Chinese massage which seemed to aggravate the problem and few weeks ago. can the sensations at the front be caused by the back or is it the sinuses
Posted Thu, 9 Jan 2014 in Ear, Nose and Throat Problems
Answered by Dr. Prahlad Duggal 11 hours later
Brief Answer: Symptoms can be because of sinusitis. Detailed Answer: Hi, Thanks for the query. Your MRI of the brain is more or less normal and it has got an incidental finding of sinusitis involving both the maxillary sinuses. Your cervical spine scan reveals some changes in your discs but these do not warrant any intervention immediately. Please consult a physiotherapist for neck and shoulder exercises and this should give you relief in neck pain which also radiates to the head. Your symptoms of the face can be because of sinusitis. A CT scan PNS will give a better picture of the osteomeatal complex and if a surgical decision is to made, a CT is the investigation of choice. But all sinusitis patients do not need surgery and an extended medical treatment in the form of intra nasal steroid sprays and may be oral steroids for few days help. Please discus this with your ENT. Feel free to ask another query. Regards
Above answer was peer-reviewed by
Follow-up: What could cause pain at back of brain stem,head and lower neck despite normal MRI result and can it be Sinusitis? 6 hours later
Is it possible I have pinched nerves in the neck? I have been using acupuncture which has given some relief. Can the sensations at all be from the brain stem? When I look down I get waives of sensation in the face and sometimes dizzy, and I seem to break out in a sweat, again could this be the sinus? CT shows enhanced mulislice CT imaging of the paranasal sinuses was done with formatting in the axial, coronal and sagital planes. There is complete opofication of the left maxillary antrum with complete obstruction to the left ostiomeatal unit. In the right maxillary antrum there is mild mucosal thckening seen and the ostiomeatal window is patent. The frontal, sphenoid and ethmoid sinuses are not significantly involved. The lack of pneumatisiation of the right frontal sinus is developmental and not pathological. The nasal septum is mildly deviated to the left. The nasal turbinates and postnasal space appear normal.
Answered by Dr. Prahlad Duggal 7 hours later
Brief Answer: Unlikely to have pinched nerves, no evidence MRI Detailed Answer: Thanks for the query. Your MRI description does not point to pinched nerves. There can be some element of complaint which is because of disc problem but pinching is not there in description. Heaviness and fullness can be because of sinus but dizziness is usually not because of that. CT scan is showing sinus involvement which warrants surgical treatment but after an extended medical treatment. This will involve endoscopic surgery. Lack of pneumatisation is nothing to be worried about. Feel free to ask another query. Regards
Above answer was peer-reviewed by
Follow-up: What could cause pain at back of brain stem,head and lower neck despite normal MRI result and can it be Sinusitis? 2 hours later
Hi I went to the Physio today and he stretched my head. I have had burning behind my eyes & nerve sensations around there as well as the rest of my face. I now have a bit of pain radiating behind my eyes, is this a problem? Do you think this is my back of my head as when I turn my head it clicks and sends some pain up to the top of my head. How can I get rid of the sensations, I have had acupuncture which has some success, but I tried physio again, and it seems to flare it up again. Any ideas? Will it settle down again, as it seemed to be getting a bit better. I also have sensations going down my shoulders & arms, and they burn also at times?
Answered by Dr. Prahlad Duggal 52 minutes later
Brief Answer: Continue with physio and do gentle exercises Detailed Answer: Thanks for the query. Physiotherapy exercises take some time to become effective. Your description of the pain and other sensations point towards muscular problem and some degenerative changes in cervical vertebrae which do not need any intervention. Just do light exercises over prolonged periods and things should be fine. Please continue with the physiotherapy and just tell him/her to be a little slow on things. Do take adequate rest also and maintain a god posture. Feel free to ask another query. Regards
Above answer was peer-reviewed by
Follow-up: What could cause pain at back of brain stem,head and lower neck despite normal MRI result and can it be Sinusitis? 23 hours later
Hi many thanks for your detailed answer, it has been quite helpful. Will the sensations or tics as I call them go away? You said this could be sinus related is that correct? Why does it come and go? Could I do anything to stop this? It is very uncomfortable, could tregtratol (cabamazabeine) or lyrica help? What causes the tics or sensations to occur? One Neurologist said that the pain at the back of the head was muscular the other said it could be fibrmolgia (sorry not sure of the spelling). The ENT said the left XXXXXXX sinus should be drained. Again many thanks
Answered by Dr. Prahlad Duggal 36 minutes later
Brief Answer: Pls go for ENT surgery if medical treatment fails Detailed Answer: Thanks for the query. Things will improve with time and medical treatment for sinusitis. The variation (comes and goes) can be explained with sinus blockade which can come and goes. Your symptoms do not suggest the need for carbamazepine. Still your treating doctor can decide depending upon the intensity of symptoms. But before starting carbamazepine, the sinuses should be cleared so that the residual problem can be attributed to neurological problem. Feel free to ask another query. Regards
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