Brief Answer: Let me hit the highlights Detailed Answer: Hi there. I understand that you would be worried by all the jargon in this report. So let me try and break it down or you into small pieces and after you understand them, we can discuss their significance. ------"The subtle right paraspinal soft tissue abnormality is at C7-T1"------ There is a change in the signal coming to the MRI from the muscles and tendons surrounding your lower neck vertebrae and you upper chest vertebrae. If you run your finger down the middle of the back of your neck. You will eventually hit the spine that is the most prominent. That is C7's spine and that is where this abnormal signal is coming from. Do you have any pain or symptoms in this area? Or were any of the injection that you had given here? "Abnormality" is a pretty vague term and i need a bit more information before i can gauge it's significance. ------"The pituitary gland is somewhat prominent which could be related to patient's age."-------------------------------------------------------------------------- Here the Radiologist has compared the size of your pituitary gland to the normal ones they have seen over the year and felt it was on the larger side of normal. This is understandable because people rarely get MRI's at your age and he would have seen too many 22 year old pituitaries. We do know that the gland is larger when we are younger as it has more cells and is creating more hormones. As we age, it shrinks. Overall I would say that this is not really something to worry about. Unless you have been diagnosed with or have been suffering from any hormonal issues. In which case we need to revisit this. ---The dural venous sinuses are also slightly prominent. In the appropriate clinical setting, intracranial hypotension could be considered.-------------------------------- What they are saying here is that the veins that run through the center, top and back of the brain are larger than they would normally appear. They think that if your symptoms are right. you might be suffering from a situation where the pressure in your head is lower than it should be. Now I can't tell if this is significant or not until you tell me if you have been having headaches or not. If you have. The headaches should get worse when you are standing and should get better when you lie down. That's textbook for Intracranial Hypotension. As to the cause. I am loath to point fingers at the first thing I think of. But you did mention that you had injections into the spine. If there by any chance were a leak of the fluid that circulates in the spinal cord.. called CSF. Then that COULD theoretically be the cause. But you have to remember that there are many other causes and I'm only going by what you have typed into the query. Any more information you have on this will be helpful. The funny thing about neurology and the brain in general is sometimes that "if it walks like a duck.. quacks like a duck... and looks like a duck.. it might NOT be a damn duck". So we have to be very careful before we point fingers. ---------------------------------------------------------------------------------------------- "There is a small area of CSF prominence in the anterior middle cranial fossa, likely to represent an arachnoid cyst, with no significant mass effect. Flow-voids are seen in the basilar and internal carotid arteries as well as in the large posterior dural sinuses. The pineal, sella, and craniocervical junction regions are within normal limits."--------------------------------------------------------------------------------------- Arachnoid cysts are basically developmental artifacts in the brain. For the most part they are harmless. They only get bad if they get big enough to press against normal brain tissue. In this case the radiologist has said that they DO NOT. So i am going to say that thats not significant. If you are really worried about them. get another MRI in 10-15 years and see if they have grown by then. Thats how slow they grow. Now, to the flow voids... I am assuming that they did not inject any 'contrast/dye' for this MRI. If they did, please correct me. Standard MRI can’t see fluid that is moving, such as blood in an artery, and this creates “flow voids” that appear as black holes on the image. This is PERFECTLY NORMAL. Ignore it. The rest of that passage is normal ----------The visualized orbital contents, skullbase and surrounding soft tissues are unremarkable. Note is made of mildly prominent adenoid tissue containing small cystic foci. Asymmetric signal in the petrous apices likely reflect asymmetric pneumatization. The visualized paranasal sinuses and mastoid air cells are unremarkable.------------------------------------------------------------------------------ You are still quite young, your adenoids haven't completely dissipated yet. Unless you recently had a throat infection or something. Not a significant finding. Don't worry. Asymmetric Petrous pneumatization? Good lord your radiologist was being very thorough. This is another birth anomally, happens in TONS of people and is of no consequence. Ignore it. ------------------------------------------------------------------------------------------ Now ends the Brain. From what I have read so far. You have a perfectly lovely one. We shall look at the MRI of the Spine now ------------------------------------------------------------------------------------------ ------------------------There is a crescentic dorsal epidural fluid, starting at the level of C7, extending to upper thoracic spine, incompletely imaged. No abnormal enhancement is seen. In the upper thoracic spine, the central canal is narrowed, although there is no obvious mass effect on the spinal cord. Maximal thickness of this collection in the upper thoracic spine is approximately 4 mm.-------------------- The radiologist sees some kind of fluid in the epidural space, which shouldn't really be there. Though you can't really tell what fluid it is purely by imaging. They gave us a great clue. They said that it's NOT enhancing. That's great a signal enhancing fluid in this case would most likely be inflammatory tissue or pus in that epidural space. But since it's not enhancing. Don't worry. But why that fluid is there in the first place is a mystery to me. Again, just like before. It could be explained by leakage of CSF after a tap or injection in that region. But it could be alot of things. I need more information. This is a significant finding and you need to bring this up with your spine guy. If there is a CSF leak, it needs to be addressed. Central thoracic canal narrowing is pretty common in women. Don't worry about it. They only time that you have to worry is if the canal is squeezing the cord. That ain't happening here. So no worries. It does bring up another issue though. As women age, they tend to lose bone density and suffer from a disease called osteoporosis. That would be BAD in this case as the canal would get even narrower. Don't let this happen to you. Exercise, eat right, do stretches and talk to your primary about osteoporosis prevention. You're youth will protect you for another 2 to 3 decades. but then after that, it could get rough in this part of the spine. Be careful! ---------------------------------------------------------------------------------------------- There is a minimal linear T2 hyperintense signal enhancement in the right paraspinal soft tissue of T7-L1, which could be related to recent epidural injection. --------------------------------------------------------------------------------------------- That sort of explains itself. You had an injection there i bet. That ought to be the cause. Most of the time it will clear up pretty fast. The best person that can explain whats going on here is the person who did the injecting. Talk to them about it. i dunno what they injected and why they did it. So most of what I type here would be wild speculation. Again I need more info. ---------------------------------------------------------------------------------------------- There are mild degenerative changes involving the intervertebral discs, without remarkable central canal or foraminal stenosis. The visualized paraspinal soft tissue is without worrisome finding. ---------------------------------------------------------------------------------------------- So here the radiologist has said that your showing age related changes in the soft discs that cushion the vertebrae. I'm actually intrigued by this. You're a bit on the young side to show something like this. I normally see something like this in people who are overweight. I'm not saying that's the only cause. Years of adventure sports or off road driving can lead to the same effect (lots of wear and tear on the back). Nonetheless, it's an incidental finding here and the best you can do about it is to be really nice to your back. Exercise regularly and make sure you maintain a healthy weight. 'Age related' = We can't do anything about it.. Unfortunately. So after this, the text of the MRI repeats itself. I think something happened when they copied this text to you. But anyways. I'm reasonably sure I covered all the important findings. The injections MAY BE what are causing the changes in this image. But please believe me when I tell you that... An image WITHOUT a symptoms is useless! So can you tell me what made you get the injections and what has been going on since then? That way we can have a more useful discussion. Until then... well I hope I helped. At least to cut through the Jargon. Feel free to follow-up at your convenience. You are in the US and I'm in Bangalore. So your night is my day and vice versa. So there might be a delay in our communication. But overall I will try and get back to ASAP. Take care. Thanks for coming to HealthCareMagic.com Vinay

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Brief Answer: CSF leak and Reaction to injectable Detailed Answer: Hi. Thanks for following up. God you've been through Hell. I am sorry. Just so sorry. I hope you are getting better over time. I think you have one major problem and might have 1 minor problem. The Major problem: CSF Leak If this is true then you are in luck. Because IT CAN BE FIXED! There are many ways of doing it. In my practice I normally admit the patient in the hospital and implant a tiny tube through the skin and between the lumbar vertebrae. This tube is called a lumbar shunt (or lumbar drain) and what it does is drains CSF that is being made from your brain out of the body via the shunt into a a bag at the side of the bed. It's not very painful, but it is uncomfortable and you have to stay bed bound as long as the catheter is in. The catheter is basically draining CSF through a 'man made' or 'doctor made' shunt that is sterile and is draining it out of the body. The catheter is larger than the other tiny holes in the dura that are leaking CSF... so CSF would prefer to drain through the XXXXXXX rather than the other holes. Over time (days), the existing holes should seal up since CSF is not trying to push out between them. Then, normally I can take out the catheter at the bed side and wait a few more days. The dural sac in the lumbar region is much thicker and normally heals quite well. All in all the method is SLOW and tedious but yields good results with minimal invasion of the spine. But make no mistake. It does not always work. Sometimes the lumbar 'doctor made' hole doesn't get better and it just shifts the problem or worsens it. This has never happened in my experience... but it has been known to happen. So it would be silly of me not to warn you. Secondly. The damn XXXXXXX is a highway for infections and has to be kept really really clean. A good nursing team can help you there though. Normally nurses who deal with these things are insanely careful about not letting an infection happen.. and that is to their credit. The second option is to operate and I'm not going to get into that until we see that bridge coming up before us. So if it is a CSF leak, you are in for some time and treatment, but eventually things should get back to normal. I'm hoping that's how it goes for you. The Minor problem: Reaction to the content of the injections. I am thinking that whatever med was in the injection (normally its a combination of a steroid and a local anesthetic) may have had some odd side effects on your brain. It's really really a reach, but if the steroid & anesthetic (which i can't be sure was given) got into your CSF AND/OR your bloodstream and hit the brain(which I can't be sure that it did), then you could suffer from what is called 'steroid psychosis' which is a temporary side effect of steroids that happens to a small portion of the population. I have never seen it happen after an injection. The more I theorize, the more I make myself feel like i'm full of it. But i've seen steroid psychosis in people who were on injectable steroids and oral steroids. So it's a possibility.. a very remote possibility. But if that's the case, again, rejoice, because the side effect wears off once the steroid wears off and there is no long lasting harm done to the brain. The major issue I'm more sure of, the minor issue is a shot in the dark to try and fit your symptoms into a narrative that I have concocted in my head. If I can think of something more realistic or believable or if i am missing something that is making me overlook a theory that fits better, i will get back to you. Again. I hope I am helping here. Feel free to follow up! Take heart, the body has incredible regenerative capability and at your age, the CNS is well nigh indestructible. You WILL get better in time. It's just that you, unfortunate soul, are suffering AT this time. It shall pass. I give you my best. Vinay

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Brief Answer: Take Care Detailed Answer: If you need any other info, let me know

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