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Cerebrovascular Ischaemic Disease/small White Matter Infarcts. Few Focal Areas Of
Question: Cerebrovascular ischaemic disease/small white matter infarcts. Few focal areas of increased T2 signal are present in the subcortial & deep white matter of right front & temporal lobes largest measuring 1cm. Please advise as to what this means & treatment if needed . Thanks
Cerebrovascular ischaemic disease/small white matter infarcts. Few focal areas of increased T2 signal are present in the subcortial & deep white matter of right front & temporal lobes largest measuring 1cm. Please advise as to what this means & treatment if needed . Thanks
Brief Answer:
Nonspecific results & so not entirely impressive BUT read on young lady
Detailed Answer:
Good afternoon.
Thank you for sharing your results of what appears to be an MRI of the brain, your brain I would imagine...or at least someone you know? The findings of ischaemic (as we Yanks would write ischEmic) with small white matter infarcts would be looked at in isolation as being very nonspecific findings. They do not signal the area of a STROKE in the generic or common sense of the word. Yes, they do represent less than PERFECT findings of the brain....but they are within what we would call tolerance levels of normalcy if you take into consideration the processes of aging which could be a contributing or causative factor for this picture, or smoking cigarettes, or being a diabetic, or having hypertension (high blood pressure), or any other numbers of metabolic sorts of diseases that could minor changes and losses to oxygenation to the brain which cause MICROINFARCTS that are usually clinically SILENT.
However, when congealed into a radiographic picture using technology such as an MRI (which can resolve lesions down to 1 mm in diameter) can be visualized in their cumulative effect. Of course, there is somewhat of a limit to how much degenerative disease is allowed to make place and be considered within the limit of normalcy and that would be your neurological functioning.
Now, as far as the "few focal areas of increased T2 signal" lesions that are in the subcortical and deep white matter in the right frontal and temporal largest measuring up to 1 cm. in diameter....now these are slightly bigger and potentially more important things to analyze especially if they are located either JUXTACORTICALLY....in other words...right at the BORDER between the cortex and subcortex (or the gray and white matter junctions). Or if these are right next to the border of the ventricular white matter region.
If an individual has symptoms that go along with a clinical picture of something such as DEMYELINATION then, the diagnosis could be anything from nutritional deficiencies of B12, Vitamin D, or other elements taken in through the diet to something such as sarcoidosis, multiple sclerosis, or other demyelinating diseases. It really depends on the clinical information (which you've not provided young lady....).
Also, these scan results do not include any discussions on the presence or absence of IV contrast such as gadolinium. If these are NONCONTRASTED images then, it may not be possible to fully exclude certain pathologies and it would be much better if the ordering physician were to have run the test using a little contrast.
I would NEVER treat anybody simply on the basis of this scan...not enough information. I wouldn't be surprised if this person DIDN'T NEED any treatment at all....but again, depends on why the scan was obtained, and if a contrasted study was either done or is forthcoming as to how much weight can be placed on these results.
If getting a contrasted study were completely and utterly out of the question then, if I were the ordering physician I might ask the neuroradiologist to see if they could read these films once again using gradient or proton spin sequences. That would be the "poor man's alternative" to the IV gadolinium. Plus I never like shooting the IV contrast into someone if I can avoid it....sometimes, it's absolutely necessary but other times we can get away without contrast and still get a fair amount of information.
I'm sorry if this has created yet more questions than answers.....but the lesson to be learned is that rarely, if ever in the world of medicine can results from a single test or study make a diagnosis....unless of course, it's a PREGNANCY TEST! LOL.....Perhaps, in that single case a test result is pretty darned diagnostic, wouldn't you say?
But with anything else...it's always best that one provide some descriptive context as to why the study was ordered, symptoms that are current vs. what may have been happening in the immediate days or weeks prior to going to the doctor in the first place. That makes the scan results SO MUCH EASIER to understand.
Oh, and of course, remember what I said about smoking, diabetes, hypertension....if there is any medical history of any of that going on as well do be sure to let your interpreting physician know....Cheers my dear!
And so, if I've provided useful or helpful information to your question could you do me the utmost of favors in not forgetting to CLOSE THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at: www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 29 minutes of professional time to research, assimilate, and respond in complete form.
Nonspecific results & so not entirely impressive BUT read on young lady
Detailed Answer:
Good afternoon.
Thank you for sharing your results of what appears to be an MRI of the brain, your brain I would imagine...or at least someone you know? The findings of ischaemic (as we Yanks would write ischEmic) with small white matter infarcts would be looked at in isolation as being very nonspecific findings. They do not signal the area of a STROKE in the generic or common sense of the word. Yes, they do represent less than PERFECT findings of the brain....but they are within what we would call tolerance levels of normalcy if you take into consideration the processes of aging which could be a contributing or causative factor for this picture, or smoking cigarettes, or being a diabetic, or having hypertension (high blood pressure), or any other numbers of metabolic sorts of diseases that could minor changes and losses to oxygenation to the brain which cause MICROINFARCTS that are usually clinically SILENT.
However, when congealed into a radiographic picture using technology such as an MRI (which can resolve lesions down to 1 mm in diameter) can be visualized in their cumulative effect. Of course, there is somewhat of a limit to how much degenerative disease is allowed to make place and be considered within the limit of normalcy and that would be your neurological functioning.
Now, as far as the "few focal areas of increased T2 signal" lesions that are in the subcortical and deep white matter in the right frontal and temporal largest measuring up to 1 cm. in diameter....now these are slightly bigger and potentially more important things to analyze especially if they are located either JUXTACORTICALLY....in other words...right at the BORDER between the cortex and subcortex (or the gray and white matter junctions). Or if these are right next to the border of the ventricular white matter region.
If an individual has symptoms that go along with a clinical picture of something such as DEMYELINATION then, the diagnosis could be anything from nutritional deficiencies of B12, Vitamin D, or other elements taken in through the diet to something such as sarcoidosis, multiple sclerosis, or other demyelinating diseases. It really depends on the clinical information (which you've not provided young lady....).
Also, these scan results do not include any discussions on the presence or absence of IV contrast such as gadolinium. If these are NONCONTRASTED images then, it may not be possible to fully exclude certain pathologies and it would be much better if the ordering physician were to have run the test using a little contrast.
I would NEVER treat anybody simply on the basis of this scan...not enough information. I wouldn't be surprised if this person DIDN'T NEED any treatment at all....but again, depends on why the scan was obtained, and if a contrasted study was either done or is forthcoming as to how much weight can be placed on these results.
If getting a contrasted study were completely and utterly out of the question then, if I were the ordering physician I might ask the neuroradiologist to see if they could read these films once again using gradient or proton spin sequences. That would be the "poor man's alternative" to the IV gadolinium. Plus I never like shooting the IV contrast into someone if I can avoid it....sometimes, it's absolutely necessary but other times we can get away without contrast and still get a fair amount of information.
I'm sorry if this has created yet more questions than answers.....but the lesson to be learned is that rarely, if ever in the world of medicine can results from a single test or study make a diagnosis....unless of course, it's a PREGNANCY TEST! LOL.....Perhaps, in that single case a test result is pretty darned diagnostic, wouldn't you say?
But with anything else...it's always best that one provide some descriptive context as to why the study was ordered, symptoms that are current vs. what may have been happening in the immediate days or weeks prior to going to the doctor in the first place. That makes the scan results SO MUCH EASIER to understand.
Oh, and of course, remember what I said about smoking, diabetes, hypertension....if there is any medical history of any of that going on as well do be sure to let your interpreting physician know....Cheers my dear!
And so, if I've provided useful or helpful information to your question could you do me the utmost of favors in not forgetting to CLOSE THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at: www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 29 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Nonspecific results & so not entirely impressive BUT read on young lady
Detailed Answer:
Good afternoon.
Thank you for sharing your results of what appears to be an MRI of the brain, your brain I would imagine...or at least someone you know? The findings of ischaemic (as we Yanks would write ischEmic) with small white matter infarcts would be looked at in isolation as being very nonspecific findings. They do not signal the area of a STROKE in the generic or common sense of the word. Yes, they do represent less than PERFECT findings of the brain....but they are within what we would call tolerance levels of normalcy if you take into consideration the processes of aging which could be a contributing or causative factor for this picture, or smoking cigarettes, or being a diabetic, or having hypertension (high blood pressure), or any other numbers of metabolic sorts of diseases that could minor changes and losses to oxygenation to the brain which cause MICROINFARCTS that are usually clinically SILENT.
However, when congealed into a radiographic picture using technology such as an MRI (which can resolve lesions down to 1 mm in diameter) can be visualized in their cumulative effect. Of course, there is somewhat of a limit to how much degenerative disease is allowed to make place and be considered within the limit of normalcy and that would be your neurological functioning.
Now, as far as the "few focal areas of increased T2 signal" lesions that are in the subcortical and deep white matter in the right frontal and temporal largest measuring up to 1 cm. in diameter....now these are slightly bigger and potentially more important things to analyze especially if they are located either JUXTACORTICALLY....in other words...right at the BORDER between the cortex and subcortex (or the gray and white matter junctions). Or if these are right next to the border of the ventricular white matter region.
If an individual has symptoms that go along with a clinical picture of something such as DEMYELINATION then, the diagnosis could be anything from nutritional deficiencies of B12, Vitamin D, or other elements taken in through the diet to something such as sarcoidosis, multiple sclerosis, or other demyelinating diseases. It really depends on the clinical information (which you've not provided young lady....).
Also, these scan results do not include any discussions on the presence or absence of IV contrast such as gadolinium. If these are NONCONTRASTED images then, it may not be possible to fully exclude certain pathologies and it would be much better if the ordering physician were to have run the test using a little contrast.
I would NEVER treat anybody simply on the basis of this scan...not enough information. I wouldn't be surprised if this person DIDN'T NEED any treatment at all....but again, depends on why the scan was obtained, and if a contrasted study was either done or is forthcoming as to how much weight can be placed on these results.
If getting a contrasted study were completely and utterly out of the question then, if I were the ordering physician I might ask the neuroradiologist to see if they could read these films once again using gradient or proton spin sequences. That would be the "poor man's alternative" to the IV gadolinium. Plus I never like shooting the IV contrast into someone if I can avoid it....sometimes, it's absolutely necessary but other times we can get away without contrast and still get a fair amount of information.
I'm sorry if this has created yet more questions than answers.....but the lesson to be learned is that rarely, if ever in the world of medicine can results from a single test or study make a diagnosis....unless of course, it's a PREGNANCY TEST! LOL.....Perhaps, in that single case a test result is pretty darned diagnostic, wouldn't you say?
But with anything else...it's always best that one provide some descriptive context as to why the study was ordered, symptoms that are current vs. what may have been happening in the immediate days or weeks prior to going to the doctor in the first place. That makes the scan results SO MUCH EASIER to understand.
Oh, and of course, remember what I said about smoking, diabetes, hypertension....if there is any medical history of any of that going on as well do be sure to let your interpreting physician know....Cheers my dear!
And so, if I've provided useful or helpful information to your question could you do me the utmost of favors in not forgetting to CLOSE THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at: www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 29 minutes of professional time to research, assimilate, and respond in complete form.
Nonspecific results & so not entirely impressive BUT read on young lady
Detailed Answer:
Good afternoon.
Thank you for sharing your results of what appears to be an MRI of the brain, your brain I would imagine...or at least someone you know? The findings of ischaemic (as we Yanks would write ischEmic) with small white matter infarcts would be looked at in isolation as being very nonspecific findings. They do not signal the area of a STROKE in the generic or common sense of the word. Yes, they do represent less than PERFECT findings of the brain....but they are within what we would call tolerance levels of normalcy if you take into consideration the processes of aging which could be a contributing or causative factor for this picture, or smoking cigarettes, or being a diabetic, or having hypertension (high blood pressure), or any other numbers of metabolic sorts of diseases that could minor changes and losses to oxygenation to the brain which cause MICROINFARCTS that are usually clinically SILENT.
However, when congealed into a radiographic picture using technology such as an MRI (which can resolve lesions down to 1 mm in diameter) can be visualized in their cumulative effect. Of course, there is somewhat of a limit to how much degenerative disease is allowed to make place and be considered within the limit of normalcy and that would be your neurological functioning.
Now, as far as the "few focal areas of increased T2 signal" lesions that are in the subcortical and deep white matter in the right frontal and temporal largest measuring up to 1 cm. in diameter....now these are slightly bigger and potentially more important things to analyze especially if they are located either JUXTACORTICALLY....in other words...right at the BORDER between the cortex and subcortex (or the gray and white matter junctions). Or if these are right next to the border of the ventricular white matter region.
If an individual has symptoms that go along with a clinical picture of something such as DEMYELINATION then, the diagnosis could be anything from nutritional deficiencies of B12, Vitamin D, or other elements taken in through the diet to something such as sarcoidosis, multiple sclerosis, or other demyelinating diseases. It really depends on the clinical information (which you've not provided young lady....).
Also, these scan results do not include any discussions on the presence or absence of IV contrast such as gadolinium. If these are NONCONTRASTED images then, it may not be possible to fully exclude certain pathologies and it would be much better if the ordering physician were to have run the test using a little contrast.
I would NEVER treat anybody simply on the basis of this scan...not enough information. I wouldn't be surprised if this person DIDN'T NEED any treatment at all....but again, depends on why the scan was obtained, and if a contrasted study was either done or is forthcoming as to how much weight can be placed on these results.
If getting a contrasted study were completely and utterly out of the question then, if I were the ordering physician I might ask the neuroradiologist to see if they could read these films once again using gradient or proton spin sequences. That would be the "poor man's alternative" to the IV gadolinium. Plus I never like shooting the IV contrast into someone if I can avoid it....sometimes, it's absolutely necessary but other times we can get away without contrast and still get a fair amount of information.
I'm sorry if this has created yet more questions than answers.....but the lesson to be learned is that rarely, if ever in the world of medicine can results from a single test or study make a diagnosis....unless of course, it's a PREGNANCY TEST! LOL.....Perhaps, in that single case a test result is pretty darned diagnostic, wouldn't you say?
But with anything else...it's always best that one provide some descriptive context as to why the study was ordered, symptoms that are current vs. what may have been happening in the immediate days or weeks prior to going to the doctor in the first place. That makes the scan results SO MUCH EASIER to understand.
Oh, and of course, remember what I said about smoking, diabetes, hypertension....if there is any medical history of any of that going on as well do be sure to let your interpreting physician know....Cheers my dear!
And so, if I've provided useful or helpful information to your question could you do me the utmost of favors in not forgetting to CLOSE THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few weeks if you'd drop me a line at: www.bit.ly/drdariushsaghafi
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
This query required 29 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sorry should have given more info - have been suffering from Tigeminal Neuralgia - previous MRI results Prominent Pointine angleblood vessels encroaching upon the Trigeminal ganglion.also sizeable disc profusion C5/c6 compressive myelopathy plus narrowing of the exiting foramina bilateraly . They are referring me to a neurosurgeon & a spinal surgeon. Am in considerable pain & new symptom us my left eye will not open at times intermittently , have tried lots of medications unsuccessfully. Am in constant pain dull ache but then a pain comes that is so sharp & am not able to think clearly - awaiting your comments thankyou
Sorry should have given more info - have been suffering from Tigeminal Neuralgia - previous MRI results Prominent Pointine angleblood vessels encroaching upon the Trigeminal ganglion.also sizeable disc profusion C5/c6 compressive myelopathy plus narrowing of the exiting foramina bilateraly . They are referring me to a neurosurgeon & a spinal surgeon. Am in considerable pain & new symptom us my left eye will not open at times intermittently , have tried lots of medications unsuccessfully. Am in constant pain dull ache but then a pain comes that is so sharp & am not able to think clearly - awaiting your comments thankyou
Brief Answer:
Oh my...but there is more information behind the curtain isn't there? :)
Detailed Answer:
Ask and you shall find! ;0
So there IS a bit more hidden information for the asking isn't there young lady? And since you're asking many questions....I suppose I'm relegated to doing the best I can at TRANSLATING Greek and Latin into English...HA!
So sorry that you're experiencing pains as you describe and the scan results are a bit more telling in terms of your symptoms as compared to the 1st go around. Let's have at this latest cacophany of vocabulary, shall we?
1. The radiologist doing the read believes there to be some blood vessel encroachment upon the trigeminal ganglion which is the location in the brain from where the TRIGEMINAL NERVE projects across space and flares out to 3 major places in the face and head to innervate the skin and other structures located in the ORBIT and FRONTAL area of the face and head up to about your hairline (where your eyelid seems to be giving some trouble), the MAXILLA (cheek and large sinus cavity behind to include areas a bit in front of the ear by a couple of centimeters), and MANDIBULAR (jawbone area that covers a band of area between the front of the ear and backward a bit to about the midline) for the both sensory as well as motor purposes. Take a look at this diagram if you've got a moment and you can see a LOVELY cartoon drawing of what the anatomy looks like which may help you understand why you're having some of the pain and other symptoms in the areas of the face and head.
http://cdn.yourarticlelibrary.com/wp-content/uploads/2013/09/clip_image00654.jpg
2. The scan is SUGGESTING is that there may be some small blood vessel (usually a very tiny artery or loop of an artery) that could be passing extremely closely to the trajectory of the nerve as it spirals out from the ganglion to go on its way to the front of the head. Since your left eye seems to be the organ you refer to with the droopy eyelid I am going to hazard a guess that it's the left ganglion and left trigeminal nerve that are involved. If the artery or arteries happen to come into contact with any part of the trigeminal nerve (even if BEFORE the level of the TRIGEMINAL GANGLION itself which would be closer to the brainstem then, PAINFUL or even WEAKENED muscle actions can happen depending upon which tract of the trigeminal nerve is being mostly IRRITATED by these rogue blood vessels. You may be familiar with the problems that occur when small siblings begin using their hands on each other to play in an IRRITATING way, right? One is just having devlish fun while the other just gets more and more irritated and frustrated until SOMEONE finally comes and separates the warring factions! LOL......Well, in this case the siblings would be the trigeminal nerve root or any of its divisions exiting the TRIGEMINAL GANGLION and the ROGUE artery or arteries that hovering too close for comfort. But if the NEUROSURGEON can get in between these little playmates and keep them from irritating each other.....ahhhhh....well, now there may be piece.....for the children, for the parents, and everyone's happy!
3. Of course, pain medications trying to alleviate the neuropathic pains caused by this irritatative effect of what is PRESUMED to be blood vessels that may somehow be in excessive contact or COMPRESSING the nerve fibers or even the nerve roots themselves as they leave either the brainstem (pons) or from the ganglion would be to blame for all this discomfort as well as your left eyelid that may want to be intermittently droopy....make sense?
If I were your neurologist on this case I'd be requesting some HIGH RESOLUTION MRI and MRA images of several locations (maybe they've already done these). One would be MECKELS CAVE in the CAVERNOUS SINUS with attention to the TRIGEMINAL (or GASSERIAN) GANGLION. Another area that I believe may be compromised would be from where the TRIGEMINAL NERVE first exits the PONTINE REGION of the brainstem. I would ask for some focused HIGH RESOLUTION cuts through that region looking for any evidence of obstruction or compromise.
The compressive myelopathy is yet another widget in the pie to deal with but simply put your spinal cord is being SQUEEZED a bit (usually by arthritic degenerative processes such as bulging discs, herniated discs, calcifications of small bones that are spurred) at the C5/6 level. This could in theory compromise some of the OPHTHALMIC FIBERS that go to the orbital portion of the TRIGEMINAL NERVE because these fibers actually drop down a few segments into the spinal cord before turning back upward to travel to the eye/orbital/frontal region of the head and face. Also, you could be getting some zingers down your left arm if that myelopathy is on the left side as well or even weakness in the DELTOID MUSCLE which means lifting the arm against gravity could be a little more difficult or it may cause you pain to do so.
Again, I'm so sorry that you're so uncomfortable but in a way the good news is that these scans do provide at least some plausible/compelling evidence for why things are the way they are. Now, the heavy lifting comes with the neurosurgeons and the spinal surgeons to see what they can offer in terms of decompressive surgical procedures to get some of this "off your shoulders...and your EYE" so to speak!
I'm going to provide you one more link to the actual article on trigeminal anatomy that you may find interesting although I guarantee you're going to find an alphabet soup of GREEK AND LATIN in here too! LOL..... But look, there are very nice diagrams and I'm sure that a well versed young lady with some obvious vested interests in knowing as much as possible would be able to make at least some heads and tails from the pictures and you could even print some of these things out to take to your doctors to explain what's in the drawings and show you what the plan just might be if they think they can get in and make this all better.
Once again young lady, if I've provided useful or helpful information to your question would you be so kind as to not forget to CLOSE THE QUERY along with some constructive feedback and maybe even a 5 STAR rating if you feel I've done your question justice?
And by all means as well as PLEASE drop me a line at: www.bit.ly/drdariushsaghafi and let me know how the good doctors are going to proceed. Surgery in this case I believe can have its challenges (though admittedly I'm not a surgeon...I'm a NEUROLOGIST....one who TELLS the surgeons where to cut...while they build the highway and smile all the way to the bank! LOLOLOL). If I were in your very position I might wish to know their opinion on doing things in stages.....in other words, with the compressive MYELOPATHY in the spinal cord POSSIBLY needing to be addressed and the uncertain issue with whether or not there is TRULY compressive problems going on around or in the TRIGEMINAL GANGLION.....one must wonder whether fixing everything at once is likely to cause everything to get better (cured even?) or could other unforeseen problems arise that may lead to more difficulties such as pain or other untoward effects of manipulating such structures.
One test that may help resolve some of those questions would be AN EMG/NCV electrical study looking exactly at the SPINAL COMPRESSIVE at C5/6. The electrical test is fairly sensitive to cord compressions and it can detect changes downstream from where the spinal nerves are exiting into the neck, shoulders, and arms to tell whether that phenomenon is causing electrical problems of import....or does it just LOOK bad on the scan? See my point? And so that may be one little wrinkle I would throw into the discussion if I were the one being proposed upon by my friendly surgeons.
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
Cheers Milady!
This query required 90 minutes of professional time to research, assimilate, and respond in complete form.
Oh my...but there is more information behind the curtain isn't there? :)
Detailed Answer:
Ask and you shall find! ;0
So there IS a bit more hidden information for the asking isn't there young lady? And since you're asking many questions....I suppose I'm relegated to doing the best I can at TRANSLATING Greek and Latin into English...HA!
So sorry that you're experiencing pains as you describe and the scan results are a bit more telling in terms of your symptoms as compared to the 1st go around. Let's have at this latest cacophany of vocabulary, shall we?
1. The radiologist doing the read believes there to be some blood vessel encroachment upon the trigeminal ganglion which is the location in the brain from where the TRIGEMINAL NERVE projects across space and flares out to 3 major places in the face and head to innervate the skin and other structures located in the ORBIT and FRONTAL area of the face and head up to about your hairline (where your eyelid seems to be giving some trouble), the MAXILLA (cheek and large sinus cavity behind to include areas a bit in front of the ear by a couple of centimeters), and MANDIBULAR (jawbone area that covers a band of area between the front of the ear and backward a bit to about the midline) for the both sensory as well as motor purposes. Take a look at this diagram if you've got a moment and you can see a LOVELY cartoon drawing of what the anatomy looks like which may help you understand why you're having some of the pain and other symptoms in the areas of the face and head.
http://cdn.yourarticlelibrary.com/wp-content/uploads/2013/09/clip_image00654.jpg
2. The scan is SUGGESTING is that there may be some small blood vessel (usually a very tiny artery or loop of an artery) that could be passing extremely closely to the trajectory of the nerve as it spirals out from the ganglion to go on its way to the front of the head. Since your left eye seems to be the organ you refer to with the droopy eyelid I am going to hazard a guess that it's the left ganglion and left trigeminal nerve that are involved. If the artery or arteries happen to come into contact with any part of the trigeminal nerve (even if BEFORE the level of the TRIGEMINAL GANGLION itself which would be closer to the brainstem then, PAINFUL or even WEAKENED muscle actions can happen depending upon which tract of the trigeminal nerve is being mostly IRRITATED by these rogue blood vessels. You may be familiar with the problems that occur when small siblings begin using their hands on each other to play in an IRRITATING way, right? One is just having devlish fun while the other just gets more and more irritated and frustrated until SOMEONE finally comes and separates the warring factions! LOL......Well, in this case the siblings would be the trigeminal nerve root or any of its divisions exiting the TRIGEMINAL GANGLION and the ROGUE artery or arteries that hovering too close for comfort. But if the NEUROSURGEON can get in between these little playmates and keep them from irritating each other.....ahhhhh....well, now there may be piece.....for the children, for the parents, and everyone's happy!
3. Of course, pain medications trying to alleviate the neuropathic pains caused by this irritatative effect of what is PRESUMED to be blood vessels that may somehow be in excessive contact or COMPRESSING the nerve fibers or even the nerve roots themselves as they leave either the brainstem (pons) or from the ganglion would be to blame for all this discomfort as well as your left eyelid that may want to be intermittently droopy....make sense?
If I were your neurologist on this case I'd be requesting some HIGH RESOLUTION MRI and MRA images of several locations (maybe they've already done these). One would be MECKELS CAVE in the CAVERNOUS SINUS with attention to the TRIGEMINAL (or GASSERIAN) GANGLION. Another area that I believe may be compromised would be from where the TRIGEMINAL NERVE first exits the PONTINE REGION of the brainstem. I would ask for some focused HIGH RESOLUTION cuts through that region looking for any evidence of obstruction or compromise.
The compressive myelopathy is yet another widget in the pie to deal with but simply put your spinal cord is being SQUEEZED a bit (usually by arthritic degenerative processes such as bulging discs, herniated discs, calcifications of small bones that are spurred) at the C5/6 level. This could in theory compromise some of the OPHTHALMIC FIBERS that go to the orbital portion of the TRIGEMINAL NERVE because these fibers actually drop down a few segments into the spinal cord before turning back upward to travel to the eye/orbital/frontal region of the head and face. Also, you could be getting some zingers down your left arm if that myelopathy is on the left side as well or even weakness in the DELTOID MUSCLE which means lifting the arm against gravity could be a little more difficult or it may cause you pain to do so.
Again, I'm so sorry that you're so uncomfortable but in a way the good news is that these scans do provide at least some plausible/compelling evidence for why things are the way they are. Now, the heavy lifting comes with the neurosurgeons and the spinal surgeons to see what they can offer in terms of decompressive surgical procedures to get some of this "off your shoulders...and your EYE" so to speak!
I'm going to provide you one more link to the actual article on trigeminal anatomy that you may find interesting although I guarantee you're going to find an alphabet soup of GREEK AND LATIN in here too! LOL..... But look, there are very nice diagrams and I'm sure that a well versed young lady with some obvious vested interests in knowing as much as possible would be able to make at least some heads and tails from the pictures and you could even print some of these things out to take to your doctors to explain what's in the drawings and show you what the plan just might be if they think they can get in and make this all better.
Once again young lady, if I've provided useful or helpful information to your question would you be so kind as to not forget to CLOSE THE QUERY along with some constructive feedback and maybe even a 5 STAR rating if you feel I've done your question justice?
And by all means as well as PLEASE drop me a line at: www.bit.ly/drdariushsaghafi and let me know how the good doctors are going to proceed. Surgery in this case I believe can have its challenges (though admittedly I'm not a surgeon...I'm a NEUROLOGIST....one who TELLS the surgeons where to cut...while they build the highway and smile all the way to the bank! LOLOLOL). If I were in your very position I might wish to know their opinion on doing things in stages.....in other words, with the compressive MYELOPATHY in the spinal cord POSSIBLY needing to be addressed and the uncertain issue with whether or not there is TRULY compressive problems going on around or in the TRIGEMINAL GANGLION.....one must wonder whether fixing everything at once is likely to cause everything to get better (cured even?) or could other unforeseen problems arise that may lead to more difficulties such as pain or other untoward effects of manipulating such structures.
One test that may help resolve some of those questions would be AN EMG/NCV electrical study looking exactly at the SPINAL COMPRESSIVE at C5/6. The electrical test is fairly sensitive to cord compressions and it can detect changes downstream from where the spinal nerves are exiting into the neck, shoulders, and arms to tell whether that phenomenon is causing electrical problems of import....or does it just LOOK bad on the scan? See my point? And so that may be one little wrinkle I would throw into the discussion if I were the one being proposed upon by my friendly surgeons.
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
Cheers Milady!
This query required 90 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Oh my...but there is more information behind the curtain isn't there? :)
Detailed Answer:
Ask and you shall find! ;0
So there IS a bit more hidden information for the asking isn't there young lady? And since you're asking many questions....I suppose I'm relegated to doing the best I can at TRANSLATING Greek and Latin into English...HA!
So sorry that you're experiencing pains as you describe and the scan results are a bit more telling in terms of your symptoms as compared to the 1st go around. Let's have at this latest cacophany of vocabulary, shall we?
1. The radiologist doing the read believes there to be some blood vessel encroachment upon the trigeminal ganglion which is the location in the brain from where the TRIGEMINAL NERVE projects across space and flares out to 3 major places in the face and head to innervate the skin and other structures located in the ORBIT and FRONTAL area of the face and head up to about your hairline (where your eyelid seems to be giving some trouble), the MAXILLA (cheek and large sinus cavity behind to include areas a bit in front of the ear by a couple of centimeters), and MANDIBULAR (jawbone area that covers a band of area between the front of the ear and backward a bit to about the midline) for the both sensory as well as motor purposes. Take a look at this diagram if you've got a moment and you can see a LOVELY cartoon drawing of what the anatomy looks like which may help you understand why you're having some of the pain and other symptoms in the areas of the face and head.
http://cdn.yourarticlelibrary.com/wp-content/uploads/2013/09/clip_image00654.jpg
2. The scan is SUGGESTING is that there may be some small blood vessel (usually a very tiny artery or loop of an artery) that could be passing extremely closely to the trajectory of the nerve as it spirals out from the ganglion to go on its way to the front of the head. Since your left eye seems to be the organ you refer to with the droopy eyelid I am going to hazard a guess that it's the left ganglion and left trigeminal nerve that are involved. If the artery or arteries happen to come into contact with any part of the trigeminal nerve (even if BEFORE the level of the TRIGEMINAL GANGLION itself which would be closer to the brainstem then, PAINFUL or even WEAKENED muscle actions can happen depending upon which tract of the trigeminal nerve is being mostly IRRITATED by these rogue blood vessels. You may be familiar with the problems that occur when small siblings begin using their hands on each other to play in an IRRITATING way, right? One is just having devlish fun while the other just gets more and more irritated and frustrated until SOMEONE finally comes and separates the warring factions! LOL......Well, in this case the siblings would be the trigeminal nerve root or any of its divisions exiting the TRIGEMINAL GANGLION and the ROGUE artery or arteries that hovering too close for comfort. But if the NEUROSURGEON can get in between these little playmates and keep them from irritating each other.....ahhhhh....well, now there may be piece.....for the children, for the parents, and everyone's happy!
3. Of course, pain medications trying to alleviate the neuropathic pains caused by this irritatative effect of what is PRESUMED to be blood vessels that may somehow be in excessive contact or COMPRESSING the nerve fibers or even the nerve roots themselves as they leave either the brainstem (pons) or from the ganglion would be to blame for all this discomfort as well as your left eyelid that may want to be intermittently droopy....make sense?
If I were your neurologist on this case I'd be requesting some HIGH RESOLUTION MRI and MRA images of several locations (maybe they've already done these). One would be MECKELS CAVE in the CAVERNOUS SINUS with attention to the TRIGEMINAL (or GASSERIAN) GANGLION. Another area that I believe may be compromised would be from where the TRIGEMINAL NERVE first exits the PONTINE REGION of the brainstem. I would ask for some focused HIGH RESOLUTION cuts through that region looking for any evidence of obstruction or compromise.
The compressive myelopathy is yet another widget in the pie to deal with but simply put your spinal cord is being SQUEEZED a bit (usually by arthritic degenerative processes such as bulging discs, herniated discs, calcifications of small bones that are spurred) at the C5/6 level. This could in theory compromise some of the OPHTHALMIC FIBERS that go to the orbital portion of the TRIGEMINAL NERVE because these fibers actually drop down a few segments into the spinal cord before turning back upward to travel to the eye/orbital/frontal region of the head and face. Also, you could be getting some zingers down your left arm if that myelopathy is on the left side as well or even weakness in the DELTOID MUSCLE which means lifting the arm against gravity could be a little more difficult or it may cause you pain to do so.
Again, I'm so sorry that you're so uncomfortable but in a way the good news is that these scans do provide at least some plausible/compelling evidence for why things are the way they are. Now, the heavy lifting comes with the neurosurgeons and the spinal surgeons to see what they can offer in terms of decompressive surgical procedures to get some of this "off your shoulders...and your EYE" so to speak!
I'm going to provide you one more link to the actual article on trigeminal anatomy that you may find interesting although I guarantee you're going to find an alphabet soup of GREEK AND LATIN in here too! LOL..... But look, there are very nice diagrams and I'm sure that a well versed young lady with some obvious vested interests in knowing as much as possible would be able to make at least some heads and tails from the pictures and you could even print some of these things out to take to your doctors to explain what's in the drawings and show you what the plan just might be if they think they can get in and make this all better.
Once again young lady, if I've provided useful or helpful information to your question would you be so kind as to not forget to CLOSE THE QUERY along with some constructive feedback and maybe even a 5 STAR rating if you feel I've done your question justice?
And by all means as well as PLEASE drop me a line at: www.bit.ly/drdariushsaghafi and let me know how the good doctors are going to proceed. Surgery in this case I believe can have its challenges (though admittedly I'm not a surgeon...I'm a NEUROLOGIST....one who TELLS the surgeons where to cut...while they build the highway and smile all the way to the bank! LOLOLOL). If I were in your very position I might wish to know their opinion on doing things in stages.....in other words, with the compressive MYELOPATHY in the spinal cord POSSIBLY needing to be addressed and the uncertain issue with whether or not there is TRULY compressive problems going on around or in the TRIGEMINAL GANGLION.....one must wonder whether fixing everything at once is likely to cause everything to get better (cured even?) or could other unforeseen problems arise that may lead to more difficulties such as pain or other untoward effects of manipulating such structures.
One test that may help resolve some of those questions would be AN EMG/NCV electrical study looking exactly at the SPINAL COMPRESSIVE at C5/6. The electrical test is fairly sensitive to cord compressions and it can detect changes downstream from where the spinal nerves are exiting into the neck, shoulders, and arms to tell whether that phenomenon is causing electrical problems of import....or does it just LOOK bad on the scan? See my point? And so that may be one little wrinkle I would throw into the discussion if I were the one being proposed upon by my friendly surgeons.
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
Cheers Milady!
This query required 90 minutes of professional time to research, assimilate, and respond in complete form.
Oh my...but there is more information behind the curtain isn't there? :)
Detailed Answer:
Ask and you shall find! ;0
So there IS a bit more hidden information for the asking isn't there young lady? And since you're asking many questions....I suppose I'm relegated to doing the best I can at TRANSLATING Greek and Latin into English...HA!
So sorry that you're experiencing pains as you describe and the scan results are a bit more telling in terms of your symptoms as compared to the 1st go around. Let's have at this latest cacophany of vocabulary, shall we?
1. The radiologist doing the read believes there to be some blood vessel encroachment upon the trigeminal ganglion which is the location in the brain from where the TRIGEMINAL NERVE projects across space and flares out to 3 major places in the face and head to innervate the skin and other structures located in the ORBIT and FRONTAL area of the face and head up to about your hairline (where your eyelid seems to be giving some trouble), the MAXILLA (cheek and large sinus cavity behind to include areas a bit in front of the ear by a couple of centimeters), and MANDIBULAR (jawbone area that covers a band of area between the front of the ear and backward a bit to about the midline) for the both sensory as well as motor purposes. Take a look at this diagram if you've got a moment and you can see a LOVELY cartoon drawing of what the anatomy looks like which may help you understand why you're having some of the pain and other symptoms in the areas of the face and head.
http://cdn.yourarticlelibrary.com/wp-content/uploads/2013/09/clip_image00654.jpg
2. The scan is SUGGESTING is that there may be some small blood vessel (usually a very tiny artery or loop of an artery) that could be passing extremely closely to the trajectory of the nerve as it spirals out from the ganglion to go on its way to the front of the head. Since your left eye seems to be the organ you refer to with the droopy eyelid I am going to hazard a guess that it's the left ganglion and left trigeminal nerve that are involved. If the artery or arteries happen to come into contact with any part of the trigeminal nerve (even if BEFORE the level of the TRIGEMINAL GANGLION itself which would be closer to the brainstem then, PAINFUL or even WEAKENED muscle actions can happen depending upon which tract of the trigeminal nerve is being mostly IRRITATED by these rogue blood vessels. You may be familiar with the problems that occur when small siblings begin using their hands on each other to play in an IRRITATING way, right? One is just having devlish fun while the other just gets more and more irritated and frustrated until SOMEONE finally comes and separates the warring factions! LOL......Well, in this case the siblings would be the trigeminal nerve root or any of its divisions exiting the TRIGEMINAL GANGLION and the ROGUE artery or arteries that hovering too close for comfort. But if the NEUROSURGEON can get in between these little playmates and keep them from irritating each other.....ahhhhh....well, now there may be piece.....for the children, for the parents, and everyone's happy!
3. Of course, pain medications trying to alleviate the neuropathic pains caused by this irritatative effect of what is PRESUMED to be blood vessels that may somehow be in excessive contact or COMPRESSING the nerve fibers or even the nerve roots themselves as they leave either the brainstem (pons) or from the ganglion would be to blame for all this discomfort as well as your left eyelid that may want to be intermittently droopy....make sense?
If I were your neurologist on this case I'd be requesting some HIGH RESOLUTION MRI and MRA images of several locations (maybe they've already done these). One would be MECKELS CAVE in the CAVERNOUS SINUS with attention to the TRIGEMINAL (or GASSERIAN) GANGLION. Another area that I believe may be compromised would be from where the TRIGEMINAL NERVE first exits the PONTINE REGION of the brainstem. I would ask for some focused HIGH RESOLUTION cuts through that region looking for any evidence of obstruction or compromise.
The compressive myelopathy is yet another widget in the pie to deal with but simply put your spinal cord is being SQUEEZED a bit (usually by arthritic degenerative processes such as bulging discs, herniated discs, calcifications of small bones that are spurred) at the C5/6 level. This could in theory compromise some of the OPHTHALMIC FIBERS that go to the orbital portion of the TRIGEMINAL NERVE because these fibers actually drop down a few segments into the spinal cord before turning back upward to travel to the eye/orbital/frontal region of the head and face. Also, you could be getting some zingers down your left arm if that myelopathy is on the left side as well or even weakness in the DELTOID MUSCLE which means lifting the arm against gravity could be a little more difficult or it may cause you pain to do so.
Again, I'm so sorry that you're so uncomfortable but in a way the good news is that these scans do provide at least some plausible/compelling evidence for why things are the way they are. Now, the heavy lifting comes with the neurosurgeons and the spinal surgeons to see what they can offer in terms of decompressive surgical procedures to get some of this "off your shoulders...and your EYE" so to speak!
I'm going to provide you one more link to the actual article on trigeminal anatomy that you may find interesting although I guarantee you're going to find an alphabet soup of GREEK AND LATIN in here too! LOL..... But look, there are very nice diagrams and I'm sure that a well versed young lady with some obvious vested interests in knowing as much as possible would be able to make at least some heads and tails from the pictures and you could even print some of these things out to take to your doctors to explain what's in the drawings and show you what the plan just might be if they think they can get in and make this all better.
Once again young lady, if I've provided useful or helpful information to your question would you be so kind as to not forget to CLOSE THE QUERY along with some constructive feedback and maybe even a 5 STAR rating if you feel I've done your question justice?
And by all means as well as PLEASE drop me a line at: www.bit.ly/drdariushsaghafi and let me know how the good doctors are going to proceed. Surgery in this case I believe can have its challenges (though admittedly I'm not a surgeon...I'm a NEUROLOGIST....one who TELLS the surgeons where to cut...while they build the highway and smile all the way to the bank! LOLOLOL). If I were in your very position I might wish to know their opinion on doing things in stages.....in other words, with the compressive MYELOPATHY in the spinal cord POSSIBLY needing to be addressed and the uncertain issue with whether or not there is TRULY compressive problems going on around or in the TRIGEMINAL GANGLION.....one must wonder whether fixing everything at once is likely to cause everything to get better (cured even?) or could other unforeseen problems arise that may lead to more difficulties such as pain or other untoward effects of manipulating such structures.
One test that may help resolve some of those questions would be AN EMG/NCV electrical study looking exactly at the SPINAL COMPRESSIVE at C5/6. The electrical test is fairly sensitive to cord compressions and it can detect changes downstream from where the spinal nerves are exiting into the neck, shoulders, and arms to tell whether that phenomenon is causing electrical problems of import....or does it just LOOK bad on the scan? See my point? And so that may be one little wrinkle I would throw into the discussion if I were the one being proposed upon by my friendly surgeons.
You can always reach me at that address for this or other questions. I wish you the best with everything and hope this information does help you.
Cheers Milady!
This query required 90 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thankyou for your detailed help in all the above. Have now been put on Pregablin which I am hoping will help with the pain. Have appointment with the
Neuro surgeon & spine guys. Once again thanks for your help .
Neuro surgeon & spine guys. Once again thanks for your help .
Thankyou for your detailed help in all the above. Have now been put on Pregablin which I am hoping will help with the pain. Have appointment with the
Neuro surgeon & spine guys. Once again thanks for your help .
Neuro surgeon & spine guys. Once again thanks for your help .
Brief Answer:
Glad to hear PREGABALIN (Lyrica) is helping
Detailed Answer:
So glad to hear that the pregabalin is helping in your case.
Again, you may sense how cynical I can be with respect to what things show on radiographs, what symptoms patients have, and the good that neuro or spinal surgeons can be...especially when it comes to these sorts of surgeries. In my experience speaking and examining a number of patients who have had these types of surgeries.... the percentage of people who've had successes using surgical approaches is likely less than
5-10%....VERY VERY LOW percentage. I would want PROOF OF an EXTRAORDINARILY SOLID nature that would convince me that ALL symptoms will be reduced or eliminated before going under the knifed.
For example, ELECTRICAL STUDIES of the cervical cord nerve roots to find out whether she has a peripheral neuropathy vs. an actual radiculopathy causing these symptoms.
I'd be thrilled if you'd let me know what the upshot of all the decisions are in the future and how you are feeling. You can track me down at: www.bit.ly/drdariushsaghafi to send me a short note just like you've done to this point.
Many thanks for your kind words and positive feedback if you'd be so kind to leave it after CLOSING THE QUERY. Cheers!
This query required 113 minutes of professional time to research, assimilate, and respond in complete form.
Glad to hear PREGABALIN (Lyrica) is helping
Detailed Answer:
So glad to hear that the pregabalin is helping in your case.
Again, you may sense how cynical I can be with respect to what things show on radiographs, what symptoms patients have, and the good that neuro or spinal surgeons can be...especially when it comes to these sorts of surgeries. In my experience speaking and examining a number of patients who have had these types of surgeries.... the percentage of people who've had successes using surgical approaches is likely less than
5-10%....VERY VERY LOW percentage. I would want PROOF OF an EXTRAORDINARILY SOLID nature that would convince me that ALL symptoms will be reduced or eliminated before going under the knifed.
For example, ELECTRICAL STUDIES of the cervical cord nerve roots to find out whether she has a peripheral neuropathy vs. an actual radiculopathy causing these symptoms.
I'd be thrilled if you'd let me know what the upshot of all the decisions are in the future and how you are feeling. You can track me down at: www.bit.ly/drdariushsaghafi to send me a short note just like you've done to this point.
Many thanks for your kind words and positive feedback if you'd be so kind to leave it after CLOSING THE QUERY. Cheers!
This query required 113 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Glad to hear PREGABALIN (Lyrica) is helping
Detailed Answer:
So glad to hear that the pregabalin is helping in your case.
Again, you may sense how cynical I can be with respect to what things show on radiographs, what symptoms patients have, and the good that neuro or spinal surgeons can be...especially when it comes to these sorts of surgeries. In my experience speaking and examining a number of patients who have had these types of surgeries.... the percentage of people who've had successes using surgical approaches is likely less than
5-10%....VERY VERY LOW percentage. I would want PROOF OF an EXTRAORDINARILY SOLID nature that would convince me that ALL symptoms will be reduced or eliminated before going under the knifed.
For example, ELECTRICAL STUDIES of the cervical cord nerve roots to find out whether she has a peripheral neuropathy vs. an actual radiculopathy causing these symptoms.
I'd be thrilled if you'd let me know what the upshot of all the decisions are in the future and how you are feeling. You can track me down at: www.bit.ly/drdariushsaghafi to send me a short note just like you've done to this point.
Many thanks for your kind words and positive feedback if you'd be so kind to leave it after CLOSING THE QUERY. Cheers!
This query required 113 minutes of professional time to research, assimilate, and respond in complete form.
Glad to hear PREGABALIN (Lyrica) is helping
Detailed Answer:
So glad to hear that the pregabalin is helping in your case.
Again, you may sense how cynical I can be with respect to what things show on radiographs, what symptoms patients have, and the good that neuro or spinal surgeons can be...especially when it comes to these sorts of surgeries. In my experience speaking and examining a number of patients who have had these types of surgeries.... the percentage of people who've had successes using surgical approaches is likely less than
5-10%....VERY VERY LOW percentage. I would want PROOF OF an EXTRAORDINARILY SOLID nature that would convince me that ALL symptoms will be reduced or eliminated before going under the knifed.
For example, ELECTRICAL STUDIES of the cervical cord nerve roots to find out whether she has a peripheral neuropathy vs. an actual radiculopathy causing these symptoms.
I'd be thrilled if you'd let me know what the upshot of all the decisions are in the future and how you are feeling. You can track me down at: www.bit.ly/drdariushsaghafi to send me a short note just like you've done to this point.
Many thanks for your kind words and positive feedback if you'd be so kind to leave it after CLOSING THE QUERY. Cheers!
This query required 113 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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