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What Does My MRI Report Indicate?
Question: Dear Doctor. Am 20 years old man. I got report of MRI today written: "There is an oval shaped faintly intense T2 and hypointense T1 focus
in the cerebellum adjacent to the superior aspect of the 4th ventricle
on the right side the nature of which is uncertain, follow up is recommended
if clinically indicated.
Mucosal thickening and market air-fluid level is seen in the left maxillary sinus."
My question - pls explain me by simple language so I could understand how seriosly and dangerous it is. Am so worry. Waiting for your reply. Thank you in advance.
in the cerebellum adjacent to the superior aspect of the 4th ventricle
on the right side the nature of which is uncertain, follow up is recommended
if clinically indicated.
Mucosal thickening and market air-fluid level is seen in the left maxillary sinus."
My question - pls explain me by simple language so I could understand how seriosly and dangerous it is. Am so worry. Waiting for your reply. Thank you in advance.
Brief Answer:
Several possibilities.
Detailed Answer:
I read your question carefully and I understand your concern.
It would have been helpful to know a little more about what made your doctor order a MRI though, what were your symptoms, since when did you have them and their evolution in time.
You have to understand that tests complete the clinical history and physical exam, they never make a diagnosis on their own.
To comment on that MRI report only, it basically says only that there is a small abnormal area in the your cerebellum (little brain), however that doesn't clarify much about the nature of it. Also a MRI with contrast might have been helpful, was that performed?
The possibilities could be several like multiple sclerosis, stroke, an infection, a tumor. Based on your age the most likely possibility would be multiple sclerosis.
If you give some more info on your symptoms, perhaps I might be more specific in my answer.
I remain at you disposal for further questions.
Several possibilities.
Detailed Answer:
I read your question carefully and I understand your concern.
It would have been helpful to know a little more about what made your doctor order a MRI though, what were your symptoms, since when did you have them and their evolution in time.
You have to understand that tests complete the clinical history and physical exam, they never make a diagnosis on their own.
To comment on that MRI report only, it basically says only that there is a small abnormal area in the your cerebellum (little brain), however that doesn't clarify much about the nature of it. Also a MRI with contrast might have been helpful, was that performed?
The possibilities could be several like multiple sclerosis, stroke, an infection, a tumor. Based on your age the most likely possibility would be multiple sclerosis.
If you give some more info on your symptoms, perhaps I might be more specific in my answer.
I remain at you disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
First, thank you very much for soon reply. I was waiting unpatiently.
So, I have often headache for few last years. It comes and out approximately day after day last 2-3 years. Sometimes pain lasts shortly (1-2 hours), sometimes oit lasts from early morning till night. Also have a pain in eyes then. I didnt care so much, thought I am young and it is not so dangerous, just simple headache and I usually was getting anagin pills to decrease pain and it helped. But mother became worry because of so often headaches and asked me to visit doctor. That is how happened.
correction from my previous text - "analginum pills"
So, I have often headache for few last years. It comes and out approximately day after day last 2-3 years. Sometimes pain lasts shortly (1-2 hours), sometimes oit lasts from early morning till night. Also have a pain in eyes then. I didnt care so much, thought I am young and it is not so dangerous, just simple headache and I usually was getting anagin pills to decrease pain and it helped. But mother became worry because of so often headaches and asked me to visit doctor. That is how happened.
correction from my previous text - "analginum pills"
Brief Answer:
Read below.
Detailed Answer:
Thank you for that additional info.
Ok after learning what drove you to have the MRI, I think there is less reason to be concerned. Headache is not a symptom of multiple sclerosis, stroke happens in an abrupt manner, doesn't come and go for two years, and tumor or infection would have a constant progressively worsening nature during these years unlike the intermittent headache you describe.
That MRI finding is incidental, it has no relation to your headache. It might be a remnant of an old infection or a benign cyst. For now if the doctor hasn't found any other signs in his physical exam apart from the headache no particular treatment is needed, but another MRI should be scheduled after some months, preferably with contrast to make sure that area hasn't evolved or manifested new features.
As for the headache itself, it looks like tension type headache, the most common primary headache (primary meaning with no identifiable cause), for which the occasional pain killer like Ibuprofen is usually enough. If you have symptoms like a stuffed nose, nasal discharge perhaps the possibility of left maxillary sinusitis (the air fluid level on MRI) can also be considered which can necessitate nasal decongestants and if not responsive a course of antibiotics.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for that additional info.
Ok after learning what drove you to have the MRI, I think there is less reason to be concerned. Headache is not a symptom of multiple sclerosis, stroke happens in an abrupt manner, doesn't come and go for two years, and tumor or infection would have a constant progressively worsening nature during these years unlike the intermittent headache you describe.
That MRI finding is incidental, it has no relation to your headache. It might be a remnant of an old infection or a benign cyst. For now if the doctor hasn't found any other signs in his physical exam apart from the headache no particular treatment is needed, but another MRI should be scheduled after some months, preferably with contrast to make sure that area hasn't evolved or manifested new features.
As for the headache itself, it looks like tension type headache, the most common primary headache (primary meaning with no identifiable cause), for which the occasional pain killer like Ibuprofen is usually enough. If you have symptoms like a stuffed nose, nasal discharge perhaps the possibility of left maxillary sinusitis (the air fluid level on MRI) can also be considered which can necessitate nasal decongestants and if not responsive a course of antibiotics.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I would like to add what wassaid in report because I wrote you what was bad on my opinion. But good things (I think it is all good points) I didnt mention - "The CSF spacesare of normal size. No definite masses or axtraaxial fluid collectors.
No midline shift. No bleeding. There is no evidence of infraction or abnormal
signal intensities. The major vascular voids appear unremarkable.
The gray white matter differentiation is normal.
The sella and parasellar region is unremarkable"
ow thank you very much dear Doctor. I got a bit better mood and hopes to live long. At least will sleep tonight. Thank you very much my dear Doctor. I am his motherif honestly.....I am encouraged now and will do my best to help my dearest son.I love him more than my life and anything in the world. Goodnight :)
No midline shift. No bleeding. There is no evidence of infraction or abnormal
signal intensities. The major vascular voids appear unremarkable.
The gray white matter differentiation is normal.
The sella and parasellar region is unremarkable"
ow thank you very much dear Doctor. I got a bit better mood and hopes to live long. At least will sleep tonight. Thank you very much my dear Doctor. I am his motherif honestly.....I am encouraged now and will do my best to help my dearest son.I love him more than my life and anything in the world. Goodnight :)
Brief Answer:
Thank you!
Detailed Answer:
Yes, the rest of the report is all normal. It doesn't mention them using contrast unfortunately, it would have made me more confident in my answer. I would say a control MRI with contrast should be scheduled at a later time.
Thank you for your appreciative words, it definitely feels great to have helped to lighten the mood a little bit for you both.
Wishing you good health!
Thank you!
Detailed Answer:
Yes, the rest of the report is all normal. It doesn't mention them using contrast unfortunately, it would have made me more confident in my answer. I would say a control MRI with contrast should be scheduled at a later time.
Thank you for your appreciative words, it definitely feels great to have helped to lighten the mood a little bit for you both.
Wishing you good health!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, we will do contrast MRI later with your kind advise. Surey, to be more confident. Thank you very much.
Brief Answer:
You are welcome!
Detailed Answer:
You are welcome. Best of luck!
You are welcome!
Detailed Answer:
You are welcome. Best of luck!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor, today we visited Doctor. He even didnt enter us. He studied CD alone, read report which I told you yesterday about. We got order to get Dexamethasone 4 injections 5 times after each 2 days and after 2 weeks to visit him again. Also he said that son should get again MRI contrast picture in 3 month. I just cant understand for what he advised Dexamethasone 4 ijections. It is so heavy medicine. It is hormons but not even antibiotics. As I understand those hormons cant treat or solve problem but it works like druggs. Why he didnt advise him antibiotics to treat local problem (may be in nose). I think I should try to go to another doctor to see what he says to be sure in using Dexamethasone. Or I am stupid, Doctor? Pls advise
Brief Answer:
Read below.
Detailed Answer:
I am sorry about the anguish you seem to be in.
One the one hand you should be relieved that he has also thought a repeat MRI in 3 months time, that means he doesn’t notice something life threatening as well.
About the Dexamethasone, I understand why he is prescribing it. Being it an abnormal area whose nature is difficult to understand he is giving Dexamethasone just as a precaution. Dexamethasone is often used to reduce swelling in the brain. So he just wants to make sure there won’t happen any complications during this waiting period and is giving Dexamethasone to keep things under control anyway and check again in two weeks time to verify that no new signs are appearing which would indicate disease progression.
Personally I am not sure I agree with that decision. If your son is feeling well, has no other signs apart from that headache from time to time which is relieved by Analgin, I would yes check up again in 2-4 weeks time but would wait to start Dexamethasone, so that I could really evaluate progression (Dexamethasone might falsely hide disease progression). Since the headache has been present at the same intensity for 2-3 years there is no reason to fear a quick progression during these weeks. I hope I am making sense to you.
That is no clear cut decision though, on the one hand his approach is maybe safer, while mine would give a better indication regarding presence of progression.
You shouldn’t panic about Dexamethasone side effects, they aren’t likely in a short course of treatment and at his young age.
Of course you could see another doctor for a second opinion as well since you are not satisfied with the way he treated you and the fact he didn't examine or explain much. I do not have the luxury of being able to examine physically for other neurological signs so a virtual consult can't be a substitute for a full evaluation.
As for antibiotics, I don't think they should be used in such a hurry, as I said only if there are signs of sinusitis (nasal congestion, nasal discharge) and even if that was the case it usually is tried with nasal decongestants first to try and drain the sinus naturally.
Read below.
Detailed Answer:
I am sorry about the anguish you seem to be in.
One the one hand you should be relieved that he has also thought a repeat MRI in 3 months time, that means he doesn’t notice something life threatening as well.
About the Dexamethasone, I understand why he is prescribing it. Being it an abnormal area whose nature is difficult to understand he is giving Dexamethasone just as a precaution. Dexamethasone is often used to reduce swelling in the brain. So he just wants to make sure there won’t happen any complications during this waiting period and is giving Dexamethasone to keep things under control anyway and check again in two weeks time to verify that no new signs are appearing which would indicate disease progression.
Personally I am not sure I agree with that decision. If your son is feeling well, has no other signs apart from that headache from time to time which is relieved by Analgin, I would yes check up again in 2-4 weeks time but would wait to start Dexamethasone, so that I could really evaluate progression (Dexamethasone might falsely hide disease progression). Since the headache has been present at the same intensity for 2-3 years there is no reason to fear a quick progression during these weeks. I hope I am making sense to you.
That is no clear cut decision though, on the one hand his approach is maybe safer, while mine would give a better indication regarding presence of progression.
You shouldn’t panic about Dexamethasone side effects, they aren’t likely in a short course of treatment and at his young age.
Of course you could see another doctor for a second opinion as well since you are not satisfied with the way he treated you and the fact he didn't examine or explain much. I do not have the luxury of being able to examine physically for other neurological signs so a virtual consult can't be a substitute for a full evaluation.
As for antibiotics, I don't think they should be used in such a hurry, as I said only if there are signs of sinusitis (nasal congestion, nasal discharge) and even if that was the case it usually is tried with nasal decongestants first to try and drain the sinus naturally.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear dear dear Doctor. You have no idea how you help me and encourage. I understand deeply all you tried to explain and it gives me to be calm and strong for farther actions. Yes, I chose another doctor (Ibrahim Sbeih) to hear his opinion and to be sure we are doing all right. Also I feel (probably because I so want it) that everything will be ok with my son and as you gave to understand that son's headache doesnt connect with what is found throught MRI. I hope abnormal area on MRI will be not progressed because it is old and forgoten. From other side, we will try to find local solution for son's often headache. I will try to inform you just what said another Doctor. Thank you very much for your support. You are like sunshine for me.
Brief Answer:
Read below.
Detailed Answer:
Thank you again for your kind words, you sound such a loving and caring mother, your son is lucky to have you and I am really happy to have provided some comfort till the issue is clarified.
From some quick google-ing the doctor you mentioned is a famous Neurosurgeon so it seems you will be in good hands.
I hope things will work out for the best.
Read below.
Detailed Answer:
Thank you again for your kind words, you sound such a loving and caring mother, your son is lucky to have you and I am really happy to have provided some comfort till the issue is clarified.
From some quick google-ing the doctor you mentioned is a famous Neurosurgeon so it seems you will be in good hands.
I hope things will work out for the best.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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