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Dr. Andrew Rynne

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What does the following MRI result indicate?

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3631 Questions

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Posted on Mon, 26 Oct 2015 in General Health
Question: If I showed you pictures of my MRI would you be able to tell me if there is a contusion on my spinal cord. The radiologist and my neurologist both say there is, even though it is slight.
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Yes

Detailed Answer:
Hello and thank you for your confidence in Healthcaremagic.

If you can upload MRI images I would gladly look at them to confirm whether there is contusion, so yes, that is possible.
An MRI exam contains many images in the DICOM format. I suggest to not alter them, simply try to identify on the CD and upload the DICOM folder, if you zip it in one file might be simpler for you. I am not sure whether you can upload a file or folder that big directly on the site, but you can upload it to a service such as dropbox or google drive and put the link.
Just suggestions from past experiences with other patients, if you do it some other way you are more comfortable with, there is no problem.

Looking forward to hearing from you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 8 hours later
I uploaded some pics of the mRI. Are they clear enough

https://www.dXXXXXXX.com/XX/XXXX/XXXXX

here is link
doctor
Answered by Dr. Olsi Taka 12 hours later
Brief Answer:
Images inadequate

Detailed Answer:
Hello again!

I am sorry for answering a bit late but I had just left for work when you sent the images and it was a long busy day.

Now I am afraid that the images are not adequate to express an opinion. More than half of the slices didn't even include the spinal cord and I am sure there were more slices than that. Please try again, but do not convert to .jpg, upload the entire folder as it is. When we have the images in their original dicom format we can zoom, change contrast, compare levels etc, with .jpg I can do nothing of that. Since you are able to upload to dropbox do it again, but either upload the whole folder included in the CD (usually in the Cd there is only the one big folder containing all files), you can zip it if you want to have one single file.

If I were to judge only by those few images, I didn't see any damages, but as I said that is not a confident answer.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 48 minutes later
You're actually right. I remember them showing me the slices, which I don't know how to access and they had arrows pointing to where the problem was. I'll just leave it alone right now and ask my treating neurologist. Thanks though
doctor
Answered by Dr. Olsi Taka 26 minutes later
Brief Answer:
Read below.

Detailed Answer:
I am aware you can not pick the slices yourself, only a radiologist/neurologist/neurosurgeon can, I am not sure even most primary physicians can. That is why I said to send the whole folder as it is, it is not impossible.

If you decide to retry, I remain available.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 2 days later
Let me ask you something. My auto accident with a dump truck happened a year ago. I started getting headaches about a month and a half ago. Some of them that I get are completely debilitating, like I can't leave the house without wanting to vomit. The majority of them feel like there is intense pressure in my head like my head wants to explode around the temples. There is also stabbing pains at times on my left temple and cheeks. I did suffer a pretty bad concussion with no loss of consciousness and then the spinal cord injury.

Are late onset headaches common? Are these most likely related to head injury or spinal cord injury? Also the meds I'm on do not seem to help. i take lyrica and motrin. Is there another medication I can ask to take?
doctor
Answered by Dr. Olsi Taka 50 minutes later
Brief Answer:
Read below.

Detailed Answer:
Hello again!

After a concussion there is the possibility of suffering headaches which can persist for a long time, even over a year. However if you were headache free for almost a year till one month and a half ago I don't think that is your case, such late onset is not common.
As for the spinal trauma, in theory it can lead to increased predisposition to neck arthritis which in turn can cause headache, but your description of location is not that compatible with that type of pain which is usually in the back of the head not in the front, causing symptoms at the cheeks like you describe.
So I would consider some other cause like sinusitis (possible if also nasal congestion) or simple tension type headache. As for treating it, well if there is sinusitis it needs decongestants and antibiotics. For tension type headache motrin is a good treatment, for difficult cases preventive treatment with amitriptyline may be considered. However since you are also under Lyrica should be discussed with your doctor. Amitriptyline while used for headache prevention shares also some of Lyrica's effect on peripheral neuropathic pain so if introduced reducing or removing Lyrica should be considered.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 1 hour later
I need to give you some more specifics. I forget that the nerve pain that travels up your neck to head is considered a headache. Before I started getting these constant headaches (a month and a half ago), I was getting the traveling nerve pain that would start in the neck and go all the way to the top of my head. Those were the ones that were debilitating and nauseating. My neurologist injected me in the back of my skull twice to stop the pain. I must say the treatment was effective, but now I just have these tension type pressure headaches.
doctor
Answered by Dr. Olsi Taka 6 hours later
Brief Answer:
Read below

Detailed Answer:
Thank you for the additional information.

The pain you describe in the past seems like occipital neuralgia. In terms of distribution I still do not see it as compatible with the current pain. Of course pain irradiation is not always textbook like, can be variable among individuals, and if this pain was present even before one and a half months it might be related, but if it has developed only in this recent period I still don't see it as related to the trauma, nor concussion neither spinal trauma.

By the way I see only now that in the medication tried field apart from Motrin and Lyrica you have put Lexapro as well. If that is still the case it can't be taken both with amitriptyline which I mentioned, should be interrupted. Also drugs like Lexapro can work both ways on headache, in some patients they reduce them (so if you used to take it and now interrupted might be a factor), in some others they might actually cause headache as a side effect (24% of patients, not a small percentage). So that must be taken into account as well.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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