Brief Answer:
Please find MRI related findings explained below.

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Please allow me to explain your MRI findings in simple language.

A. What does finding #1 mean?
1. There are small scattered subcentimeter lymph nodes involving every lymph node level. These are felt to be reactive.

This refers to multiple small probably peanut sized lymph nodes present in the neck region. Anatomically, the neck is divided into seven levels and there are possible small lymphnodes at each of these levels in you and because the size is not mentioned, I guess it is on both sides.

The term reactive lymph node refers to the lymph nodes getting swollen in reaction to an infection or inflammation. In other words, it is not looking like lymphnode enlargement due to conditions like cancers and is a benign cause.

B. What does finding #4 mean?
4. There is scattered mucosal thickening within the mastoid air cells bilaterally.

There is the temporal bone, one on each side. This temporal bone has a part called mastoid which is located behind and above the ear. This forms an important part of the inner ear. The mastoid bone, unlike a typical bone, is made out of air cells and can be imagined like a sponge with small holes.

Under normal conditions the air cells contain air and are lined by a thin layer called mucosa. In mild infection or inflammation, and even under normal circumstances, this mucosa appears thickened as in you. This is also commonly seen in the general population and is a benign condition.

This is usually seen as an incidental finding and not of any clinical importance unless accompanied with an ear infection or pain and pus discharge from the ears.

C. Can they possibly be a reason for my daily temporal headaches?

To the best of my knowledge, 30 percent of the population can have mild or scattered mucosal thickening in the mastoid air cells and have no symptoms. This is considered to be an extension of normal.

In the absence of any ear condition, scattered mucosal thickening in the mastoids do no cause temporal headaches.

There has been a lot of medical research on the MRI findings of mild mucosal thickening in the air sinuses and mastoids and it has found that "Even major mucosal swelling in a paranasal sinus is not necessarily a sign of infection. In radiological reports the terms "sinusitis" and "mastoiditis" should therefore be used with great caution. The initiation of treatment should be based on clinical symptoms and not on radiological abnormalities alone."

In conclusion, since there are small scattered lymphnodes of a likely reactive nature on both sides of neck, attempts should be made to diagnose any related ear, nose or throat infective conditions, which can cause the temporal headaches.

If we do not consider the lymphnodes in the neck region, there might be other causes for temporal headache like temporal arteritis, migraine headache, tension headache, and cluster headache.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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