What does this MRI report for facial pain indicate?

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Posted on Sat, 15 Oct 2016 in Brain and Spine
Question: I HAVE BEEN HAVING FACIAL PAIN FOR 7 YEARS. IWAS DIAGNOSED WITH TRIGENIMAL NEURALGIA. I WAS RECENTLY TOLD AFTER MRI AND MRA BY NEUROLOGIST THAT BLOOD VESSELS WERE LOOPING AROUND BOTH TRIGENIMAL NERVES ON BOTH SIDES. WENT TO SEE NEROSURGEON AND HE SAID HE NEVER HAS SEEN THIS AND SAID THAT I MIGHT HAVE BEEN DIAGNOSED. IHAVE PAIN THAT FLUCTUATES FROM RIGHT TO LEFT. I AM IN PAIN DAILY AND IT LIMITS FROM HAVING A SIMPLE CONVERSATION. IS IT SOMETHING ELSE THAT I COULD POSSIBLY HAVE. PLEASE ADVISE
doctor
Answered by Dr. Erion Spaho 2 hours later
Brief Answer:
MRI findings not uploaded.

Detailed Answer:
Hello, and thanks for using HCM.

I have read your question and understand your concerns.

Please upload the MRI report and possibly DICOM images in order to understand better your condition.

Awaiting.......
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Erion Spaho 2 hours later
I AM UNABLE TO INCLUDE IMAGES HOPEFULLY THIS WILL HELP! THANKS
--------------------------------------------------------------------------------

********** FINAL REPORT **********
Name: XXXXX
Exam: MRI Brain w and w o Contrast-E At 0754 Hours Acc#: MR0000
Exam Date: 0000 Physician: XXXXXXX M.D.,Syed XXXXXXX XXXXXXX


Exams: MR of the brain with and without contrast
MR angiogram of the head without contrast
Date: 8/25/2016 9:01 AM
History: 52-year-old female with headache, fatigue, bilateral facial pain.
Comparison: None.
Technique: Routine pulse sequences were obtained before and after the uneventful administration of 8.5 ml of Gadavist. 3 D time of flight
images were obtained of the arteries of the circle of Willis. MIP images of the right and left carotid arteries and the vertebral basilar
arteries were then generated.
Findings:
The ventricles are normal in their size, shape, and configuration. There is no shift of the midline structures. No significant extra-axial
collections of fluid or blood are demonstrated.
There are periventricular and subcortical white matter FLAIR hyperintensities favored to represent chronic small vessel ischemic disease.
There is no restricted diffusion to suggest acute infarct.
The sella is empty. The normal signal flow-voids of the vessels of the skull base are identified and unremarkable in their appearance.
There is nonobstructive mucosal thickening of the sinuses. No mastoid effusion.
Thin cut high-resolution T2 images through the internal auditory canals were obtained. Internal auditory canals appear unremarkable.
There is no cerebellopontine angle mass lesion. There are prominent vascular loops bilaterally which contacts the trigeminal nerves near
the root entry zones bilaterally.
No abnormal contrast enhancement.
MRA head: The right internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major
branch vessels to the right anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence
of aneurysm or vascular malformation.
The left internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major branch vessels
to the left anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence of aneurysm or
vascular malformation.
Evaluation of the posterior circulation demonstrates normal caliber of the vertebral arteries, basilar artery, and major branch vessels of
the posterior cerebral arteries bilaterally without evidence of stenosis or occlusion. There is no evidence of aneurysm or vascular
malformation.
Impression:
1. Negative for acute intracranial abnormality.
2. Mild chronic small vessel ischemic disease.
3. Prominent vascular loops crossing the trigeminal nerves at the root entry zone bilaterally.
4. Normal MR angiography of the brain.
Mount Carmel thanks you for the opportunity to care for your patient.
Workstation ID: SAPACSDRD3 - PS360
********** FINAL REPORT **********
Dictated By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:03
Assigned Physician: XXXXXXX MD , J XXXXXXX
Reviewed and Electronically Signed By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:14
Transcribed by: SCP 08/25/2016 09:03



Result

--------------------------------------------------------------------------------

********** FINAL REPORT **********
Name: XXXXX ID #: 0000
Exam: MRA Head w o Contrast-E At 0754 Hours Acc#: MR0000
Exam Date: 0000 Physician: XXXXXXX M.D.,Syed XXXXXXX XXXXXXX


Exams: MR of the brain with and without contrast
MR angiogram of the head without contrast
Date: 8/25/2016 9:01 AM
History: 52-year-old female with headache, fatigue, bilateral facial pain.
Comparison: None.
Technique: Routine pulse sequences were obtained before and after the uneventful administration of 8.5 ml of Gadavist. 3 D time of flight
images were obtained of the arteries of the circle of Willis. MIP images of the right and left carotid arteries and the vertebral basilar
arteries were then generated.
Findings:
The ventricles are normal in their size, shape, and configuration. There is no shift of the midline structures. No significant extra-axial
collections of fluid or blood are demonstrated.
There are periventricular and subcortical white matter FLAIR hyperintensities favored to represent chronic small vessel ischemic disease.
There is no restricted diffusion to suggest acute infarct.
The sella is empty. The normal signal flow-voids of the vessels of the skull base are identified and unremarkable in their appearance.
There is nonobstructive mucosal thickening of the sinuses. No mastoid effusion.
Thin cut high-resolution T2 images through the internal auditory canals were obtained. Internal auditory canals appear unremarkable.
There is no cerebellopontine angle mass lesion. There are prominent vascular loops bilaterally which contacts the trigeminal nerves near
the root entry zones bilaterally.
No abnormal contrast enhancement.
MRA head: The right internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major
branch vessels to the right anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence
of aneurysm or vascular malformation.
The left internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major branch vessels
to the left anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence of aneurysm or
vascular malformation.
Evaluation of the posterior circulation demonstrates normal caliber of the vertebral arteries, basilar artery, and major branch vessels of
the posterior cerebral arteries bilaterally without evidence of stenosis or occlusion. There is no evidence of aneurysm or vascular
malformation.
Impression:
1. Negative for acute intracranial abnormality.
2. Mild chronic small vessel ischemic disease.
3. Prominent vascular loops crossing the trigeminal nerves at the root entry zone bilaterally.
4. Normal MR angiography of the brain.
Mount Carmel thanks you for the opportunity to care for your patient.
Workstation ID: SAPACSDRD3 - PS360
********** FINAL REPORT **********
Dictated By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:03
Assigned Physician: XXXXXXX MD , J XXXXXXX
Reviewed and Electronically Signed By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:14
Transcribed by: SCP 08/25/2016 09:03









doctor
Answered by Dr. Erion Spaho 3 hours later
Brief Answer:
MRI findings explained.

Detailed Answer:
Welcome back and thanks for writing down the MRI/MRA report.

The report states that there is actually neurovascular conflict of both trigeminal nerves at their root entry zone, so, it is probable that bilateral trigeminal neuralgia is the correct diagnosis in your case.

This needs to be correlated with clinical findings.

There are also two other findings such empty sella and small arteries disease ( the last one probably caused by uncontrolled high blood pressure ), these two other findings are not related to facial pain.

If your symptoms are not controlled by conservative treatment, neurovascular decompression by surgery should be considered.

Hope you found the answer helpful.

Let me know if I can assist you further.

Greetings.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3794 Questions

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