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What Does This MRI Report Indicate?
Question: My MRI Showed near complete opacification of the right maxillary sinus (large mucous retention cyst) with mild bilateral maxillary sinus and patchy mild ethmoid air cell and right frontal sinus mucosal thickening. It also showed Dysconjugate gaze with increased CSF signal of the optic nerve sheaths bilaterally and mild nonspecific heterogeneity of marrow of non expanded clivus probably due to residual red marrow.
I am a 39 yo white female, 5'3" 219 lbs with pseudo Cushing symptoms but suppressed and lost weight on the low Dow dose dexamethasone. I have sever spinal stenosis of my lower lumbar in L5/S1 and moderate in L3/L4. I have had sinus drainage in my throat, myoclonus, migraines and deceased vision in my right eye for 5 years. I have small white matter lesions never mentioned in radiology reports on the brain and have had two tonic clinic seizures in the past year. No signs of epilepsy. We have suspected MS for 5 years but no official diagnosis. I had CNS Lyme but the active infection is gone. We have type 2 Familial Transtnyretin Amyloidosis in our family, MS, Lupus, history of meningiomas and vascular disease.
Help me understand what is possibly going on and why I keep getting passed to doctor to doctor. I am now to see an opthamalogist, see my ENT and Nuerologisr with the new findings and see internal medicine.
I am a 39 yo white female, 5'3" 219 lbs with pseudo Cushing symptoms but suppressed and lost weight on the low Dow dose dexamethasone. I have sever spinal stenosis of my lower lumbar in L5/S1 and moderate in L3/L4. I have had sinus drainage in my throat, myoclonus, migraines and deceased vision in my right eye for 5 years. I have small white matter lesions never mentioned in radiology reports on the brain and have had two tonic clinic seizures in the past year. No signs of epilepsy. We have suspected MS for 5 years but no official diagnosis. I had CNS Lyme but the active infection is gone. We have type 2 Familial Transtnyretin Amyloidosis in our family, MS, Lupus, history of meningiomas and vascular disease.
Help me understand what is possibly going on and why I keep getting passed to doctor to doctor. I am now to see an opthamalogist, see my ENT and Nuerologisr with the new findings and see internal medicine.
Brief Answer:
What are your current symptoms?Neurological examination sheet.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I understand your concerns and I shall offer my best help in this regard.
According to your history,you seem to be worried of MS-as a diagnosis.However,no where in the MRI report you mentioned,is written about demyelinating lesions.Did other MRI's in the past show such lesions?
Further, you did not mention of any event suggestive of focal neurological deficits,typical of MS.Vision loss in right eye persisting as such for past 5 years-is unlikely to be due to MS.For vision loss,it becomes imperative to know about the pupillary light reactions,funduscopy,ocular examination findings and Visual evoked potential(VEP)-to make a probable diagnosis of the same.I hope these things must have been looked after for.If available,please upload the examination sheet/documents on which the neurologist noted down his exam.findings.That will help to make an interpretation.
Epilepsy can be idiopathic as well,if no structural lesions are detected.However,accompanying myoclonus definitely mandates a thorough evaluation.Did you get an EEG and CSF examination done?Were there any abnormalities?
There are many unanswered questions over here.Please follow up with your medical documents as that will help me a lot in forming an opinion.
I shall be glad to have you in follow-up with further details.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
What are your current symptoms?Neurological examination sheet.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I understand your concerns and I shall offer my best help in this regard.
According to your history,you seem to be worried of MS-as a diagnosis.However,no where in the MRI report you mentioned,is written about demyelinating lesions.Did other MRI's in the past show such lesions?
Further, you did not mention of any event suggestive of focal neurological deficits,typical of MS.Vision loss in right eye persisting as such for past 5 years-is unlikely to be due to MS.For vision loss,it becomes imperative to know about the pupillary light reactions,funduscopy,ocular examination findings and Visual evoked potential(VEP)-to make a probable diagnosis of the same.I hope these things must have been looked after for.If available,please upload the examination sheet/documents on which the neurologist noted down his exam.findings.That will help to make an interpretation.
Epilepsy can be idiopathic as well,if no structural lesions are detected.However,accompanying myoclonus definitely mandates a thorough evaluation.Did you get an EEG and CSF examination done?Were there any abnormalities?
There are many unanswered questions over here.Please follow up with your medical documents as that will help me a lot in forming an opinion.
I shall be glad to have you in follow-up with further details.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Naveen Kumar
I have had an EEG twice and it did not show any signs of Epilepsy. I am just now being referred to an Opthamalogist and a new Neurologist, as well as an Internist. I have tried to upload other images but it only saves one. I will try again. There has been mention of VER in the past and I have images of multiple MRI's where doctors after the fact have noted the white matter lesions but they were not indicated on the radiology reports. I am dealing with military, civilian and VA doctors. No one seems to want to figure out what is wrong, they keep passing me around.
Brief Answer:
Current issues?
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
I shall be waiting for your medical documents as those are likely to help me to move towards your diagnosis.
I want to guide you in a somewhat satisfactory manner over here,but I need to know precisely your symptoms at present,for the same.What are your major troublesome issues currently?
I shall be glad to have you in follow-up with further details.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Current issues?
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
I shall be waiting for your medical documents as those are likely to help me to move towards your diagnosis.
I want to guide you in a somewhat satisfactory manner over here,but I need to know precisely your symptoms at present,for the same.What are your major troublesome issues currently?
I shall be glad to have you in follow-up with further details.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Naveen Kumar
Symptoms:
Myoclonus triggered by stress, sudden movement and loud noise.
Severe Sinus headaches and migraines. Pain upon touch and swelling on right side of face and head.
Muscular weakness on right side.
Confirmed Fibromyalgia.
4 Rx changes in right eye over 5 years.
Speech slurring and confusion. Possibly aphasia? Cannot get words out right or sentences.
Guttate psoriasis, scalp psoriasis, inverse psoriasis.
Bell's Palsy at age 6.
Strabismus surgery at age 10.
Symptoms started after emergency c-section in 2008 and have gotten progressively worse.
Constant mucous drainage into my throat.
Incontinence. I can cough or sneeze and leak,
Mild tremors in hands. Carpel tunnel in both wrists. Nerve damage in neck and back confirmed by electro stimulation testing of the nerves. (Uncertain of procedure name)
Water retention and fat in neck and abdomen with XXXXXXX hump, moon face and lean muscular arms and legs. Suppressed on dexamethasone and no abnormal pituitary findings.
Also pain surrounding and behind right eye, eye will not open as wide as the left, pressure in eye and right temple. Often have double vision and blurriness even wearing Rx glasses.
Also myoclonus is triggere by heat. Suspected inter cranial hypertension but not yet explored. Possibly due to increased CSF signal of optic nerve sheaths bilaterally? Right ear always feels full of fluid or wax.
Trying to think of everything but there is so much. The pain and weakness are every day and sometimes on the left side as well. Peripheral neuropathy has been mentioned before as well. So much going on and I will only be 40 this month. All regular labs are normal. There is hematuria and protein in my urine as well.
Myoclonus triggered by stress, sudden movement and loud noise.
Severe Sinus headaches and migraines. Pain upon touch and swelling on right side of face and head.
Muscular weakness on right side.
Confirmed Fibromyalgia.
4 Rx changes in right eye over 5 years.
Speech slurring and confusion. Possibly aphasia? Cannot get words out right or sentences.
Guttate psoriasis, scalp psoriasis, inverse psoriasis.
Bell's Palsy at age 6.
Strabismus surgery at age 10.
Symptoms started after emergency c-section in 2008 and have gotten progressively worse.
Constant mucous drainage into my throat.
Incontinence. I can cough or sneeze and leak,
Mild tremors in hands. Carpel tunnel in both wrists. Nerve damage in neck and back confirmed by electro stimulation testing of the nerves. (Uncertain of procedure name)
Water retention and fat in neck and abdomen with XXXXXXX hump, moon face and lean muscular arms and legs. Suppressed on dexamethasone and no abnormal pituitary findings.
Also pain surrounding and behind right eye, eye will not open as wide as the left, pressure in eye and right temple. Often have double vision and blurriness even wearing Rx glasses.
Also myoclonus is triggere by heat. Suspected inter cranial hypertension but not yet explored. Possibly due to increased CSF signal of optic nerve sheaths bilaterally? Right ear always feels full of fluid or wax.
Trying to think of everything but there is so much. The pain and weakness are every day and sometimes on the left side as well. Peripheral neuropathy has been mentioned before as well. So much going on and I will only be 40 this month. All regular labs are normal. There is hematuria and protein in my urine as well.
Brief Answer:
Needs a dedicated neurological examination.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing further details.
In the background of progressive speech dysfunction,seizures and myoclonus-it becomes mandatory to get a dedicated neurological examination done to approach the diagnosis.It is not possible to establish the diagnosis just on the basis of history,in your case.
You may need to undergo nerve conduction studies and CSF analysis.Hematuria and proteinuria further enhance the clinical mystery.Can you upload the reports available with you?
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Needs a dedicated neurological examination.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing further details.
In the background of progressive speech dysfunction,seizures and myoclonus-it becomes mandatory to get a dedicated neurological examination done to approach the diagnosis.It is not possible to establish the diagnosis just on the basis of history,in your case.
You may need to undergo nerve conduction studies and CSF analysis.Hematuria and proteinuria further enhance the clinical mystery.Can you upload the reports available with you?
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Naveen Kumar
I just got my new appointment to neurology for this Wednesday and have been approved for nerve conduction testing as well as other procedures. No one has checked my CSF but a spinal tap has been mentioned in the past but never done. The doctor I am to see is for headaches/ migraines but they have other specialists. Is there something specific I should ask to be Investigated or done? Direction on how to proceed is welcome. Thank you.
Brief Answer:
NCS/CSF/Review of MRI's
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Its good that you are scheduled for a neurologist's examination.That will facilitate the diagnosis.Investigations depends on the examination findings,however,considering the above discussion-NCS,CSF study and a cross opinion on previous MRI's appears reasonable.
Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
NCS/CSF/Review of MRI's
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Its good that you are scheduled for a neurologist's examination.That will facilitate the diagnosis.Investigations depends on the examination findings,however,considering the above discussion-NCS,CSF study and a cross opinion on previous MRI's appears reasonable.
Hope that I have answered your query.If you have some further questions,I shall be glad to have you in follow-up else please close the thread,rate it and write a review.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Naveen Kumar
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