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Radiology/Mri Scan - Vertebral arteries

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QUESTION: Hello Doctor, please could you take a look at the vertebral arteries from a recent non contrast mri scan.

I have numbness in the right side of face, right side leg, both feet and arms, tingling in my hands and the numbness comes and goes.
Also my backside area becomes numb with Fibromyalgia body pains.

I have speech problems and cognitive decline. Constant Dizzy head and i use to be a medium to heavy drinker of Alcohol. Stopped since May 2013.

here is the enclosed MRI Report

MRI Brain
There are no intracranial space occupying lessions. Normal Signals are returned from the grey and white matter of brain on all Pulse sequences. There is no evidence of acute ischaemia, demyelination or other structural changes. The ventricles and cisteral spaces are appropriate for age. There is no hydrocephalous or cerebral atrophy. The mammillary bodies and periaqueductal grey matter show normal appearance. Pituitary gland is normal for age.
No parasellar or suprasellar mases. Vascular flow voids are well preserved. Minimal mucosal thickening is seen in the paranasal sinuses. High resolution scan through the posterior fossa reveals normal appearance tot he cranial nerves.

Mri Whole Spine.

There is normal alignment.. Mild straightening of the cervical spine is seen. Minor degenerative changes are seen in the c3-c4 and c4-c5 intervertebral disk and also in the L5-S1 intervertebral disk.
L5-S1 intervertebral disk shows posterocentral disc protusion but there is no thecal compression or nerve root impingement. Rest of intervertebral disks appear unremarkable. Motion artefacts degrade the axial images through the dorsal spine. The spinal cord is normal in the thickness. Prominent central canal is seen in the dorsal cord extending from T4-T10 levels.

The significance of this finding in isolation is uncertain. Neurology opinion may help.

Thank you for your time  

i have attached the full mri in winrar format.

http://www.mediafire.com/download/26cp54d7b73x352/Mri_Scan.rar

Rob

ANSWER: Robert,

The downloaded file has numerous JPG images.  I can't load these into a reader and I certainly can't open all of them up at the same time to be able to scroll through them.  If you can upload them as DICOM, I'll be able to do that.

Two images that you attached show only a small slice through the vertebral arteries.  I see the right one but the left one is not visualized on these images. The left artery may be very small (normal congenital) or diseased or occluded.  however, these images are not meant to  evaluate the vertebral arteries.

Why do you ask about the vertebral arteries?


Michael

---------- FOLLOW-UP ----------

QUESTION: Hi Michael, thank you for getting back so soon and looking at the files.
I have pulsatile tinnitus in the left side of my head and after looking at the mri scan, i thought the left side vertebral artery looked smaller than the right.

This may explain the dizziness and balance problems ?

Not sure if it is significant though.

i have attached the set of DICOM files
My Private details has been removed.

http://www.mediafire.com/download/npuctw9eloekb1k/Rob_DICOM.rar

Thank you once again.

Best

Rob

ANSWER: Rob,

Perhaps the left is smaller; it is hard to say as the evaluation of the arteries on cervica spine MRI is very limited. It certainly doesn't cause pulsatile tinnitus will not be caused by vertibral arteries. There are a few causes and a few of them are vascular. One is an abberant carotid artery which you don't have. another is a large jugular bulb without a good bony margin next to the middle ear. While I can't tell you anything about the bony margin, I can tell you that your left jugular bulb is very normal in size and I would not suspect it to be the cause.   Another cause is extremely rare - glomus tympanicum.  However, most commonly no structural cause is identified in great majority of people suffering from pulsatile tinnitus.  There are numerous ways to try and deal with it on the internet in a non medical way. You should search of them and try.  some say jamming a radio in between stations to get the white noise helps.  It sounds crazy but people come up with very inovative ways.  Also, on a more serious note you may want to see an ENT doctor so he can at least look into your ear and exclude most of things.

As far as your spine. Actually your mild disk at L5-S1 does approach S1 nerve roots. it doesn't displace them but if you have a specific radiculopathy to S1 distribution, it may be from that...but there needs to be a very careful examination.  Also, most of the protrusions, even the ones that contat nerve roots often do not cause any symptoms.  An additional observation is you may have a developmental defect in what is called a pars interarticularis of the left L5 (spondylolysis).  seems like that pars is thinned out and likely with a defect. It may cause some lower back pain; not into your legs but around the midline.  In some people that defect allows for the vertebral levels to move slightly. I don't see any significant forward displacement and that is probably because it is on only one side (left).  I am not sure if anyone would do anything about it but it is worth knowing that you have it.

Sounds like you have a few things to include fibromyalgia that make your daily activities unpleasant. Unfortunately, most of joint, muscle, back pain is composed of multiple factors and it is very difficult to treat such pain with a complete resolution.

I hope all of this helps, and I haven't confused you more.  If I did, please let me know.

Michael

---------- FOLLOW-UP ----------

QUESTION: Hi Michael, you have been brilliant. Thank you once again.

I will look into seeing an orthopedic surgeon. The numbness and pain in my backside area is worrying and i do have a slight problem with my bladder at the moment. I will also get the Pulsatile tinnitus looked at.

if i may, please could i ask you.

Does my Brain scan look ok to you ?
is there any damage to the cerebellum which could cause dizziness ?

Thank you once again,

Best Regards

Rob

Answer
Rob,
The brain scan looks normal.
Dizziness is such a non specific finding/symptom.  You should mention it to ENT doctor so they can figure out if this is an imbalance or vertigo or feeling of passing out or something else.  Depending on that they may want to look at different things.

Michael

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Michael K.

Expertise

Almost any kind of questions regarding any types of radiology exams, procedures, meaning of radiology reports etc...

Experience

12 year experience in the field of radiology

Organizations
American Society of Neuroradiology, Senior Member Society of Pediatric Radiology, Active Member

Publications
Radiology Seminars in pediatric neurology American Journal of Roentgenology American Journal of Neuroradiology

Education/Credentials
Board Certified in Diagnostic Radiology Additional Certificate of Qualification in Neuroradiology

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