OpenHealth Q&A

Clarification Requested on MRI Findings Regarding Brain and Cervical Spine

Age: 34 Gender: Female For the past couple of months, I have been facing symptoms that resemble those of multiple sclerosis. My medical history includes a diagnosis of Sjögren's syndrome, osteoporosis, and Ehlers-Danlos syndrome. I recently underwent MRIs of my brain and cervical spine, but my neurologist is not available to discuss the results until September 10. I would greatly appreciate any insights into my findings, particularly regarding possible Chiari malformation and the presence of unusual white matter regions. **MRI of the Brain with Contrast** **History:** Weakness and tingling sensations. **Comparative studies:** None available. **Technique:** A comprehensive MRI was conducted in multiple planes and sequences, both before and after the administration of 10 cc of MultiHance contrast via IV. **Results:** - A notable posterior angulation of the odontoid bone with an associated angulation at the cervicomedullary junction. - The paranasal sinuses and mastoid air cells appear clear. - The orbits show no abnormal findings. - Key intracranial arterial flow voids remain intact. - No signs of diffusion limitation, bleeding within the brain tissue, or extra-axial accumulation were observed. - The cerebellar tonsils are located ectopically and extend up to 6 mm. - No T2 hyperintense lesions in the white matter are detected. - The ventricles are adequately decompressed. **Conclusions:** 1. The presence of cerebellar tonsillar ectopia of 6 mm raises concerns for a potential Chiari I malformation. There is significant posterior angulation of the odontoid and anterior angulation at the cervicomedullary junction. 2. No T2 hyperintense white matter lesions or signs indicative of recent ischemia were found. **MRI of the Cervical Spine with Contrast** **History:** Symptoms include weakness and numbness in the upper limbs. **Comparative analyses:** None available. **Technique:** A cervical spine MRI in multiple planes and sequences was conducted before and after administering 10 cc of MultiHance contrast intravenously. **Findings:** - There is evidence of degenerative changes in the bone marrow at various levels. - Chronic posterior angulation of the odontoid is noted again, alongside the cerebellar tonsillar ectopia. - The assessment of the spinal cord signal is impacted by imaging artifacts. A localized area of T2 hyperintensity measuring 5 x 4 mm appears in the anteromedial section of the cervical cord between C4 and C5. - At C2-C3, there are no significant degenerative alterations. The spinal canal remains unremarkable, and there is no significant foraminal narrowing at this level. - C3-C4 shows no notable degenerative changes. The spinal canal and foramina are clear of significant narrowing. - At C4-C5, there are also no significant degenerative changes present. The spinal canal remains unremarkable with no significant narrowing of the foramina. - At C5-C6, there is a posterior disc osteophyte complex and mild bilateral uncovertebral joint enlargement, leading to mild right foraminal narrowing and some flattening of the ventral cord, indicating mild to moderate stenosis. - At C6-C7, similar degenerative findings include a posterior disc osteophyte complex and bilateral uncovertebral joint hypertrophy, along with moderate stenosis in the spinal canal and mild bilateral foraminal narrowing. - C7-T1 shows posterior disc osteophyte formation and bilateral uncovertebral joint changes, resulting in mild to moderate stenosis in the spinal canal, with no significant narrowing of the foramina. **Conclusions:** 1. The evaluation of cord signal is limited by artifacts. The localized area of T2 hyperintensity in the right anteromedial cervical cord measures 5 x 4 mm as seen on image 15, spanning from C4 to C5, though no associated enhancement is noted. 2. There are findings of ectopia of the cerebellar tonsils and posterior angulation of the odontoid as identified on the brain MRI. 3. Mild degenerative changes are observed at multiple levels, as described above.

Answers (1)

7/31/2025, 9:20:58 PM

OpenHealth AI

Thank you for sharing your MRI findings and symptoms. It sounds like you’re understandably anxious, considering your medical history and current symptoms. Here’s a breakdown of the MRI results and some actionable steps while you await further discussion with your neurologist.

Summary of Main Points

1. Your MRI findings suggest the possibility of Chiari I malformation due to cerebellar tonsillar ectopia.
2. There are degenerative changes in the cervical spine, along with a localized area of hyperintensity in the cervical cord.
3. No significant white matter lesions indicating multiple sclerosis were observed.

Explanation

• Chiari I Malformation: This occurs when the back of the skull is smaller than normal, causing pressure on the brain. In your case, the cerebellar tonsils are displacing 6 mm, which is a notable finding. This can be associated with symptoms like headache and balance issues.

• Cervical Spine Findings: The degenerative changes in your cervical spine are not uncommon, especially with conditions affecting connective tissues such as Ehlers-Danlos syndrome. The hyperintense area in your cervical cord needs careful evaluation, but the lack of enhancement typically indicates that it may not be a sign of acute injury.

Next Steps

1. Symptom Monitoring: Keep a detailed diary of your symptoms, noting when they occur, their severity, and any potential triggers. This can help contextualize your conditions and guide future discussions with your healthcare team.

2. Physical Activity Adjustments: Avoid activities that exacerbate your symptoms, particularly those involving heavy lifting or sudden movements. Gentle strengthening exercises and physical therapy tailored to your conditions may help.

3. Hydration and Nutrition: Maintain good hydration and a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, lean proteins, and healthy fats, as they might support overall well-being.

4. Pain Management: If you’re experiencing discomfort, consider over-the-counter options like acetaminophen or ibuprofen, unless contraindicated by other conditions or medications you're taking.

5. Prepare for Neurologist Appointment: Write down specific questions and concerns to discuss with your neurologist when you meet on September 10th. Mention all your current symptoms and any worries you have about the MRI findings.

Reassurance

While it is understandable to feel anxious about these findings, the lack of white matter lesions and the absence of acute changes is a positive aspect. The best course of action now is to remain observant, manage your symptoms, and prepare for a thorough discussion with your neurologist. You're doing the right thing by being proactive about your health.