OpenHealth Q&A

Seeking Clarification on MRI Results for Chiari Malformation and Possible White Matter Lesions

**Age:** 34 **Gender:** Female For about two months, I've been experiencing symptoms similar to multiple sclerosis. I have been diagnosed with Sjögren’s syndrome, osteoporosis, and Ehlers-Danlos syndrome (EDS). I underwent MRI scans of my brain and cervical spine, but my neurologist isn't available for a consultation until September 10. I'm hoping someone can shed light on my MRI findings, as it appears to indicate a Chiari I malformation and possibly some white lesions. ### MRI BRAIN WITH AND WITHOUT CONTRAST **History:** Weakness and tingling sensations. **Comparison:** None available. **Technique:** Multiplanar and multisequence MR imaging of the brain was conducted both pre- and post-contrast injection of 10 cc of MultiHance. **Findings:** - There is notable posterior angulation of the odontoid, impacting the cervical medullary junction. - Paranasal sinuses and mastoid air cells are clear. - The orbits appear normal with no abnormalities. - Major intracranial arterial flow voids remain intact. - No signs of diffusion restriction, intraparenchymal hemorrhage, or extra-axial issues. - Ectopia of the cerebellar tonsils is identified, measuring up to 6 mm. - No T2 hyperintense lesions seen in the white matter. - The ventricles appear decompressed. **Impression:** 1. Ectopia of the cerebellar tonsils measuring 6 mm raises concerns for a Chiari I malformation, along with significant posterior angulation of the odontoid affecting the cervicomedullary junction. 2. No T2 hyperintense lesions nor evidence of recent ischemic events observed. ### MRI CERVICAL SPINE WITH AND WITHOUT CONTRAST **History:** Weakness and tingling in the upper limbs. **Comparison:** No prior studies compared. **Technique:** Multiplanar multisequence imaging of the cervical spine executed before and after the intravenous administration of 10 cc of MultiHance. **Findings:** - Observed degenerative marrow signal at various spinal levels. - Chronic posterior angulation of the odontoid noted again, with ectopia of the cerebellar tonsils confirmed. - Evaluation of the cord characteristics is hindered by artifacts. A focused area of T2 hyperintensity in the right anteromedial cord spans 5 x 4 mm between the C4 and C5 vertebrae. - C2-C3: No major degenerative alterations. - The spinal canal appears normal, with no significant narrowing. - C3-C4: No notable degenerative changes. - The spinal canal remains unremarkable. - C4-C5: No major degenerative alterations. - The spinal canal shows no abnormalities. - C5-C6: Noteworthy for posterior disc osteophyte complex and bilateral uncovertebral joint hypertrophy, with mild narrowing on the right. - This level also indicates mild to moderate stenosis affecting the ventral cord. - C6-C7: Similar findings with posterior disc osteophyte complex and uncovertebral joint hypertrophy. Moderate stenosis of the spinal canal and mild bilateral narrowing observed. - C7-T1: Notable for posterior disc osteophyte complex and uncovertebral joint hypertrophy, with mild to moderate stenosis present and no significant foraminal narrowing. **Impression:** 1. Evaluation of cord signal limited by image artifacts; focal T2 hyperintensity located in the right anteromedial cervical cord measures 5 x 4 mm at the C4-C5 level with no corresponding enhancement detected. 2. Ectopia of the cerebellar tonsils and posterior angulation of the odontoid as noted in the brain MRI results. 3. Mild degenerative changes observed at multiple levels as indicated.

Answers (1)

8/2/2025, 3:31:19 PM

OpenHealth AI

Your MRI results indicate a Chiari I malformation, which is characterized by the downward displacement of the cerebellar tonsils into the spinal canal. This can lead to neurological symptoms, including tingling and weakness, which you've been experiencing. Your findings also include some degenerative changes in your cervical spine and a specific area of T2 hyperintensity in the cervical cord, though no enhancement indicates it isn't currently indicative of inflammation or a tumor.

Explanation of Key Findings:

1. Chiari I Malformation: This is a structural defect in the cerebellum, where part of the brain protrudes through the foramen magnum at the base of the skull. The 6 mm ectopia you have may be contributing to your symptoms.

2. White Matter Lesions: It’s crucial to note that your MRI results specifically state there were no T2 hyperintense lesions in the brain, and the reported hyperintensity in the cervical cord does not correspond with enhancement. This means there's no clear indication of recent ischemic events or multiple sclerosis at the moment.

3. Cervical Spine Degenerative Changes: You have signs of chronic degeneration in your spine that could contribute to discomfort or neurological issues.

Next Steps:

1. Symptom Monitoring: Keep a detailed log of your symptoms. Note any changes in tingling, weakness, neck pain, or other neurological symptoms. This will help provide your neurologist with crucial information at your consultation.

2. Physical Activity: Engage in gentle neck and spinal mobility exercises to maintain flexibility and reduce discomfort. Avoid activities that cause strain on your neck.

3. Pain Management: Consider over-the-counter anti-inflammatory medications like ibuprofen (if not contraindicated for you). Applying heat or cold to your neck might also be helpful for symptom relief.

4. Educate Yourself: Research Chiari malformation and degenerative spine conditions to better understand your situation while waiting for your neurologist’s appointment. This will help you formulate questions and concerns to discuss during your consultation.

5. Prepare for Your Consultation: Write down any specific concerns or questions you might have regarding potential treatments for the Chiari malformation or the areas of hyperintensity noted.

While it's understandable to feel apprehensive about these findings, preparing adequately for your consultation can ease some of that anxiety. Take care, and feel free to reach out if you have more questions or concerns.