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Help! No diagnosis yet, MRI clear

Started by gr8tone99 on 07/17/2017 11:27am

I've been suffering with neck stiffness, numbness in neck & shoulders, pain in temples radiating around ear to back of neck severe 9+ pain. Dyspnea , throbbing low back pain & heaviness in knees worse on left, , burning in both feet & popping in ear with swallowing & numbness to pinky of hands. I was unable to move while lying flat with vent mask on during sleep I woke up to machine alarming & couldn't move. Don't know how long but had several incidences like this in hospital while nurses present. No examination as to why this happened.

I had a cervical MRI with these results:
IMPRESSION:
1. Status post anterior fusion C5-6. Metal hardware creating artifacts. No significant stenosis at this level.
2. Diffuse cervical spondylosis with multilevel disc osteophyte complexes and uncovertebral/facet osteophytosis resulting in some spinal stenosis at C3-4, C4-5 and C6-7. Right foraminal encroachment at C7-T1.
3. No cord compression or spinal mass. Details and other findings as above.

On call after hours teleradiology interpretation by vRAD.

Narrative
EXAMINATION: MRI CERVICAL SPINE WO CONTRAST.

INDICATION: Patient with degenerative disease claims she can't breath. Exam for severe high cord lesion that could potentially be so bad that it would impair diaphragm. Neck pain.

TECHNIQUE: Routine MRI cervical spine without contrast was performed.

COMPARISON: Cervical spine x-rays from 9/23/2013.

FINDINGS:

Alignment: Degenerative grade 1 mild anterolisthesis at C3-4, C4-5.

Vertebral body heights: Preserved.

Disc interspaces: Anterior fusion hardware at C5-6 creating metal artifact causing image distortion and signal loss limiting assessment. C5-6 disc space is obliterated in keeping with solid bony fusion here. Disc space narrowing, disc degeneration and
endplate osteophytosis is seen throughout the cervical spine elsewhere. Advanced arthritic changes at C1-C2 articulation.

Bone marrow signal: Discogenic endplate marrow signal changes. No acute marrow edema.

Prevertebral space: Normal. No paraspinal fluid collection or mass. Incidental small polyp or retention cyst in the sphenoid sinus.

Spinal cord: Normal signal. No spinal mass or syrinx.

Cerebellar tonsils: No ectopia.

At C2-3 level, There is mild disc bulge with no evidence of stenosis.

At C3-4 level, There is posterior disc bulge and osteophytic ridge along with facet osteophytosis resulting mild to moderate. Central canal and moderate left the degree foraminal stenosis. Cervical cord is flattened. Ligamentum flavum thickening
contributing to stenosis.

At C4-5 level, There is posterior disc bulge and endplate osteophytosis indenting ventral thecal sac and causing mild cord flattening. There is no significant central canal or foraminal stenosis.

At C5-6 level, There is no evidence of stenosis.

At C6-7 level, There is posterior disc osteophyte complex indenting thecal sac causing mild to moderate cord flattening. There is mild to moderate degree of central canal and left foraminal stenosis.

At C7-T1 level, There is posterior disc osteophyte complex with no significant central canal stenosis. Right neuroforamen is narrowed by uncovertebral and facet osteophytosis.
This was June 2016;
Now more recent MRI;
MRI CERVICAL SPINE W WO CONTRAST

CLINICAL INDICATION: Multiple sclerosis

TECHNIQUE: The cervical spine was studied with a phased-array surface
coil with a 1.5 Tesla scanner. Imaging performed in the sagittal plane
with STIR, and spin-echo T1 and T2 weighted technique, and in the axial
plane with T2-weighted gradient echo technique angled through the disc
spaces. Cc IV gadavist utilizing pre and postcontrast imaging obtained

INTERPRETATION:

Post surgical changes are seen, with anterior cervical fusion at
multiple levels. Artifacts are seen secondary to the metal hardware.

No abnormal focal signal abnormality within the cervical cord. No
abnormal enhancement on the postcontrast scan.

C2-3: No disc protrusion. No cord impingement.

C3-4: A broad-based disc protrusion is seen. There is ventral cord
abutment from moderate degree. There is grade 1 anterolisthesis of C3 by
about 3 mm. Facet arthritic changes seen to a severe degree at this
level especially on the left side, showing some enhancement indicative
of active facet arthritis. The changes of progressive compared to the
prior study.

C4-5: Is a broad-based disc protrusion. Mild ventral CORD abutment
seen. Findings are stable.

C5-6: Broad-based osteophyte and protrusion. There is mild ventral cord
abutment. Stable appearance.

C6-7: Disc degenerative changes, endplate changes, marginal osteophyte
and mild protrusion. Stable appearance.

C7-T1: There is no focal disc herniation or bulge. There is no central
spinal canal stenosis or neural foraminal narrowing bilaterally.

Impression
1. NO FOCAL CORD ABNORMALITY. NO HIGH SIGNAL LESIONS WITHIN THE CORD. NO
ABNORMAL ENHANCEMENT WITHIN THE CORD.
They were looking for Multiple Sclerosis Lesion NOT DDD.
I can't get my neurologist to give me a diagnosis or tell me how to get help.
I have pain in my temple that radiates around my ear to the back of my next. I have numbness in my faces in front of my ear & I hear a rumbling pop sound when I swallow. I have a heavy feeling in my chest on the sternum(Ive had EVERY test for my heart & it's fine! I experienced severe shortness of breath on May 28 th while walking around. (I was ambulatory x5 blocks without any devices or SOB. I felt heaviness in my chest . I was seen by my pcp. I had desaturation of oxygen O2sat was 83. I was rx'd O2 @2 l. I was hospitalized x4 days without a diagnosis as to why so needed O2 24hrs a day. Was again hospitalized x 8 days for SOB. I was diagnosed with Respiratory Acidosis. I was sent home with a non intrusive Ventilator! & O2 for desaturation <96. No cause known. While in hospital I had electric shock & pain in my rectum. still stiff neck. MRZi was done looking for MS lesion to explain desaturation & difficulty breathing. MS was stable. I had the 2nd MRI done. I got home & was vacuuming under my bed, I felt strange & stood up hitting my neck onto a metal stand. Within 24 hrs I had difficulty standing & walking. I had trouble lifting my legs or bending my knees standing. I saw my neurologist (I have an intrathecal pump with Baclofen/spasms & Morphine Sulphate/pain. He though my pump rate might have been too high, he decreased the rate by 30%. I experienced increase in spasms & pain. I was admitted to hospital with symptoms as above as well as incotinence of bowel & bladder. Weakness in right leg , continued pain,, see above for description. I had a lumbar MRI with these results;
FINDINGS:

CONUS: The conus terminates at T12, which is within normal limits. The lower thoracic cord and conus appear to be within normal
limits on sagittal imaging. This region is not normally included on the axial imaging.

EPIDURAL FLUID: No abnormal epidural fluid collections are present.

VERTEBRAL BODY HEIGHT: Lumbar spine vertebral body heights are within normal limits.

VERTEBRAL BODY ALIGNMENT: There is levocurvature centered at L2-L3. There is also straightening of the lumbar lordosis.

MARROW SIGNAL: There is chronic endplate signal degenerative change at L2-L3 and L5-S1.

DISCS: There is mild multilevel degenerative disc disease manifesting as disc desiccation and ventral osteophyte formation. There
are also Schmorl's nodes at several levels.

ENHANCEMENT: There is no abnormal intradural enhancement.

OTHER: There is mild fatty atrophy of the paraspinous musculature.

There is a 1.5 x 0.6 x 2.2 cm fluid collection in the posterior subcutaneous soft tissues at the level of L2-L3 with adjacent
inflammatory changes.

Specific disc disease is as follows:

T11-T12: There is no significant disc bulge or protrusion. There is no significant spinal canal narrowing. There is no significant
neural foraminal narrowing.

T12-L1: There is no significant disc bulge or protrusion. There is no significant spinal canal narrowing. There is no significant
neural foraminal narrowing.

L1-L2: There is a mild diffuse disc bulge. There is no significant spinal canal narrowing. There is no significant neural foraminal
narrowing.

L2-L3: There is a moderate diffuse disc bulge and central protrusion resulting in mild spinal canal narrowing. There is no
significant neural foraminal narrowing.

L3-L4: There is a moderate diffuse disc bulge, right paracentral/foraminal disc protrusion, and mild facet hypertrophy bilaterally
resulting in severe spinal canal narrowing. The disc compresses the descending L4 nerve roots in the lateral recesses bilaterally
(series 6 image 27). There is also a central annular fissure. There is mild/moderate right and mild left neural foraminal narrowing.

L4-L5: There is a moderate diffuse disc bulge, right paracentral/foraminal disc protrusion, and mild/moderate facet hypertrophy
bilaterally resulting in mild to moderate spinal canal narrowing. There is compression of the descending right L5 nerve root in the
lateral recess (series 6 image 32). There is mild/moderate right and mild left neural foraminal narrowing.

L5-S1: There is a moderate diffuse disc bulge. There is no significant spinal canal narrowing. There is moderate facet hypertrophy
bilaterally. There is mild left neural foraminal narrowing.

IMPRESSION:

1. Multifactorial severe spinal canal narrowing at L3-L4.
2. Disc bulge at L4-L5, compressing the descending right L5 nerve root. Please correlate for right L5 symptomatology.
3. A 2.2 cm fluid collection in the subcutaneous soft tissues at the level of L2-L3 with adjacent inflammatory/infectious process.
This may represent cellulitis or be related to recent procedure. Please correlate with physical examination and clinical history.
4. No abnormal intradural enhancement.
I've had NO diagnosis from ANY doctor & even though I was given pain medication(Tramadol 50mg q8 hr w/ Flexeril 5 mg q8hr & Oxycodone 5mg q 6 hrs while in the hospital, I was given only 5 day supply going home. My pain management doctor won't medicate me at all other than my pump which has .072 mg per 20cc in 24 hrs continuous infusion with 375 mcg Baclofen per 20cc in 24 hrs continuous infusion.
My biggest problem since returning home after 9 days & no diagnosis or repeat CSpine MRI or any other testing done. Saw my neurologist after discharge who saw cord compression in cervical MRI called in neurosurgery who wanted more studies. Not done. Just Friday I had an SSEP UE(normal) & EMG RL(normal) Still NO DIAGNOSIS or plan of care!
Anyone HELP GUIDE ME in a sane direction. so need RELIEF!
Live in VA /DC area.

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Hi, I hear your frustration! Have you had the diagnosis of Multiple Sclerosis for long? I do not know what it entails, but scanning through your report, I am a patient not an M. D., you have more than the cervical area of your spine involved in your report mentioned. I hope that you do advocate for yourself, call your Doctor if it is within the time that he/she had said they would respond with a plan and discuss it with you. I would be climbing the walls, too! Have patience, but know that they have your best interest at heart, and if you know your Dr., s?, well then you have trust and faith in them. Sometimes it is simply a matter of time, 4 days seems long to wait yet considering the past surgery, and their is mention of that being a cause of what you are experiencing, it is more complicated than a first time encounter. I would always recommend calling back, until you find someone to get you what you need which is attention. NEVER give up. All need answers and possibilities for solutions! Best to you, praying for you and for them!

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