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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29710
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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My husband has had an MRI of his brain and complete spine. We

Resolved Question:

My husband has had an MRI of his brain and complete spine.
We got the results back, and various abnormalities were found. However our GP is too busy to explain what they mean. I can send a scan of the results if somebody is willing to try and explain them. I realize that this is a long question, and I can pay more for the answer - just tell me what you think is reasonable.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello and welcome to Just Answer, Jan.

I am Dr. Phophalia and would assist you today.

Please write down the MRI report. I would be happy to explain you the medical terminology and answer your follow up questions.

Thanks for using Just Answer.

Customer: replied 1 year ago.

Reason for exam


(MR thoracic spine) - Brain and spine. 1 yr hx of progressive parathesia of the R arm and legs. NDY


(MR Cervical spine) brain and spine.


(MR lumbar spine)


(MR brain)


 


Report


 


Technique Z34A - MS BRAIN


 


Sagittal FLAIR


Axial FLAIR


 


Axial FSE T2W ... or replace FLAIR with Axial 3D Space FLAIR


Reformat Sagittal 3D Space FLAIR


 


TECHNIQUE: #35 - CORD COMPRESSION SPINE


Sagittal T1W


Sagittal FSE T2W


Axial T2W


 


No prior comparison


 


FINDINGS:


 


BRAIN:


 


There are scattered punctate bihemispheric foci of subcortical white matter signal hyperintensity (15-20 total). No periventricular or callosal lesion is visualized. No posterior fossa lesion is seen.


 


No parenchymal mass or extraaxial fluid collection. No evidence of prior cortical infarct. The ventricles, suici, and cisterns are age-appropriate, Major intercranial flow voids are maintained.


 


Minor scattered mucosal thickening in the paranasal sinuses. Globes, orbits, regional osseous and soft tissues are unremarkable.


 


SPINE


The spinal cord demonstrates normal signal and bulk.


In the cervical spine, alignment is normal. Disc spaces are preserved. No significant disc bulge or herniation is visualized.



In the thoracic spine, there is minimal anterior wedging of T6 and T7 which may reflect remote trauma. Mild associated exaggeration of normal thoracic kyphosis. Mild multilevel disc space narrowing is visualized.


No focal disc herniation or significant disc bulge is seen to cause spinal canal or foraminal narrowing.


 


In the lumbar spine, there is mild straightening of normal lumbar lordosis. Moderate spondylosis at L5/S1 and mild spondylosis at L4/5. Conus medullaris demonstrates normal signal and bulk and is not low-lying.


 


At L4/5, there is a mild circumferential disc bulg. Mild bilateral foraminal narrowing. No significant central spinal canal narrowing.


At L5/S1, there is a mild circumferential disc bulge which contacts the bilateral descending S1 nerve roots. The distribution and morphology of the lesions does not strongly suggest inflammatory demyelination. In a patient of this age, the most likely diagnosis is mild white matter microangiopathic change, although the sequela of prior migraine headaches or vasculitis could have a similar appearance.
No cord lesion is visualized. Minor degenerative changes in the thoracic and lumbar spine as descirbed.


 


Signed


Dated


 


 


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello Jan,

Following is the explanation of the terms;

BRAIN:


 


There are scattered punctate bihemispheric foci of subcortical white matter signal hyperintensity (15-20 total). No periventricular or callosal lesion is visualized. No posterior fossa lesion is seen. = These changes are usually age related, or due to high blood pressure, diabetes (decreased blood supply of small arteries) or rarely due to multiple sclerosis.


 


No parenchymal mass or extraaxial fluid collection. No evidence of prior cortical infarct. The ventricles, suici, and cisterns are age-appropriate, Major intercranial flow voids are maintained. = There is nothing abnormal here.


 


Minor scattered mucosal thickening in the paranasal sinuses. Globes, orbits, regional osseous and soft tissues are unremarkable. = This point to very mild sinus inflammation (usually due to chronic allergies).


 


SPINE


The spinal cord demonstrates normal signal and bulk. = No abnormality here.


In the cervical spine, alignment is normal. Disc spaces are preserved. No significant disc bulge or herniation is visualized. = Neck spine is normal.



In the thoracic spine, there is minimal anterior wedging of T6 and T7 which may reflect remote trauma. Mild associated exaggeration of normal thoracic kyphosis. Mild multilevel disc space narrowing is visualized.
= There is likelihood of mid back injury long ago due to which there is a mild change in the curvature of the mid spine / mid back. Overall there is nothing serious or significant.


No focal disc herniation or significant disc bulge is seen to cause spinal canal or foraminal narrowing. = No problem detected in mid back in disc and spinal cord.


 


In the lumbar spine, there is mild straightening of normal lumbar lordosis. Moderate spondylosis at L5/S1 and mild spondylosis at L4/5. Conus medullaris demonstrates normal signal and bulk and is not low-lying. = The lower spine / back has change in the curvature which can be age related change; also showing mild arthritis of lower back.


 


At L4/5, there is a mild circumferential disc bulg. Mild bilateral foraminal narrowing. No significant central spinal canal narrowing. = There is disc protrusion or disc herniation which is causing pinched nerve.


At L5/S1, there is a mild circumferential disc bulge which contacts the bilateral descending S1 nerve roots. The distribution and morphology of the lesions does not strongly suggest inflammatory demyelination. In a patient of this age, the most likely diagnosis is mild white matter microangiopathic change, although the sequela of prior migraine headaches or vasculitis could have a similar appearance. = Here, in the lowest part of the spine / back, there is again a disc protrusion or herniation which is causing significant pinching of the nerves which can cause numbness, tingling or pain in the lower limb. The nerve changes can also due to migraine and decreased blood supply of the nerve (can be predisposed due to high blood pressure, medications, diabetes).

 


No cord lesion is visualized. Minor degenerative changes in the thoracic and lumbar spine as described. = Normal in mid back and upper part of the lower back.


 

Customer: replied 1 year ago.

Can anything be done about these pinched nerves?


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
Yes, Jan. The mainstay of the treatment of pinched nerves is physical therapy and back care. Following is the comprehensive management;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the symptoms.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

 

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

 

3) Local analgesic gels or sprays / ointment

 

4) Hot fomentation

 

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

 

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

 

7) Lumbosacral corset or support or brace

 

8) If obese or over weight, reduce weight for long term benefit.

 

9) Epidural steroid shots

 

10) Surgery is usually last resort, when the above conservative measures fail. He can start the following exercises;

 

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

 

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (he can pick up his own set, which suits him);

http://www.mayoclinic.com/health/back-pain/LB00001_D

One can consult following specialists (apart from GP);

a) Orthopedist

b) Neurologist

c) MD in Physical medicine and rehabilitation


It is privilege assisting you.

Dr. Arun
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29710
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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