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What Does My MRI Scan Test Report Indicate?
Posted on
Fri, 29 Jan 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Fri, 29 Jan 2016
Answered on
Tue, 8 Mar 2016
Last reviewed on
Question : Hello, folks.
I have two comparative MRI head and neck scans, taken a year apart, and would like to ask a neurologist a simple question about whether or not one of them shows a potential RH cerebellar ischaemic area. The files are of the same patient - me - and are taken twelve months apart using the same scanner at my local hospital.
I had a scan last year which revealed a hypoplastic right basilar artery which was believed to be not clinically significant.
I recently ( a week ago) had what I believed was an attack of BPPV but this has returned on a number of occasions. The symptoms are vertigo, some degree of bilteral weakness in the forearms and hands, and there has been persistent visual migraine like ocular disturbances constantly for over a month.
I have a history of mild hypertension (BP high 150's/110) and may have recently had spells of atrial fibrillation (under investigation.)
Whilst I am aware that no doctor would tie himself to a diagnosis of a TIA online (rightly so) I would like to find out whether my assessment of my latest MRI (done yesterday) is correct - "potential ischaemic area in right cerebellum." This is at the level of the pituitary gland but in the RH cerebellar cortex itself. It extends upwards through the cerebellum.
I have two comparative MRI head and neck scans, taken a year apart, and would like to ask a neurologist a simple question about whether or not one of them shows a potential RH cerebellar ischaemic area. The files are of the same patient - me - and are taken twelve months apart using the same scanner at my local hospital.
I had a scan last year which revealed a hypoplastic right basilar artery which was believed to be not clinically significant.
I recently ( a week ago) had what I believed was an attack of BPPV but this has returned on a number of occasions. The symptoms are vertigo, some degree of bilteral weakness in the forearms and hands, and there has been persistent visual migraine like ocular disturbances constantly for over a month.
I have a history of mild hypertension (BP high 150's/110) and may have recently had spells of atrial fibrillation (under investigation.)
Whilst I am aware that no doctor would tie himself to a diagnosis of a TIA online (rightly so) I would like to find out whether my assessment of my latest MRI (done yesterday) is correct - "potential ischaemic area in right cerebellum." This is at the level of the pituitary gland but in the RH cerebellar cortex itself. It extends upwards through the cerebellum.
Brief Answer:
More images needed
Detailed Answer:
I read your question carefully and I viewed the images which you provided. I am a neurologist who deals mainly with stroke, so I believe to be the right person for your case.
Those images are not complete I have to say. An MRI makes many cuts/slices at different levels of the brain. In order to assess the cerebellum one needs to see all the cuts including the cerebellum, a single one shows only that particular level. In particular the image of 2015 you provide is not adequate as it slices only the very top part of the cerebellum, 95% of that photo shows the upper brain. So it's impossible to make any comment on that 2015 image.
As for the 2016 one, that slice shows an ischemic area, on the LEFT side of the cerebellum (which is on the right side in the photo). Doesn't show much anything on the right side (but as I said it's a single slice, can't judge the rest of the cerebellum).
The MRI apart from having many slices, uses also several techniques, some techniques (sequences - like DWI, Flair, T1, T2, TOF, GRE, contrast T1 etc) are better for some things say ischemic stroke, some for something else say hemorrhage. Also some sequences show stroke in the early phase, some in later stages, so if I had all the images might be able to determine the age of that stroke, whether it corresponds to one week ago when you had the vertigo episode, or whether it is the remnant of an old lesion months or years ago.
So it is advisable to upload the whole MRI. I know may be difficult to do here for every single image. My advice is to find a folder called DICOM in the disc you have provided. That folder has all the images inside. Make a single ZIP file of it for convenience, upload it in a file sharing service like Dropbox for example and send me the link so that I can download and view all the images. I hope I am making sense to you, otherwise you can upload the images one by one, but there are so many of them will be more hard work.
I remain at your disposal for further questions.
More images needed
Detailed Answer:
I read your question carefully and I viewed the images which you provided. I am a neurologist who deals mainly with stroke, so I believe to be the right person for your case.
Those images are not complete I have to say. An MRI makes many cuts/slices at different levels of the brain. In order to assess the cerebellum one needs to see all the cuts including the cerebellum, a single one shows only that particular level. In particular the image of 2015 you provide is not adequate as it slices only the very top part of the cerebellum, 95% of that photo shows the upper brain. So it's impossible to make any comment on that 2015 image.
As for the 2016 one, that slice shows an ischemic area, on the LEFT side of the cerebellum (which is on the right side in the photo). Doesn't show much anything on the right side (but as I said it's a single slice, can't judge the rest of the cerebellum).
The MRI apart from having many slices, uses also several techniques, some techniques (sequences - like DWI, Flair, T1, T2, TOF, GRE, contrast T1 etc) are better for some things say ischemic stroke, some for something else say hemorrhage. Also some sequences show stroke in the early phase, some in later stages, so if I had all the images might be able to determine the age of that stroke, whether it corresponds to one week ago when you had the vertigo episode, or whether it is the remnant of an old lesion months or years ago.
So it is advisable to upload the whole MRI. I know may be difficult to do here for every single image. My advice is to find a folder called DICOM in the disc you have provided. That folder has all the images inside. Make a single ZIP file of it for convenience, upload it in a file sharing service like Dropbox for example and send me the link so that I can download and view all the images. I hope I am making sense to you, otherwise you can upload the images one by one, but there are so many of them will be more hard work.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello, Doctor Taka, thank you very much for your swift reply. I did think this was actually the case. It certainly feels like there's been some kind of cerebellar involvement which seems to be fairly recent. I think the confusion about which side this occurs in is due to the image being inverted, and me not reading it correctly.
I've uploaded the DICOM file to Dropbox. It can be found at
https://www.YYYY.com/s/YYYY/YYYY.rar?YY=0
I must say that a non expert glance at the 2015 scan revealed a pretty clear cerebellum, but - over to you, of course.
Thanks and all the best XXXXXXX XXXX
PS Forgot to mention. There is some evidence of dysphagia at the moment - just a slight sensation - but I was actually woken up last night by pins and needles across my face, in my eyelids and also (severely) in my left arm. There is a generalised feeling of dizziness and mild nausea today which worsens upon even mild exercise.
I've uploaded the DICOM file to Dropbox. It can be found at
https://www.YYYY.com/s/YYYY/YYYY.rar?YY=0
I must say that a non expert glance at the 2015 scan revealed a pretty clear cerebellum, but - over to you, of course.
Thanks and all the best XXXXXXX XXXX
PS Forgot to mention. There is some evidence of dysphagia at the moment - just a slight sensation - but I was actually woken up last night by pins and needles across my face, in my eyelids and also (severely) in my left arm. There is a generalised feeling of dizziness and mild nausea today which worsens upon even mild exercise.
Brief Answer:
Read below.
Detailed Answer:
Thank you for the images.
The MRI of 2015 looks clear to me apart from the hipoplastic right vertebral artery (not bazilar, there is only one basilar artery created by the left and right vertebral arteries). It is not the most ideal MRI. I do not know if it was done with the purpose of searching a stroke, a MRI done in a stroke patient should always include diffusion sequences.
In the 2016 MRI there are several scattered ischemic lesions, left cerebellar ones as well as a single punctiform one in diffusion sequences, in the inferior part of the temporal lobe (doesn't change much in the analysis as very small it's in the territory of the same posterior vascular system). If you want to know where, look at the bright spots on the diffusion sequences, it's Series 5 (the one with 62 images) image 39, 40, 41, 42, 44.
Now it is good they are searching for atrial fibrillation, but I think some vascular imaging is necessary as well for the vertebral arteries in the neck and head. You mention head and neck MRI, have no images of the neck there, I believe it to be necessary especially since as I told you all the lesions are in the posterior circulation. Emboli can come both from the heart as well as the blood vessels, but when from the heart they usually involve randomly different territories (anterior, posterior, right, left) not only one. So some blood vessel imaging, Angio CT or Angio MRI is recommended.
As for the symptoms, if I had to judge only by those lesion I would say they can justify some dysarthria, errant movement coordination on the right limbs (limb ataxia - on the same side with the cerebellar hemisphere involved), some balance issues and some nausea. If there is narrowing of the left vertebral artery though, there may be episodes of low blood perfusion making other areas apart from those infarcted ones suffer and cause those other symptoms you describe. That is why I believe that blood vessel imaging is necessary.
Regarding treatment, I do not see you mentioning any blood thinner, like antiagregants or anticoagulants. You should be at least on an antiaggregant such as Aspirin (Clopidogrel and Aspirin/Dypiridamole combination being other valid alternatives) to prevent further stroke. If atrial fibrillation is seen, or a blood vessel issue such as vessel wall dissection, anticoagulant treatment may be necessary.
I hope to have been of help.
Read below.
Detailed Answer:
Thank you for the images.
The MRI of 2015 looks clear to me apart from the hipoplastic right vertebral artery (not bazilar, there is only one basilar artery created by the left and right vertebral arteries). It is not the most ideal MRI. I do not know if it was done with the purpose of searching a stroke, a MRI done in a stroke patient should always include diffusion sequences.
In the 2016 MRI there are several scattered ischemic lesions, left cerebellar ones as well as a single punctiform one in diffusion sequences, in the inferior part of the temporal lobe (doesn't change much in the analysis as very small it's in the territory of the same posterior vascular system). If you want to know where, look at the bright spots on the diffusion sequences, it's Series 5 (the one with 62 images) image 39, 40, 41, 42, 44.
Now it is good they are searching for atrial fibrillation, but I think some vascular imaging is necessary as well for the vertebral arteries in the neck and head. You mention head and neck MRI, have no images of the neck there, I believe it to be necessary especially since as I told you all the lesions are in the posterior circulation. Emboli can come both from the heart as well as the blood vessels, but when from the heart they usually involve randomly different territories (anterior, posterior, right, left) not only one. So some blood vessel imaging, Angio CT or Angio MRI is recommended.
As for the symptoms, if I had to judge only by those lesion I would say they can justify some dysarthria, errant movement coordination on the right limbs (limb ataxia - on the same side with the cerebellar hemisphere involved), some balance issues and some nausea. If there is narrowing of the left vertebral artery though, there may be episodes of low blood perfusion making other areas apart from those infarcted ones suffer and cause those other symptoms you describe. That is why I believe that blood vessel imaging is necessary.
Regarding treatment, I do not see you mentioning any blood thinner, like antiagregants or anticoagulants. You should be at least on an antiaggregant such as Aspirin (Clopidogrel and Aspirin/Dypiridamole combination being other valid alternatives) to prevent further stroke. If atrial fibrillation is seen, or a blood vessel issue such as vessel wall dissection, anticoagulant treatment may be necessary.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you, Dr Taka, that's been fantastic and the best money I have ever spent.
I'll contact my physician and see what the next steps are. Typically, in the UK, MRI results take 10 days to be interpreted and this is obviously why I got in touch. Hopefully a course of anticoagulants and some investigation of circulation issues.
Many, many thanks for your swift and detailed reply. I wish you all the very best for the future.
Best regards XXXXXXX Francis
I'll contact my physician and see what the next steps are. Typically, in the UK, MRI results take 10 days to be interpreted and this is obviously why I got in touch. Hopefully a course of anticoagulants and some investigation of circulation issues.
Many, many thanks for your swift and detailed reply. I wish you all the very best for the future.
Best regards XXXXXXX Francis
Brief Answer:
Thank you!
Detailed Answer:
Thank you for your kind appreciative words. Wishing all the best for you too.
Thank you!
Detailed Answer:
Thank you for your kind appreciative words. Wishing all the best for you too.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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