m****9
发帖数: 26 | 1 由于最近几个月来，一直头晕，四肢乏力，四肢发麻，去看了neurologist, 做了头部
，颈椎的MRI，刚拿到报告，医生说没有大的问题，需要进一步去看神经外科，但是我
看到头部MRI的报告显示有问题，这个让我很担心。 然后这个颈椎的问题能引起头晕么
？ 报告上写的是没有脊髓和神经压迫。 请帮忙看看怎么回事？ 暂时我还没拿到片子
，如果有需要，等拿到片子后，我也可以上传。 谢谢。
头部的报告内容：
MRI BRAIN WITHOUT AND WITH CONTRAST
History: Headaches, unsteady gait, and bilateral leg greater than arm
numbness. Evaluate for demyelinating disease.
Technique: Precontrast T1 axial, DWI axial, GRE T2 axial images were
obtained. Postcontrast 3 mm thick T2 axial, T1 axials, 3-D T1 series and 3-D
T2 FLAIR series which were reconstructed into the sagittal, axial and
coronal planes were obtained after administration of 9 cc of MultiHance.
Comparison: None
Findings: There are 5 punctate T2 hyperintense predominantly anterior deep
white matter lesions. None have an ovoid configuration or involve the corpus
callosum. None are in a periventricular or juxtacortical location. No T2
hyperintensities are seen involving the brainstem or cerebellar hemispheres.
None of these areas demonstrate mass effect, enhancement, hemorrhage or
restricted diffusion. The ventricles and sulci are normal in size and
position without midline shift or mass effect. No extra-axial fluid
collections are seen. The large intracranial vessels as visualized are
within normal limits. Specifically, there is no evidence of occlusion or
greater than 50% narrowing of the dural venous sinuses on the postcontrast
isotropic 1-mm resolution 3-D T1-weighted series. Lastly a 14 mm long area
of fullness is seen involving the subcutaneous tissues posterior to the
right posterior parietal scalp (series 904 images 21-25 and series 903
images 46-48. This does not demonstrate abnormal enhancement or T2
hyperintensity. No invasion of the underlying calvarium is seen. The
etiology is unclear but it has a benign appearance.
IMPRESSION: THERE ARE 5 PUNCTATE PREDOMINANTLY DEEP BILATERAL ANTERIOR WHITE
MATTER LESIONS WITHOUT MASS EFFECT OR ENHANCEMENT TO SUGGEST A RECENT
ABNORMALITY. THESE DO NOT MEET THE REVISED MCDONALD CRITERIA OF DISSEMINATED
IN SPACE.
颈椎的报告内容：
MRI CERVICAL SPINE WITHOUT AND WITH CONTRAST
History: Patient with unsteady gait and bilateral leg greater than arm
numbness. Evaluate for demyelinating disease.
Technique: T2 sagittal, STIR sagittal, 2D MERGE T2 axial, T1 sagittal and T1
axial axial images without and with contrast of the cervical spine were
performed using 9 cc of Multihance.
Comparison: None
Findings: Normal cervical spine bony alignment is seen. There is no
evidence of a paraspinous mass. The size and signal intensity of the
cervical cord are within normal limits. Specifically no areas of T2
hyperintensity or abnormal gadolinium enhancement are identified to suggest
regions of demyelination.
C2-3: Within normal limits.
C3-4: A focal right paracentral disc herniation is seen effacing most of the
CSF anterior cervical cord without cord compression or cord edema (series 7
image 11).
C4-5: A broad-based disc bulge is seen effacing some but not all the CSF
anterior cervical cord without cord compression or nerve root compression (
series 7 image 15).
C5-6: Within normal limits.
C6-7: Within normal limits.
C7-T1: Within normal limits.
IMPRESSION:
1. NO FOCAL AREAS OF T2 HYPERINTENSITY OR ENHANCEMENT IS SEEN INVOLVING THE
CERVICAL OR UPPER THORACIC CORD TO SUGGEST DEMYELINATING DISEASE AS
QUESTIONED CLINICALLY.
2. AT THE C3-4 LEVEL THERE IS A FOCAL RIGHT PARACENTRAL DISC HERNIATION
CAUSING MILD/MODERATE CENTRAL CANAL STENOSIS WITHOUT CORD COMPRESSION OR
NERVE ROOT COMPRESSION.
3. BROAD-BASED DISC BULGE SEEN AT THE C4-5 LEVEL CAUSING MILD STENOSIS. | l*h
发帖数: 4124 | 2 your age? sex?
I assume you are young (20-40 yo).
I am worried you might have/develop multiple sclerosis. I strongly disagree
on your neurologist's opinion "没有大的问题". the radiologist had the right
suspicion, just not sufficient to meet the diagnostic criteria yet.
what does your neurologist's training background look like?
I would recommend you have repeat MRI of the head/brain in 1 -2 months. if
your neurologist refuses to order repeat MRI and insists there is nothing to
worry about in the brain, go to see another neurologist. You cannot dismiss
those T2W hyperintense foci without repeat studies. In addition, McDonald's
criteria are deficient in both sensitivity and specificity in Asian
population.
It doesn't hurt to get a neurosurgical consultation on your cervical discs,
but surgery is not required at this time.
【在 m****9 的大作中提到】
: 由于最近几个月来，一直头晕，四肢乏力，四肢发麻，去看了neurologist, 做了头部
: ，颈椎的MRI，刚拿到报告，医生说没有大的问题，需要进一步去看神经外科，但是我
: 看到头部MRI的报告显示有问题，这个让我很担心。 然后这个颈椎的问题能引起头晕么
: ？ 报告上写的是没有脊髓和神经压迫。 请帮忙看看怎么回事？ 暂时我还没拿到片子
: ，如果有需要，等拿到片子后，我也可以上传。 谢谢。
: 头部的报告内容：
: MRI BRAIN WITHOUT AND WITH CONTRAST
: History: Headaches, unsteady gait, and bilateral leg greater than arm
: numbness. Evaluate for demyelinating disease.
: Technique: Precontrast T1 axial, DWI axial, GRE T2 axial images were
| l*h
发帖数: 4124 | 3 if you have the neurologist's complete note, you can post it. | m****9
发帖数: 26 | 4 你好，首先谢谢你的回复。 我24岁，男。 医生的意见很简单：
MRI shows nothing concerning intracranially or with the soft tissue of his
neck. He does have some narrowing in his cervical region that warrant a
neurosurgical opinion.
请问你是医生么？ 我在医疗实践板块也发了同样的帖子http://www.mitbbs.com/article_t/Medicalpractice/67035.html，回复是不用担心。。。我看的神经科医生是：
Erica Austin DO, 背景不了解...
【在 l*h 的大作中提到】
: if you have the neurologist's complete note, you can post it.
| m****9
发帖数: 26 | 5 对了，今年3月份和五月份在国内做过两次脑ct，报告都是正常。
【在 l*h 的大作中提到】
: if you have the neurologist's complete note, you can post it.
| h***f
发帖数: 162 | 6 Why are you seeing a DO.... they're not even real doctors... | m****9
发帖数: 26 | 7 我是先在校医院看的，然后refer过去的，我貌似不能选择。现在真想吐槽美国的医疗
流程。。。
【在 h***f 的大作中提到】
: Why are you seeing a DO.... they're not even real doctors...
| l*h
发帖数: 4124 | 8 The punctate T2W hyerintense foci are definitely something that need some
attention. They don't have the typical shape of MS lesions, they are not in
the typical locations of MS lesions, they may be completely harmless, but
they cannot be simply dismissed as "nothing concerning intracranially." If
you take a typical MS patient who has not progressed to advanced stage yet,
have monthly head/brain MRI for a full year, you usually can only find
typical shaped lesions at typical locations on 3 or 4 of the 12 scans. On 3
or 4 scans, you may find nothing, on the other scans, you may be able to
find some atypical changes.
So the approaches to this kind of findings are:
1. if there is clinical symptoms/signs, it would be better to set up monthly
repeat scans.
2. if there is no objective clinical findings, put the patient on "watchful
waiting," repeat MRI in a few months, repeat neurological exam every now and
then. if repeat MRI shows no changes, and the patient does not develop new
symptoms/signs, a conclusion that the lesions are not worrisome may be made.
医疗实践板块 is a gathering spot for quacks.
【在 m****9 的大作中提到】
: 你好，首先谢谢你的回复。 我24岁，男。 医生的意见很简单：
: MRI shows nothing concerning intracranially or with the soft tissue of his
: neck. He does have some narrowing in his cervical region that warrant a
: neurosurgical opinion.
: 请问你是医生么？ 我在医疗实践板块也发了同样的帖子http://www.mitbbs.com/article_t/Medicalpractice/67035.html，回复是不用担心。。。我看的神经科医生是：
: Erica Austin DO, 背景不了解...
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