View Full Version : Jeszel's MRI Report
13th November 2009, 10:16 PM
I was almost positive that Jeszel had SM, but it was officially confirmed. :(
We've decided to try prilosec along with the Gabapentin since Jeszel has excess brain fluid. Tagamet and diuretics did not improve her syptoms.
The report is still a bit confusing to me. My breeder asked how severe, but I'll have to call the doctor again to be able to know if this is all considered severe or not. Here are the findings:
On MR images of the head there is mild impingement on the cerebellum caused by the conformation of the occipital bone. There is enlargement of the lateral and third ventricles. Although not specifically included for evaluation there is increased T2 signal in the dorsal portion of the spinal cord in the rostral cervical spine. There are no other abnormalities seen.
There is mild occipital malformation causing impingement of the cerebellum, with resulting ventricular enlargement and probable syringomyelia in the cervical spinal cord. MRI of the cervical spine could be considered for a more definitive evaluation of the severity and extent of syringomyelia.
Love my Cavaliers
13th November 2009, 10:54 PM
I'm so sorry you have joined the SM club. Also sorry that I can't help you interpret the radiology report, but there are very knowledgeable people on this forum who can do that. I do hope that the gabapentin helps Jeszel. It may take a while to determine the correct dosage, so don't give up hope if you don't see improvement right away. I hope she will be a happier dog soon.
13th November 2009, 10:55 PM
I'm sorry you got this confirmation. :flwr:
The translation of the report is that she has the Chiari-like malformation (CM, which affects the occiput, the bone at the back base of the skull)) which is causing some mild compression of the hindbrain (the cerebellum, the bit at the base).
An increased T2 signal in the dorsal region means that when they pass a signal through the tissues during the MRI, at the top of the spinal cord there's an indication of some sort of changes. No signal means normal tissues, as far as I know. When you get T1 or T2 signals, it means the MRI is sensing some changes that may or may not be significant. My understanding is a T2 signal can indicate a cyst (syrinx).
There is some enlargement of the ventricles, the fluid spaces in the interior of the brain. In some breeds dilated ventricles are normal. In cavaliers they are not, but the meaning of the dilation is still not understood -- but is generally simply marked on the report if seen on MRI. Many neurologists believe it has some association with SM. Severe dilation means hydrocephalus.
The next part seems a bit odd -- the report is saying it is likely there are syrnixes (ie SM) in the top part of the spine (this is where it usually shows) and is recommending an MRI of this region. But an MRI for SM should have included at least the top few vertebrae and the region most likely to have a syrinx visible. So either they didn't MRI the top of the spine (strange, as then you cannot diagnose SM as it is in the spine!) or the suspected syrinx is below the point at which they MRId (unusual but possible). I would ask them to clarify this and also ask why the cervical spine wasn;t MRId as a matter of course.
In short: your dog has NOT (yet?) been definitively diagnosed with SM because they have not confirmed any syrinxes, but does have CM and cerebellar compression as a result (that alone can cause symptoms). The good news is that this seems to be mild, which is better than severe compression. But it can cause symptoms just like SM.
Without knowing whether there are syrinxes it isn't possible to tell how severe Jezsel is. The description is only of mild compression (presumably mild CM then?).
Did the people doing the MRI know how to do one for SM? Did they only do the head and no vertebrae? That's what I would want answered.
Hope that helps a bit.
13th November 2009, 10:56 PM
"There is mild occipital malformation causing impingement of the cerebellum, with resulting ventricular enlargement and PROBABLE syringomyelia in the cervical spinal cord. MRI of the cervical spine could be considered for a more definitive evaluation of the severity and extent of syringomyelia."
Not the wording I would have liked, as the word PROBABLE is still not giving a definite YES or NO answer and pushing you down the route of another MRI scan.
I have been party to several MRI mini scans and every one stated a PRESENCE or ABSENCE of the dreaded SM.
Have you decided where you are taking this ?
13th November 2009, 11:02 PM
Just as an addendum: this kind of scan is why the mini scans are not always the best option for diagnosis though they often cost less. It would be a pain, and costly, to have to do a full scan now. I'd want some clarification from them on how they did this scan. :thmbsup:
16th November 2009, 02:30 AM
Thanks for the info. I assumed that my neurologist ordered the head and neck MRI. It cost $1700, so I hope that they did not just scan her head.
My neurologist said that the MRI confirmed SM since she had the malformation and excess fluid. I'm going to put a call in to get more info from him regarding the scan.
The Gabapentin has improved her neck scratching since we put Jeszel on it about 6 months ago. My neurologist said that we would continue with drug therapy.
16th November 2009, 12:54 PM
Oh Jeszel, I'm so sorry your girl is not doing so well. It's so hard to watch our babies suffer.
16th November 2009, 04:32 PM
"My neurologist said that the MRI confirmed SM since she had the malformation and excess fluid. I'm going to put a call in to get more info from him regarding the scan."
The malformation together with excess fluid is NOT sufficient to diagnose SM. A syrinx must be identified in order to confirm the diagnosis.
16th November 2009, 05:22 PM
Sending you a big :hug: I know you'll be very down right now.
Don't feel shy to call the neuro, they are usually very happy to help.
My report didn't answer all my questions, I phone a couple of times for clarification on CM and herniation. She said most people don't know as much about SM as I did and therefore that's why the report was not as detailed as I'd liked.
Find out as much as you can but it all boils down to the same thing...love your little treasure with all your heart and be as gentle as you can.
16th November 2009, 06:56 PM
If gabapentin is helping then the symptoms could definitely be from the malformation alone. But dilated ventricles definitely are not SM, they are simply dilated ventricles; there would indeed need to by a syrinx present. Did they give you a disk with scan images ? That would be the norm as well, or at minimum some film images.
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