I just received a copy of my recent MRI. The neuro I am seeing her in town failed to mention to me this piece of info from my very recent MRI w/ and w/o contrast. She also said that based on my multitude of other symptoms i ma no longer within her scope of practice and therefore she is sending me to Mayo Clinic, Jacksonville Florida. This is what the report reads:
"The origin of the 5th nerve on left appears to be slightly larger than that on the right and the posterior cerebellar artery appears to be in intimate contact with that proximal nerve."
If roughly translated- would this be saying that the impression is that the artery is rubbing the trigeminal nerve? And if so, is this a similar report to what is most commonly referred to as "compression"?
Also, the MRI report states that there has been no change between this report and the MRI of Oct 2011, so I am wondering why this portion was not stated on that previous MRI? I did have the imaging done in two different states. My main other complaint, aside form the many small complaints, is that of spontanous hearing loss episodes occurring sometimes alone or following postural blood pressure increase upon standing.
The language you report indeed describes a vascular compression. If you have been under a neurologist's care, I am VERY puzzled concerning why this earlier report did not generate greater interest or reaction. The sudden positional hearing loss, however, is quite probably something of a different nature. I think in that case I would be concerned that you should be thoroughly evaluated for an acoustic neuroma -- which should have been visible in the same MRI images, if you have one.
I would agree that having you evaluated by a major regional treatment center like Mayo seems to be a very good idea, and as soon as practicable.
Thank you for your reply. I was evaluated for an AN, with specific AIC MRI w/contrast done. The report from that part of the study is "of no impression, all parts intact and normal. No interference in eighth nerve." I set up an appt with an ENT for this next week so that I can have full inner ear exams and reports done BEFORE I get to Mayo to avoid the run around. A few points are somewhat bothersome to me though:
- My major in A&P has taught me that the IPCA is the cerebellar artery, not adjacent to the fifth nerve, yet the PCA (cerebral artery) is is adjacent to the fifth nerve, so should I ask for better clarification of my MRI? Seems like the positional language is not anatomically correct as used by the radiologist, or possible missing info.
-I have read several studies that TN can be dx and current dx supported by an ENT, am I correct in observing this? I am going to have the ENT review my MRI as well, in hopes that they will have something more to say about the compression.
- My nature of TN has changed, in the severity of pain, type of pain and trigger types. It seems I have moved int quite the case of typical, whereas before is was considered more of an atypical. Is that common?
I sincerely appreciate your input. I have been given the run around here to such extremes that I am currently in the midst of filing formal complaints with certain boards. Florida truly has a mess of a health care system.
If acoustic neuroma has been eliminated, then other two suspects come to mind. One would be a small tumor and the other a small aneurism in the vicinity of the nerve involved in auditory sensing -- but only if the hearing loss is specific to one side. If you're losing hearing on both sides at the same time, then I wouldn't blame any physician for scratching their head in puzzlement.
Good idea to do the groundwork before you get to Mayo
Clarification does seem to be needed in physiological terminology used in your report. Call the office of the radiologist who wrote the report, and ask for it.
Diagnosis of TN is done on the basis of patterns of pain and trigger zones, combined with patient response to common anti-seizure or anti-neuropathy meds. MRI imagery can be confirming but is not accepted as diagnostic. An unusually well trained Ear Nose and Throat specialist may recognize the symptoms, as well as neurologists, anesthesiologists, and some specialists in emergency medicine. Depends on physician training and currency, as much as anything else.
It's not uncommon for TN pain to change in character. At one time, Type II (Atypical) TN was called "pre-"trigeminal neuralgia, as it has been observed to occur as a sort of precursor to the emergence of Type I (typical) TN in some patients. That terminology is no longer used, in part because it has become more widely recognized that both of these types of pain are common in the same patients, and the order of presentation isn't a fixed pattern. In a demographic study of members here at LwTN, I found that at least 20% of our patient population declared that they had both types of pain.
While I'm happy to help if I can, please remember that my doctorate is in systems engineering, not a medical field. You'll need to confirm the observations of fact above, with medical professionals.
Thank you very much for your reply. I am noting your observations, and yes will discuss them with a doctor along with other input from those with TN experience. It helps quite a bit to bounce thoughts off of others. Now if I can bounce those thoughts off of a receptive doctor, well that may need a little extra work. ;)