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Brain & Nervous System Disorders Message Board

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Last year, September 08, I was in a car accident in which I began to get headaches and pain in my neck/shoulders. I began physical therapy in November 08 for 2 months that relieved the pain and headaches. Shortly after had to have steroid shots put in my c-spine around a slipped disc in February 09.

In August 09 I began to get headaches again to the point that they turned into severe migraines that would last continually for 5-6 days at a time. Pain now was prominent in my neck in the same place I had the steroid shots and now pain moving down my back and into my shoulders. At one point I had to see a dentist because I was grinding my teeth so bad at night that they think I developed TMJ. I also had an episode where I lost vision in my right eye one morning for like a minute.

I went to my PCP initially who prescribed Vicodin for the pain and Flexeril for stiffness in my neck. I was then referred to see a Neurologist who had an MRI done on my brain that came back fine. She told me to go to the doctor I saw after my car accident and begin physical therapy. Later my neurologist ordered another MRI on my neck when I told her that I had also went back to the physician I saw after my car accident and they didn't order anything except physical therapy as well. (MRI Results on the bottom) I have been ordered to continue to rest and take it easy.

Before this onset I worked 8+ hours a day at a desk on the computer and 4-5 nights a week teach and dance Salsa. I have been going to physical therapy now for over 3 months, not going out, not working at a desk for 8 hours, just being pretty much lazy. Physical therapy doesn't do much during my sessions except caress my brow, putting me on heat and put the electric shock pads on my neck and shoulders which only makes me feel worse then when I came in. Every time I attempt to get on the computer to see if I have made any progress so that I might be able to go back to work, I can only stay on for about 2-3 hours before my neck/back/shoulders begin to hurt and it triggers a migraine that lasts for 2+ days.

I recently went and asked for the actual report for my MRI and films and took them to another doctor for a second opinion. It was at this point that I found out that I have 2 types of cysts in my neck and a disc desiccation. The doctor told me that there was no need for surgery but to go see my neurologists again and go to physical therapy.

Can someone please tell me what this MRI report means below? My work is stressing that my Short Term Disability is about to end but I know that as soon as I get on the computer I will begin to have pain in my neck/back/shoulder with tingling/numbness in my right arm when I elevate it and result in a migraine to where they will have to send me home.

MRI Report
1. Mild upper cervical spondylosis, without MRI evidence to suggest acute marrow or soft tissue edema.
2.Probably right upper neck epidermal inclusion cycst. Right maxillary orbit/sinus hyperintense focus. In the clinical question of dental or sinus disease, dedicated facial bone or sinus CT could further evaluate, as clinically necessary.

Diagnostic Interpretation:
History: Daily migraines and left occipital pain to left shoulder.

Technique: Sagittal T1 and T2 imaging was obtained through the cervical and upper thoracic spine, with axial T2 and volume gradient echo imaging from C2 to C7/T1 on the 3T Verio.

Findings: The visualized craniocervical junction and posterior fossa are unremarkable. No intrinsic signal abnormalities are demonstrated in the cervical cord. No STIR signal abnormalities are identified to suggest acute marrow or soft tissue edema. Multiple perineural/Tarlow foraminal cysts: right C4/5, left C5/6, bilateral C6/7, C7/T1.

C2/3-C5/6: Disc desiccation. Mild anterior marginal spurring. Minimal disc bulging without significant disc extrusion, limiting central or foraminal stenosis.

C6/7, C7/T1: No significant disc desiccation, extrusion, limited central or foraminal stenosis.

T2/3: Right paracentral disc protrusion with small amount of superiorly extruded disc material, flattening the right ventral cord, along posterior, inferior, T2 vertebral body.

0.7 x o.3 x 0.9 cm right posterior neck STIR and T2 hyperintese lesion, compatible with epidermal inclusion cyst. 0.5 x 0.9 cm T2 hyperintense focus in the inferior right maxillary sinus or right maxilla seen on on sagittal imaging.

Please help me understand what is going on. I have been reading about the cysts and I've read where they can be nerve damaging. An my pain in my right shoulder now is prominent pretty much at all times. The migraines are under control as long as I do not do anything for extended amounts of time.

Thank you!

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