Pressure from neck? No pain.

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  • andrea2289
    Participant
    Post count: 2
    #24526 |

    Hi there. I’m hoping you have some insight as to what might be going on. In the beginning of January, I had a sudden onset of tingling in my leg, which spread to both legs and both arms. The tingling is still there but has subsided and eye/sinus pressure is my biggest symptom. I also have facial numbness off and on, brain fog (not dizziness), but the biggest symptom is the pressure. The pressure is significantly worse when I’m sitting and mainly behind the eye and sinus area. Driving for more than 20 minutes is almost unbearable, as is sitting at my desk, which preventing me from even being able to work.

    I’ve gone to my eye doctor, and my eye pressure tested fine even while I was feeling the pressure. I’ve also had a CT angiography of the head and neck, as well as a brain MRI. I DO have three meningiomas, but both Mayo and my team at Vanderbilt are confident they are not causing any of these symptoms and were incidental findings.

    My neurologist said he see no signs of intracranial pressure, but I am scheduled for a lumbar puncture next week. My last cervical MRI was January 26th, but that was before I felt this pressure. I also just had a lumbar and thoracic. Insurance wouldn’t approve another cervical, even though there is a worsening of symptoms. I’ll post the results below.

    The pressure can also be exacerbated by literally anything touching the back of my upper neck. I can’t even lay back on the couch. Literally, anything pressing on the back of my upper neck makes the pressure behind my eye worse.

    I went to a chiropractor, and she said something about occipital nerves and muscles. She worked on that area, and I did feel better, although it only lasted about two days. I also had two bupivacaine injections into the muscle of my neck, and that helped for about two days as well. Could this all be a muscle issue?

    And even though I do have benign brain tumors, I’ve been telling them for two months that I think something is going on in my neck. My doctor seems to be stumped. I have no pain, none. It’s all pressure. Here are my MRI reports. Thank-you in advance!

    ——————————————————————

    26-Jan-2017 22:15 *** Final ***
    Exam: MR Cervical Spine WO+W/CST

    Technique: In addition to routine cervical spine protocol, sagittal STIR T2 sequence was obtained for evaluation of spinal cord signal abnormality. This was followed by postcontrast study.

    Contrast: 7.5 mL IV Gadavist

    Impression: Stable exam with C3-C6 disc degeneration with C4-C5 disc height loss and right uncovertebral spur.

    Findings: Again identified is mild kyphotic deformity of the upper cervical spine with minimal retrolisthesis of C4 upon C5. The remaining vertebrae demonstrate normal alignment. The vertebral bodies have normal height and there is no marrow signal abnormality.

    There is mild height loss and bulging of the C4-C5 disc with small right uncovertebral joint spurs. There are C3-C6 enhancing disc annulus fissures. No other significant disc abnormality is identified. The spinal canal and neural foramina are widely patent. The craniovertebral junction, facet joints and visualized soft tissues of the neck appear unremarkable.

    The cervical and visualized upper thoracic spinal cord appears normal. In particular there is evidence for intrinsic cord signal abnormality. No evidence for abnormal intramedullary or leptomeningeal enhancement.

    The incidental left paramedian posterior pontine telangectasia noted on the brain MRI is again identified.

    ——————————————————————

    Exam performed on 2017/03/03 09:56
    MRI OF THE THORACIC AND LUMBAR SPINE
    HISTORY: Q85.9 Phakomatosis, unspecified

    TECHNIQUE: Multiplanar multisequence MR imaging of the thoracic and lumbar spine was performed before and after
    administration of 6.5 mL Gadavist intravenously.

    FINDINGS:

    Thoracic spine: Thoracic vertebra are normal in height and alignment. There is no abnormal marrow signal. Intervertebral
    disc spaces are preserved. The spinal cord is normal in size and signal intensity.

    Lumbar spine: Lumbar vertebra normal in height and alignment. A subcentimeter sclerotic focus in the L1 vertebral body is
    most likely a bone island. There is mild degenerative edema of the inferior L4 endplate. Degenerative disc disease is
    greatest at L4-L5 where there is a mild disc bulge and also mild facet arthropathy. There is resultant mild bilateral L4-L5
    neural foraminal narrowing. There is a minimal L3-L4 disc bulge. There is no canal stenosis.

    There is no abnormal contrast enhancement in the thoracic or lumbar spine.

    IMPRESSION:
    1. Mild L4-L5 degenerative disc disease and facet hypertrophy with mild neural foraminal narrowing.
    2. Normal MRI of the thoracic spine.

    Dr. Corenman
    Moderator
    Post count: 5105

    Some of the dictated report is not congruent. The sentence “The cervical and visualized upper thoracic spinal cord appears normal. In particular there is evidence for intrinsic cord signal abnormality. No evidence for abnormal intramedullary or leptomeningeal enhancement”. makes no sense as there cannot be a normal appearance but “evidence for intrinsic cord signal abnormality”. Probably a missed “no” in there.

    He does say “craniovertebral junction, facet joints and visualized soft tissues of the neck appear unremarkable” so there is no significant degenerative change to the facets. You still might have inflammatory facet disease that does not show up on the MRI scan. You can test this possibility with facet blocks (see https://neckandback.com/treatments/facet-blocks-and-rhizotomies-neck/ and https://neckandback.com/treatments/pain-diary-instructions-for-spinal-injections-neck/.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
    If this forum has helped you, please let Dr. Corenman know!

    andrea2289
    Participant
    Post count: 2

    I have my first appointment at a pain clinic next week, and I will mention this. Thank-you for your help 🙂

    What are your thoughts on upright MRIs? I had a friend say it sounded like some sort of instability, and that’s nearly impossible to diagnose without an upright MRI.

    Dr. Corenman
    Moderator
    Post count: 5105

    Upright MRIs are worthless in my opinion. Two factors that make it worthless. First is the the machine is a 0.7 Tesla strength magnet, a very low power machine. Imagine that the machine Tesla strength is the power of a flash bulb at night. The more powerful the flashbulb, the greater the illumination of the picture. Our machine at the clinic is 3.0 Tesla. You can understand then the problem with this “stand-up MRI” to resolve good pictures.

    The second problem is the the MRI captures a picture like the old time wild-west photographs. That is, it takes some time under the camera to get the exposure and if there is motion during the exposure, ghost images would occur (the picture would become blurry). I don’t know about you but I can’t stand (or sit) perfectly still for 20-40 minutes but I certainly can lie still for that period of time. 40 minutes is about the acquisition time from the MRI images to be obtained.

    Also, with a normal (supine) MRI of great quality and standing X-rays including flexion and extension, almost all problems of instability can be diagnosed.

    Dr. Corenman

    PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
    If this forum has helped you, please let Dr. Corenman know!

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