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Further research says that the ‘posterior’ pituitary shows up differently to the ‘anterior’ pituitary on an MRI. So on a T1 weighted MRI, the posterior pituitary should show up as a bright spot, on a normal MRI, in contrast to the anterior pituitary.
Hi Barb.
Thank you so much your help!
I am meeting with 3 vascular surgeons next month in regards to vasospasm and a kinked subclavian artery, and they will be looking at the CT Angio and I will enquire about the empty sella, and much more!
I will post if anything interesting comes of the appointment.Hi MJ,
Due to our bone structure being in 3D, unless we are perfectly positioned, often scan shots are asymmetrical but, that does not mean there’s an abnormality. On the other hand, if one of your vertebrae is subluxed (shifted laterally or rotated, or both) into the wrong position, this too can show up as asymmetry. It’s down to the radiologist to determine what is an anomaly and what isn’t. Often the same bone shown in a different view can rule in (or out) any such anomaly. I have to comment here though that anomalies in the cranio-cervical junction, with it being such a complex junction, are often missed! I’d need a much bigger picture and other views, from different angles, of that area.Regarding the possible empty sella, it’s too difficult to determine from this view – photo too small and shade affected by the angle of the picture.
Can you do a ‘screen capture’ of the scan when it’s up on your computer screen and ‘paste’ it into a document in “Paint” or a similar application, then save it as a .jpeg file ? This produces a purer image. I might be able to comment further then.
Regards
Barbara
(UK)This MRI is a lot like my daughter’s except for her pituitary which is large, round and globular rather than empty sella. We followed up with new mri’s and mra’s annually to watch the pituitary but they just said all is okay.
She has POTS, Autonomic Neuropathy, Gastroparesis, and we believe Ehlers Danlos Hypermobility Type. It all started with transient vision loss and tachycardia 10 years ago. And as you all know she has constant numerous symptoms with no real help from doctors except for her gastroparesis. She now has a pacemaker on her stomach to aid in the movement of food as her stomach was paralyzed.
Yesterday, I got a call from school saying that my 13 yr old son was blind. His blackout lasted almost an hour with no sight at all. My daughter’s first episode was at the same age with same start except that her blindness lasted only 15-20 minutes. Since then continual blackouts but they only lasts seconds to a minute. AND, he has extreme hypermobility too.
What do you think of the mri attached?
Hi Kkrylee3,
My observations of this MRI are that there is nothing blatant. That is, there is no obvious excess of fluid above the brain, the corpus callosum is slightly flattened though; the cerebellar tonsils are a little low but not herniated, this possibly might cause problems according to head position; the pituitary isn’t flattened, which would suggest perhaps that if any raised intracranial pressure exists, it is intermittent.Due to time constraints, I haven’t taken any measurements of angles etc but I would suggest that a neutral, flexion and extension MRI study might be beneficial here (with there being obvious hypermobility in the child) to see if the distance between the Opisthion and the back of the Dens, is reduced, particularly when the head is in full flexion. Note – the Dens is the tip of the Odontoid – the ‘peg bone’ in neck; the Opisthion is at the back of the Foramen Magnum (i.e. hole in the bottom of the skull where the spinal cord comes through). This reduction in space may put subtle pressure on cerebellum, or brainstem, or anything else that exists within that space, altering cerebro-spinal fluid flow too. This could bring on any of the multitude of symptoms associated with that area.
An upright MRI may show a worsening state with regard to the amount of cerebellar tonsillar herniation, through the foramen magnum, which will exhibit as symptoms of Chiari 1 Malformation. So I would also suggest that if possible, the neutral, flexion and extension MRI study be taken in the upright position.
Hope some of this helps.
Regards
Barbara
(UK)For clarity, I have annotated your MRI to show the 2 points that I am referring to in the post above
I would also be curious to know what position your sons head was in prior to having his vision loss. Also had there been any recent injury (no matter how seemingly minor)? What has his doctor said caused the vision loss ?
Thank you for your response. This is my daughter’s mri (who is 23, but this was taken @ 18 yrs old. My son just lost his vision for the first time this week. He is 13 which is the same age that my daughter 1st lost her vision. They both have hypermobile joints, he also is double jointed in both elbows. The poor man’s tilt test was done on him in the E R and his heart rate jumped up 35 beats immediately upon standing. We haven’t seen a doctor yet, other than E R, on his issue. Appointment is set though. My family has members who have connective tissue disorders but not ED (Sjogrens and Scleraderma). And no, there was no physical or emotional trauma prior the blindness which lasted almost an hour with another blackout the following day for only seconds. He was sitting at his desk in class and all of a sudden, he was blind. It happened the same way for my daughter at the same age. She now has POTS, ED Hypermobility Type, Autonomic Neuropathy, and Gastroparesis.
Can your son remember whether he was looking down (head in flexion) or if his head was straight forwards, when he went blind ? … and if his head was rotated one way or the other ?
Thank you for your help. He said that he was slouched a bit in desk looking forward. No particular bend to his neck. He had gotten up just before that and sat back down. Then blindness for 1 hour. Pupils did react properly during blindness. After the hour vision came back gradually, like seeing light first, then shapes, then vision normal. At the E R I had them do a poor man’s tilt test, since my daughter has POTS, and pressure didn’t change much but heart rate went from lying down to standing: up by 35 beats.
He is even more flexible than my daughter and he has double jointed elbows but no stretchy skin. His medical history is baker’s cyst behind knee, growing pains in legs?, bottom of feet hurt to walk sometimes, and on at least three occasions had swollen lymph nodes in several locations at once. The one under arm pit stayed for weeks, others were one in shoulder and other one in neck. When in shoulder, given antibiotics which cleared it up.
When you say slouched, do you mean slouched over his desk looking forwards, or slouched back down in his seat? The first position would have put his head slightly into extension and, for those with instability, often the chin is well forwards. At one point, following my injury, if my chin was forwards and I rotated my head to my left, it would send my pupils into all kinds of shapes, so from experience I know that there is some connection there, to the eyes, with them being affected.
Okay, I’ve finally located my MRI Measurements I promised earlier on in the year, so – watch this space!
I am going to demonstrate the several methodologies I used to try and expose my Cranio Cervical Instability (CCI) and how many of those failed and didn’t catch it, so you can see how easily this diagnosis is missed.
I applied all of the following methods:
i.e. Powers; Wholeys; Lees; Kaufmanns; Dublin etc. and finally the methdology developed by Drs Bolognese/Milhorat/Nishikawa and team, which seems a little more complex initially but, once you know how to recognise the various anatomical points, it’s not that difficult. This was the method that finally confirmed it for me.I also determined that my own brainstem was being ‘pincered and stretched’, before getting this confirmed by the master (Dr Nishikawa).
IMPORTANT INFO for all patients with Craniocervical Instability (CCI) – please post it online and on Facebook
Points #2 and #7 are the MOST important of all.1. When they do the flex/ext MRI, the techs usually tell the patients to flex the neck in a way which puts the stress on the mid-lower cervical spine, to check for dynamically herniated disks; this position is not helpful for CCI patients and does not add anything to the regular supine study.
2. If the focus of the study is the craniocervical junction, the correct way to flex is by TOUCHING THE CHIN ON THE CHEST.
3. If the symptoms flare up in the chin/chest position, hanging in tough is worth it, because the surgeon will get the pic with the “smoking gun”
4. MRI upright machines have smaller magnets than regular machines, thus leading to pictures with far less details
5. Upright MRI machines can visualize the effect of gravity on the craniocervical junction (besides and in addition to flexion and extension, which are a horizontal issue)
6. Flexion/extension studies can be done on regular machines with the help of sandbags;
flexion = sandbag behind the occiput, chin touching the chest;
extension = sandbag behind the shoulders7. Flex/ext MRI studies MUST be in sagittal views and T2 sequences.
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