Greetings,

I'm hoping someone might be able to share some insight on some brain MRI test results and a referral from Neurologist to see Movement Disorder Specialist.

I'm a 27 year old male and have been experiencing what seems primarily nerve/muscle related issues for approximately 3 years. I recently saw a Neurologist about a constant and painless twitching in my left small toes, which began as only minor and occasional 'outbursts' of twitching and has evolved to a now constant, uncontrollable twitching in the left toes and starting to be the entire left foot at times. Neurologist ordered a brain MRI which showed some lesion(s). He's also referred me to see a Movement Disorder specialist as he's "stumped" and only remarks that the twitching appears to be dystonic in nature and that a specialist is warranted.

When my doctor gave me the results of my Brain MRI, he commented that I have what is probably a benign/ congenital venous angioma which I've had since birth. I then told him that I had a Brain/neck MRI two years ago and the report showed nothing. He then urged me to get him a copy of the images, which I should have in the next 1-2 weeks. I have however since obtained a copy of the original MRI from 2 years ago, which I've provided below.


My Question: Is it possible my older MRI results could have 'missed' the congenital/benign AVM which was found in my recent MRI? If not, meaning the previous MRI rules out the recent MRI findings as benign AVM, then what might it be?



MRI RESULTS:

Last Weeks MRI:

There is a prominent vein on the post-contrast images and T2 images that parallels the wall of the left frontal horn and then drains in the midline through the foramen of Monro. There are contributory veins but not the typical caput medusa-type appearance that we see with a typical venous angioma.

On diffusion images, there is no sign of a recent or subacute infarction, or abnormal restricted diffusion.

There are no signs of hemorrhage. On the coronal T1 fast-spin echo images, the prominent draining vein to the left of the midline is seen, and there is also a prominent flow void along the medial right frontal lobe and pericallosal region on the right.

Sinuses are well aerated and clear.

IMPRESSION:
Probable benign venous angioma in the left frontal region with a prominent draining vein that drains back into the internal cerebral vein on the left. However, this may be associated with a cryptic AVM. If it would help in the management of the patient, a dedicated MRA of the brain and MRV of the brain could be performed to further evaluate for any additional vascular lesion associated with venous angioma.


MRI From 2 yrs ago:

1. The diffusion weighted images are normal, no evidence of infarct.
2. There are no cranial mass lesions.
3. There are no areas of abnormal signal intensity in the brain. There are no congenital structural anomalies.
4. Ventricles are normal in size shape. No abnormal extra-axial fluid collections.
5. Normal flow voids are present in the basilar arteries and distal internal carotid arteries.


Thanks in advance for any thoughts or comments