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

Hi geeksauce, welcome.

Aside from the human factor in "reading"/interpreting imaging, errors can occur from a number of sources, so yes, it's possible that something could have been missed or misinterpreted on the earlier MRI.

sources of errors in mri

If there has been no error, I would not assume that the previous MRI rules out the recent MRI findings as benign AVM.

What you have posted is the report from the earlier MRI. Your doctor wants to see the imaging itself, presumably to see/interpret it for himself and compare the two to see what's what.

I empathize with your concern (and that waiting sucks; BT-DT), but I don't see any benefit in drawing any premature conclusions. Hang in there, and please get back to us after your doctor reviews the imaging and you find out anything concrete/definite.

Doc

Thanks Doc, no doubt, the waiting really does suck, lol. I suppose the only evidence I have for cause/concern is the fact that earlier report says no congenital anomalies, while the second says the anomalies discovered are probably congenital. But like you said, there really isn't a benefit to drawing conclusions at this point. Ughh, the waiting really does suck, lol.

Had an MRA/MVA done today--not sure if I'm supposed to wait to hear back from my neurologist who ordered it, or if I should call and make an appt.; the radiologist said the images/report would be sent to my neuro in 1-3 days. I imagine if the new images are of concern that I'll probably hear from though, so I guess Ill wait till next week before calling.

Thanks again, Ill post any updates as I get them.

Just got a call from Neurologist's office asking if I could make it in today for an appointment--in spite of our still waiting on the 2012 MRI images to arrive. Given the fact that the radiologist who did my MRA/MRV on Monday said the results/report would be sent to my Neurologist on Thursday or Friday (today), I'm rather anxious about why the rush to see me so soon. I am looking forward to getting some answers today though, too.

I guess it's a weird feeling--like a mixture of anxiety and relief.

I'll post an update after my appt.

So i got the results from my follow-up mra/mrv scan and the radiology impression is as follows:

"Giant venous angioma in left side of brain extending along the left side of the septum pellucidum and along the body of the left lateral ventricle to drain into the left internal cerebral vein. This lesion is mainly of importance should the patient have a traumatic event or should the patient ever require intraventricular intracranial pressure monitoring, or a ventricular shunt. A puncture to this vessel could lead to some serious complications and a neurosurgeon should be made aware of this preexisting condition."

Any idea what this means? lol...like..."giant?" exactly how big is a 'giant' venous angioma?

In the meantime, Im being sent to see a neurosurgeon and movement disorder specialist in the coming weeks.

Thanks for any help/thoughts/input!