Joshua’s MRIs

These MRIs were posted by Kate on a forum in July 2009.

The MRI scans were captured on June 30, 2009.

On the spinal MRI, you can see a clear defect in his lower back, so this does confirm a spina bifida diagnosis. It’s the site of Joshua’s spina bifida lesion where Kate mentions the presence of fluid, scar tissue and lipoma (a fatty tumor.) Fluid shows up as solid black on an MRI.

On the brain MRI, you can clearly see the cerebrospinal fluid (CSF) surrounding the brain. The CSF appears as a strip of black between the brain and the skull, which appears white. Kate mentions reduced CSF flow at the back of his brain and it does appear that perhaps there is less CSF in that area, but it’s difficult to perform an accurate layman’s comparison due to the angle of his head (his head is tipped back, whereas other sample MRIs had a more normal orientation.)

There are some comparison MRIs at the end. So you can see Joshua’s scans compared to a normal scan and a chiari malformation MRI compared to a healthy brain MRI.

On July 1, 2009, Kate wrote, in part:

In my nonprofessional opinion, his brain looks similar to his last scan on Feb. 20th, but his back has a lot more scar tissue and lipoma than back in February. The good news is that he doesn’t have a huge collection of fluid outside his spine like he did back in February, so I *think* the leaks he had repaired in April are finally sealed over. Again, I don’t know for sure ~ those are my guesses ~ so I’ll see what the radiologist & neurosurgeon have to say (we see her tomorrow)…


Spinal MRI With Notations

…I got the radiologist’s report on Joshua’s MRIs. In a nutshell, the report says there is reduced CSF flow at the back of Joshua’s brain where the skull meets the neck, which is not a good thing (technical speak: “CINE imaging shows restricted CSF pulsations through the posterior aspect of the foramen magnum.”) Will it be significant enough that Dr. Wehby wants to do something about it? I don’t know yet. I’ll find that out tomorrow.


Joshua Brain MRI

…The spine MRI showed significant scarring & lipomatous tissue with a low-lying conus (tip of the spinal cord ~ it’s supposed to be at the level of L1 and Joshua’s is pulled down to the sacral level right now). There is no movement of the spinal cord during CINE imaging (it’s supposed to move; the fact that it didn’t means the cord is stretched tight, which is obviously not a good thing). Again, I don’t know if this will concern Dr. Wehby enough to want to do something about it at this time. I’ll report on that tomorrow.

For comparison purposes, we obtained “normal” spinal and brain MRIs and put them side by side for a comparison. The angle on the brain MRI is a bit different so it’s difficult to determine if the differences are due to a structural abnormality or the angle/positioning.

Brain MRI Comparison Spine MRI Comparison
Normal MRI vs Chiari MRI


2 thoughts on “Joshua’s MRIs

  1. My daughter has Chiari Malformation Type 1. She was diagnosed and had decompression surgery within a month. Her herniation was not large, 12 mm, but she had several neurological symptoms and blocked flow both anterior and posterior blockage of the CSF flow, a Syrinx and that made surgery urgent. Recovery from this type of surgery is long. It can take years for some of the symptoms to go away and some never do. We were told that 80% of people (after they heal from the brain surgery) have no symptoms. For 20% there is a vast improvement but they still have symptoms and a small percentage of those have no improvement. For an even smaller percent of those a second surgery is required. Typically those who need a second surgery it is because duraplasty was not done.

    Eight months after my daughters surgery we had a consult with Dr. Ellenbogen at Seattle Children’s Hospital. People come from all over the world to be evaluated by him and have surgery for Chiari. We had this consult due to my daughter’s continued symptoms that were scary. She has balance problems, couldn’t find the words she wanted to use, walked into walls, her hands/fingers would go numb, double/blurry vision and headaches so bad she was in bed for days at a time. Dr. E had a CINE MRI done on my daughter. What he found was that she had normal flow, the Syrinx she had before surgery had resolved, and she absolutely did not need surgery again and he advised us to not allow another surgery on her because she did not need one. He gave her the diagnosis of Classic and Complex Migraines.

    The bottom images that you posted look almost exactly like my daughters images before and after surgery!

    I stated all of the above to say this:
    From what I can see in the MRI’s posted it looks like Chiari, even with his head tilted back it still looks like my daughters scans (her head was not tilted back). There are many different opinions on when surgery should be done. I will say however that for some (like my daughter) surgery was needed. There have been cases of children dying from Chiari. It’s important to remember that what Chiari means is that part of the brain has herniated into the spinal column.

    From the images of the spine it doesn’t look like he has a Syrinx and there is not one present in the neck images. There is narrowing of the spinal space but not a blockage, which is what causes Syrnix’s.

    I don’t remember if she said he had type 1 or not but I would question that given his diagnosis of spina bifida. Typically type 2 is associated with those who have spina bifida. I absolutely question him having more than two surgeries for Chiari. I don’t think I have ever heard of anyone needing more than two in all of the research I have done.

    Obviously there is something odd going on with this child. My question is why were the doctors doing all of these procedures on him? Why are the doctors not facing legal proceedings as well? Yes the mother can say whatever she wants and even point to certain symptoms but in the end it is the doctors responsibility to make sure that surgery is the correct action to take. They should face the same legal proceedings and charges as the mother and other adults that had daily interactions with this child, and the other minor children as well.

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