Dr. Anshul Varshney
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I recently had an magnetic resonance imaging (MRI) completed, and the report says the following. Inferior poles of cerebral hemispheres are seen 3 mm below the foramen magnum, with no crowding. I would like some more information. Is this MRI speaking of the cerebral tonsils?
Hello,
Welcome to icliniq.com. No, they do not mean anything like cerebral tonsils or Chiari malformation. The cerebral hemispheres' inferior pole is mostly at the level or above the foramen magnum. In your case, the level is slightly low. However, since there is no crowding, apparently, there is no point in worry. This needs to be correlated clinically. I would like to know the symptoms for which your MRI (magnetic resonance imaging) was performed.
Patient's Query
Thank you, doctor,
I had an magnetic resonance imaging (MRI) because I was having episodes of dizziness and headaches. Could you tell me what normal is and also what this could technically mean?
Hello,
Welcome back to icliniq.com. I have seen the magnetic resonance imaging (MRI) reports (attachment removed to protect the patient's identity). I do not think these findings have anything to do with your headaches. It seems to be incidental findings. The MRI seems normal to me. However, I would like to know the description of your headache under the following points: 1. Since when do you have these headaches? 2. Any vomitings associated? 3. Any pulsating sensations? 4. Any photophobia or phonophobia? 5. How is your sleep? Revert with more details for better help.
Patient's Query
Thank you doctor,
Well, about seven months ago, after a period of little sleep and high stress, I started getting dizzy spells. I also got a lot of anxiety and panic. The panic was because I was dizzy. I was also postpartum during this period. I woke up one night and had a strong sense of disorientation. After that, I would get episodes. For example, I was in my car, reaching for my wallet, when a dizzy rush came over me. It was not positional vertigo (although I did get that at one point). I have had every ear test, and the results were negative. The spells are short bursts of a head rush, zap, or disorientation feelings and usually happen if I go from head extended down (looking down at a phone) to looking up or even turning my head left or right. I have had an X-ray which shows a subluxation of my atlas joint. There was no vomiting ever. I have also had increased headaches which feel as though they come from my left ear. That ear also experiences periodic fullness. I have also developed a very quiet constant tinnitus. Hearing tests have always been normal. I am concerned with this incidental finding of the inferior pole. What could this mean?
Hello,
Welcome back to icliniq.com. Based on your symptoms, I would say that your headache is a chronic tension headache. It is unlikely to be due to the findings in the MRI (magnetic resonance imaging). Your MRI findings say that your cerebral hemisphere's inferior lobe is just below the normal position. Now, if there is crowding over there, we consider that it can cause compression. But, they have specifically mentioned that there is no crowding. So, you are in the safe zone. I do not find any reason to worry. Please ask me whatever you have in your mind.
Patient's Query
Thank you doctor,
Do you think a headache can cause dizzy rushes that are positional? Or is this more likely to be anxiety?
Hello,
Welcome back to icliniq.com. It is a well-known fact that tension headaches can cause a lot of dizziness that is a lot many times attributed to cervical headaches. But that is not true. Tension itself is the reason for all these headaches. My suggestion for you will be to be put on Escitalopram and Amitriptyline. You would see the magical difference within a month of treatment. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. I hope it helps you. If you have any further queries, please ask.
Patient's Query
Thank you doctor,
I have a pre-existing anxiety condition that I have had since my teens. Since I became dizzy, I often feel off balance. I am trying to distinguish if this is anxiety or part of migraines. It feels like it is all the time.
Hello,
Welcome back to icliniq.com. In most cases, as I have mentioned, it is just a part of a stress headache. Since you have anxiety issues, this is all probably because of that only. Since the magnetic resonance imaging (MRI) is apparently normal, the only way to differentiate between the possibilities is to see the response to treatment. So, if you are taking any treatment already, mention the names of the medicine and duration. If you have not been treated yet, discuss with your doctor about taking Escitalopram and Amitriptyline. I hope it helps.
Patient's Query
Thank you doctor,
Sometimes, when I bend over or turn my head when I get up, I get very dizzy. It is not positional vertigo or benign paroxysmal positional vertigo (BPPV), as I have been tested. Can tight neck muscles cause this?
Hello,
Welcome back to icliniq.com. Yes, tight muscles can cause this. But, again, that can be linked to stress. We categorize such headaches as chronic tension headaches. I know it is difficult to accept this. But trust me, accepting this is going to help you a lot.
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Internal Medicine
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