loss of the normal collagenous architecture of the entire anterior dura mater/tectorial membrane complex. attenuation and tenting of the posterior dura mater/tectorial membrane complex. constellation of features consistent with sequela of previous hyperextension/flexion/anterior translation stress at the craniovertibral junction. Inward tenting of the posterior dura mater/tectorial membrane complex as indirect evidence of disruption of myodural tissue connection with the posterior rectus capitis minor muscle.
Hmmmmmm this one is a bit tricky, as he uses a bunch of $64 words. Let me try to translate some if possible.
1.
loss of the normal collagenous architecture of the entire anterior dura mater/tectorial membrane complex.Means that the front portion of the spinal cord has been injured, and shows changes in the tissue. There are 3 layers of tissue surrounding the brain, the Pia, Arachnid and Dura (dura is the outermost, most dense (durable) of the tissues)
2.
attenuation and tenting of the posterior dura mater/tectorial membrane complex.Tenting suggests that the tissue has been stretched, and when back in normal position, tents up, kinda like a wrinkle in a throw rug. The tissue is normally relativley tight, but is flexible enough to bend when flexing/extending and rotating the neck. When it is overstretched, the tissue becomes longer, and then when returned to normal position, it has no where to go, except to "tent" out.
3.
constellation of features consistent with sequela of previous hyperextension/flexion/anterior translation stress at the craniovertibral junction.Small group of findings which is commonly seen with these injuries. Hyperextension is when the neck is bent too far backwards (looking up at the sky), then too far forwards (looking at your toes) with the added stress of sliding forward (think of sliding a block forward on another block). It is a fairly typical "whiplash" type injury.
4.
Inward tenting of the posterior dura mater/tectorial membrane complex as indirect evidence of disruption of myodural tissue connection with the posterior rectus capitis minor muscle.He is suggesting that the tenting that was referenced before is indirect evidence that the small fiberous tissues that attach the dura mater to the very small muscles in the spine (Post. rectus capitus minor), which help hold the vertebral bodies in place, have been torn. He cannot actually see the disruption, but is citing these findings to suggest it is there.
So, what does all this mean?Means he sees evidence of a significant whiplash, and possible instability of the cervical spine.
The "can't spell my name" part probably didn't have much to do with the neck injury, but is probably due more to the associated head injury of what is called "coup/contra-coup", which is where the brain sloshes forward (flexion), then slams into the front of the skull, then the head is whipped backwards (hyperextension), and the brain sloshes back striking the back of the skull. This will often bruise the brain, and can cause significant swelling, which is most likley what caused the confusion, and loss of memory.
This usually will resolve without significant problems, but can actually cause the brain to push down through the Foramen Magnum (big hole), which is the large hole where the spinal cord goes through. Until the swelling resolves, there can be some unusuall neurological symptoms, which can be difficult to deal with. It can be fatal if the swelling doesn't stop or go down. Depending on the severity of the bruising, it can cause anything from a passing "post-concussion syndrome" which includes dizziness, difficulty with memory, word searching etc. This usually passes within a couple of weeks, but has been seen up to a year after the injury. If the bruising is significant, and causes true tissue destruction, it can lead to permanent neurological problems. This is kind of like having a stroke, where a portion of the brain actually dies. The neurological problems can be as subtle as minimal personality changes. I don't recall as I'm writing this if you've been having other neurological issues, exept for the pain. I think I remember you saying you had an MRI of the brain. If there were any permenent damage, it would be visible by now, and should have been mentioned in the report.
Your doctor has suggested seeing a neurologist/neurosugeon, which I think would be a good idea. It's very difficult to determine how significant the findings are without actually seeing the films, and I think the neurosurgeon should be the guy/gal to look at them and determine if there is anything that needs to be done. Remember, the neurosurgeon and the radiologist may have dramatically different opinions about what is going on. The radiologist will mention just about everything that is even slightly abnormal, even if it is not clinically significant. Clinically significant means that there is something that needs to be done about what the findings are. The neurologist may tell you there is nothing wrong, and it will heal with time. S/he may tell you you need surgery. It's very difficult to say. From what I read, the only part that may require surgery is the possibility of the instability. It doesn't sound to me like the "tenting" is of clinical significance. (Disclaimer: I'm not a neurosurgeon, so they may have a much different take on the findings than I do).
i googled some of the words and from what i understand the bottom of my brain is herniated out the bottom of my skull
from a trauma point of view this usually is from brain swelling, the bottom of the brain can push thru a bit, but as the swelling resolves, it will go back up inside (like what I was discussing above). Occasionally there can be "tonsils" that will stick thru the hole, but it is called a chiari malformation, which is usually congenital (you were born that way). He did not specifically state anything about a chiari malformation, so I kinda doubt this is what is going on. It's usually pretty obvious on an MRI, so if it was there, I'd imagine he'd discuss it. You can certainly ask the neurosurgeon during your consult if s/he sees anything like that.
Hope that helps.
Erik
