Aa
Appt update, and please help with MRI report
I'll give the MRI report first. If you guys have any clue what this all means, I'd love to hear your thoughts!
(MRI Head, with & without contrast)
Findings: The ventricles, cortical sulci, and extra-axial spaces are normal in size, shape, and configuration. The midline structures are normal in position without evidence for mass or mass effect.
There are very subtle foci of increased T2 and FLAIR signal intensity within the left frontal lobe periventricular and deep white matter. The findings are non-specific in appearance and may be secondary to non-specific demyelination, ischemic gliosis, or sequelae of prior trauma or inflammation. No other significant foci of abnormal signal intensity are seen within the brain parenchyma. The lesions measure approximately 6 mm in maximal dimension.
Impression:
1. very subtle foci of increased T2 and FLAIR signal intensity within the left frontal periventricular and deep white matter.These are non-specific in appearance and may be secondary to minimal, non-specific demyelination, ischemic change, or sequelae of prior trauma or inflammation.
2. There is no evidence of intracranial mass, hemorrhage, or acute infarction.
3. There is incidentally noted minimal bilateral cerebellar tonsillar ectopia.
4. There is mucosal thickening within the left maxillary, ethmoid, and sphenoid sinus air cells compatible with inflammatory change.
(I'm assuming this last is a medical way of describing that I was getting over a cold at the time of the MRI LOL)
As for the appointment. Well, I have the impression that the doctor considers my symptoms consistent with MS, but because there is not really any "evidence" he is not going to diagnose and he will keep looking for other reasons. I have figured out that my period is a trigger, with the biggest issues being fatigue and slight feeling of vertigo. He said if the vertigo starts up then call the office to tell them I'm on my way, and he wants to see me. If anything like that comes up he wants to see me.
He is going to have me to a follow up MRI in a year, even if everything gets better before then. If things get worse then I'll probably get the MRI sooner.
Right now he is thinking my sleep might be causing some problems, if not all. I fall asleep easily, but after 2-3 hours I wake up because I'm uncomfortable, and end up tossing and turning off and on the rest of the night.
He gave me a prescription for Neurontin. He said it is used for nerve pain, especially diabetics, but it will also help me sleep. He said it is a very safe medicine and that it will be out of my system in about 6 hours so I'm not groggy in the morning with the kids. I *hate* taking medicine but I'm pretty sure I will give this one a try. Does anyone here use it?
My overall impression, is that while my doctor is looking at every possibility, I do think if I get any "hard evidence" he will make the diagnosis. Until then, I need to decide if I want to take the Neurontin to help me sleep better and see if that improves my symptoms.
~Jess
(MRI Head, with & without contrast)
Findings: The ventricles, cortical sulci, and extra-axial spaces are normal in size, shape, and configuration. The midline structures are normal in position without evidence for mass or mass effect.
There are very subtle foci of increased T2 and FLAIR signal intensity within the left frontal lobe periventricular and deep white matter. The findings are non-specific in appearance and may be secondary to non-specific demyelination, ischemic gliosis, or sequelae of prior trauma or inflammation. No other significant foci of abnormal signal intensity are seen within the brain parenchyma. The lesions measure approximately 6 mm in maximal dimension.
Impression:
1. very subtle foci of increased T2 and FLAIR signal intensity within the left frontal periventricular and deep white matter.These are non-specific in appearance and may be secondary to minimal, non-specific demyelination, ischemic change, or sequelae of prior trauma or inflammation.
2. There is no evidence of intracranial mass, hemorrhage, or acute infarction.
3. There is incidentally noted minimal bilateral cerebellar tonsillar ectopia.
4. There is mucosal thickening within the left maxillary, ethmoid, and sphenoid sinus air cells compatible with inflammatory change.
(I'm assuming this last is a medical way of describing that I was getting over a cold at the time of the MRI LOL)
As for the appointment. Well, I have the impression that the doctor considers my symptoms consistent with MS, but because there is not really any "evidence" he is not going to diagnose and he will keep looking for other reasons. I have figured out that my period is a trigger, with the biggest issues being fatigue and slight feeling of vertigo. He said if the vertigo starts up then call the office to tell them I'm on my way, and he wants to see me. If anything like that comes up he wants to see me.
He is going to have me to a follow up MRI in a year, even if everything gets better before then. If things get worse then I'll probably get the MRI sooner.
Right now he is thinking my sleep might be causing some problems, if not all. I fall asleep easily, but after 2-3 hours I wake up because I'm uncomfortable, and end up tossing and turning off and on the rest of the night.
He gave me a prescription for Neurontin. He said it is used for nerve pain, especially diabetics, but it will also help me sleep. He said it is a very safe medicine and that it will be out of my system in about 6 hours so I'm not groggy in the morning with the kids. I *hate* taking medicine but I'm pretty sure I will give this one a try. Does anyone here use it?
My overall impression, is that while my doctor is looking at every possibility, I do think if I get any "hard evidence" he will make the diagnosis. Until then, I need to decide if I want to take the Neurontin to help me sleep better and see if that improves my symptoms.
~Jess
Makes total sense! And, not long-winded at all.
Very glad he's willing to treat your symptoms. Afterall, some dx's are not a slam dunk and not ones to just jump into w/out proper evidence, so I totally understand and glad you feel comfortable w/the path he's taking. All you mention is very important, especially the office fighting for testing w/insurance. Not all willing to do that these days.
I will restress though that it never hurts to get a 2nd look at things if at some point no direction is taken.
ttys,
shell
Very glad he's willing to treat your symptoms. Afterall, some dx's are not a slam dunk and not ones to just jump into w/out proper evidence, so I totally understand and glad you feel comfortable w/the path he's taking. All you mention is very important, especially the office fighting for testing w/insurance. Not all willing to do that these days.
I will restress though that it never hurts to get a 2nd look at things if at some point no direction is taken.
ttys,
shell
Shell,
I do like my doctor, very much. I feel he is taking me very seriously...but just does not have the evidence to diagnose yet. In reading others experiences here, I know that I am most likely at the very beginning stages of MS, if this is what is causing my symptoms. I have had to make some allowances but my daily life is not impacted as much as others here. Now, once the warm weather finally starts in my area (we are supposed to be low 80's today! I need to run errands with the kids and hope things go ok) I'm not sure if that will change how I'm affected.
Basically, I have the impression that he is just waiting to have something besides the slight delay in my VEP and the hyper reflexes show up. I think that is why he wants me to come in, no appointment needed, as soon as I have an issue, either vertigo or something new. I have a feeling if I go in and am off balance at all, then he will say "Ok! Here it is! Lets start treatment!", if that makes sense? Right now, things are so subtle that if he needed to justify a diagnosis he would not be able to.
Also, the more I was thinking about the prescription he wants me to try, the more I feel confident he is not brushing me off. It sounds like he does think my cognitive issues might be caused by lack of sleep. But, instead of just prescribing me lunesta, or another sleep aide, he is wanting to treat the cause of the lack of sleep...me being sore and uncomfortable.
He said if I decide to start the medicine, call the office to set up an appointment. He will want to see me soon.
I totally get what you are saying, but my gut feeling is he is going to keep trying to figure this out and he's not going to write me off. I think the one year time frame for a repeat MRI is only if symptoms do not get worse, or I do not develop more. This doctor fought with my insurance for almost a month to get them to approve another MRI of my head...which is good because the lesions that showed up on the new MRI (3T machine) were completely missed on the MRI in January (on a 1.5T machine). But, he also showed me the images, and I can't for the life of me even see anything that looks like a spot...much less more then one!
Sorry for being so long winded! :-)
~Jess
I do like my doctor, very much. I feel he is taking me very seriously...but just does not have the evidence to diagnose yet. In reading others experiences here, I know that I am most likely at the very beginning stages of MS, if this is what is causing my symptoms. I have had to make some allowances but my daily life is not impacted as much as others here. Now, once the warm weather finally starts in my area (we are supposed to be low 80's today! I need to run errands with the kids and hope things go ok) I'm not sure if that will change how I'm affected.
Basically, I have the impression that he is just waiting to have something besides the slight delay in my VEP and the hyper reflexes show up. I think that is why he wants me to come in, no appointment needed, as soon as I have an issue, either vertigo or something new. I have a feeling if I go in and am off balance at all, then he will say "Ok! Here it is! Lets start treatment!", if that makes sense? Right now, things are so subtle that if he needed to justify a diagnosis he would not be able to.
Also, the more I was thinking about the prescription he wants me to try, the more I feel confident he is not brushing me off. It sounds like he does think my cognitive issues might be caused by lack of sleep. But, instead of just prescribing me lunesta, or another sleep aide, he is wanting to treat the cause of the lack of sleep...me being sore and uncomfortable.
He said if I decide to start the medicine, call the office to set up an appointment. He will want to see me soon.
I totally get what you are saying, but my gut feeling is he is going to keep trying to figure this out and he's not going to write me off. I think the one year time frame for a repeat MRI is only if symptoms do not get worse, or I do not develop more. This doctor fought with my insurance for almost a month to get them to approve another MRI of my head...which is good because the lesions that showed up on the new MRI (3T machine) were completely missed on the MRI in January (on a 1.5T machine). But, he also showed me the images, and I can't for the life of me even see anything that looks like a spot...much less more then one!
Sorry for being so long winded! :-)
~Jess
Hey Jess,
Ya know, don't you just love it when you go to the appt. and you think that the Dr. has "ALL" of the results of what he/she needs in hand and them wham, you walk out of there with a follow-up appt. and no definite answers.
Take the med and see if it helps you and DO call and make an appt. sooner than 1 year! That is just too much time inbetween exams. Doc will never remember you.
I think a 2nd opinion is in order. Your MRIs too. The radiologist could not make a determination (report notes: non-specific in appearance...lesions measur 6mm in max dimension). Seems to me these findings dictated your appointment from there.
If I sound sarcastic, I apologize. It's the one yr and call me if you get the vertigo back that put me over the edge. and from there, well, my 2 cents added above.
Are you in position to get a 2nd?
-Shell
Ya know, don't you just love it when you go to the appt. and you think that the Dr. has "ALL" of the results of what he/she needs in hand and them wham, you walk out of there with a follow-up appt. and no definite answers.
Take the med and see if it helps you and DO call and make an appt. sooner than 1 year! That is just too much time inbetween exams. Doc will never remember you.
I think a 2nd opinion is in order. Your MRIs too. The radiologist could not make a determination (report notes: non-specific in appearance...lesions measur 6mm in max dimension). Seems to me these findings dictated your appointment from there.
If I sound sarcastic, I apologize. It's the one yr and call me if you get the vertigo back that put me over the edge. and from there, well, my 2 cents added above.
Are you in position to get a 2nd?
-Shell
Neurontin is often mentioned around here by it's generic name, Gabapentin. I don't take it myself but I'm sure those who do will chime in soon.
I'm sure you are having some mixed feelings about all this. It seems like your doctor wants to continue to work with you though. Wouldn't it be wonderful if you could feel loads better by getting better sleep? Seems like it would certainly be worth trying.
Mary
I'm sure you are having some mixed feelings about all this. It seems like your doctor wants to continue to work with you though. Wouldn't it be wonderful if you could feel loads better by getting better sleep? Seems like it would certainly be worth trying.
Mary
Have an Answer?
You are reading content posted in the Multiple Sclerosis Community
Top Neurology Answerers
Australia
ON
Queensland, Australia
Queen Creek, AZ
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
