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Confused... !!! Help

Had MRI February 2015... here are the results

Findings:  There are several punctate areas of T2 signal abnormality scattered within the periventricular and subcortical white matter of both cerebral and cerebellar hemispheres which are nonspecific.  Findings may be compatible with multiple sclerosis given the clinical history.  Other considerations include chronic small vessel ischemic disease, migraine headaches, Lyme disease, and vasculitis.  There is no evidence of pathologic enhancement or active demyelinization.  There is no mass, mass effect, or midline shift.  There is no evidence of hemorrhage.  Diffusion-weighted images show no areas of restricted diffusion or acute infarction.  There is no hydrocephalus.  Flow related signal within the major intracranial vessels is preserved.



Impression:

1.  Nonspecific scattered areas of punctate T2 white matter signal within the cerebral and cerebellar hemispheres which may represent changes of multiple sclerosis given the clinical history with other considerations as detailed above.

2.  No evidence to suggest active demyelinization.

3.  No acute intracranial abnormality.

The neuro discussed MS with me... we talked about meds and he increased my gabapentin.. elavil, etc...
I then have a MRI of the C-spine because they never done one when they done the brain... Here are the results

C3-4:  There is a small right lateral recess disk protrusion with mild narrowing of the right lateral recess.  There is no significant central canal stenosis.



C5-6:  There is a disk bulge with right lateral recess disk protrusion producing moderate narrowing of the right lateral recess.  There is also mild mass effect on the ventral thecal sac and spinal cord.  There is overall a mild degree of central canal narrowing.



C6-7:  There is a disk bulge with small right lateral recess disk protrusion with mild narrowing of the right lateral recess.  There is no significant central canal stenosis.



T3-4:  There is a tiny disk bulge without significant central canal stenosis or neural foraminal narrowing.



All other levels are without significant degenerative disk disease, central canal stenosis, or neural foraminal narrowing.  There is a normal appearance of the craniovertebral junction with normal signal present throughout the cervical and upper thoracic spinal cord.



Impression:  Degenerative disk disease as detailed above with right lateral recess disk protrusions at C3-4, C5-6, and C6-7.

TODAY I go to neuro to get results of the C-spine MRI which I already knew because of viewing ability on line thru pt portal.  A med student enters room... we talk briefly about my symptoms and MS... he ask if I have had any new ones... etc... He say neuro is running late but would be right in...
Enter neuro...he says "you don't have MS.  This is bad disease and you don't want it"  (well who would?? )... he then walks to a pic of the brain on the wall.. points to tiny blood vessels and says something about those vessels.. not really what... then say probley migraines cause this..... (first Ive heard I have migraines)... he procedes to grab the door knob... attempting to leave and I basically grab him to ask what is going on then?  He calmly says "you have a bulging disc... nothing we can do.... just make you comfortable but no pain meds... and no surgery until you can't do it anymore" and walks out the door....

My question is..... is it normal for the radiologist and the MD to have differing opinions?  I do know the neuro went to school for these reasons... but I am confused.....
8 Responses
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5265383 tn?1669040108
ARGH ... Can't blame my phone for missing an entire word ... Meant mental HEALTH dx.  Sorry :(.
Helpful - 0
667078 tn?1316000935
Most Neurologists like to follow you over time. With my MS Specialist he did not take the word of other doctors. He took a year and a half to diagnose me this is common. I had been seen by several other neurologists who said I would be diagnosed with MS but they would not diagnose me. I thought it was nuts. I either have MS or I don't. My very first MRI showed MS, every test for MS was abnormal, all other tests were negative. I know it is frustrating. Hopefully you will be diagnosed soon.

Alex
Helpful - 0
5265383 tn?1669040108
I did a psych referral early on (honestly, in my mind a mental dx would have been better, vs a chronic degenerative illness).  I was, in fact, pretty sad that I was fine :P.

I've also been in limbo 2.5 years.  My ms neuro fully thinks what I have looks like atypical ms, and has told me.  However my LP finally came back fine and he said, no, you should have had bands.  Not ms.  Everything else ruled out (almost -- I have another idea which I asked him to pursue testing for and he finally agreed).

You can't help but keep looking with no answers and when your quality of life is hindered.

I have issues similar to you, in clear episodes; also had four months of double vision and trigeminal neuralgia for six weeks (presenting episode).  Limbo  is awful.  Ms wouldn't be a party either, but as issues keep popping up it would be good to have a plan.

In this with you; stay strong!
Helpful - 0
Avatar universal
Thanks for the responses guys.  I do understand the radiologist just reads the MRIs, however, I just kinda thought that if one had appendicitis, then the doctor would agree... never knew too many who would say .. no ... and yes MS is a lot more difficult to diagnosis... I've been in limbo for two-three years... I was relieved last month when he said MS.. because it had been suggested for 2 years.. I have done my research on it (among the other things they suggest) and to finally have a diagnosis would be a relief.  I do not mean to sound mean in my writing, but again, I am frustrated.  
I will do a second opinion and am willing to accept whatever diagnosis a doctor will make, just wishing they would make one...
The neuro in his speech about quality of life and being never pain free spoke for a sec (as all his speeches) about psychological issues.(depression/anxiety/stress associated with diabilitation)  One might not have any BEFORE they start this process but definately end up with issues during and after the process...
Helpful - 0
Avatar universal
I have had problems i.e. fatigue, gait problems... right side weakness.. foot drop, (have a brace)... foggy brain.. to name a few for about 2 years.. they aren't constant  at times vary from once a month to 7-8 months apart... GP has suggested MS for a while but also treated for things like... gout, fibromyalgia, tendonitis, seizures, restless leg syndrom etc.  to name a few... all with normal blood work... I have been tested for lyme disease also... I switched GPs a immediately sent me to a neuro who ordered the MRIs.  No one had ever ordered one til him...I am not pushing for a diagnosis of MS I would like like an answer instead of being brushed off... The neuro I have did not set with me from my first visit but giving him the benefit of the doubt, I have continued to see him.  He is the type to rush in... shake hands mumble and leave.  I am stuck in nowheresville with no one around!!!
Helpful - 0
5265383 tn?1669040108
That's pretty common.  I've stuck with my second opinion and he has yet to diagnosis me.  My first and second set of mris in 2013 met the McDonald criteria (2010) for ms, with no other options listed -- yet I stay in limbo.

I was also told migraines early on ((don't even get head aches lol). There a couple of mimics I'm still wondering about and I've had to beg him to do the tests -- says everything else is ruled out however won't commit.


If your lesions aren't textbook, even with clinical signs, it can be a slow journey just because there really are a lot of mimics that look like me.  What led you to have the mris done?
Helpful - 0
667078 tn?1316000935
Radiologists give there interpretation or suggestions. Like immisceo says it is the neurologist who diagnosis. I would get a second opinion with a MS Specialist. Not all neurologists are MS Specialist. I went to one who was a headache specialist so that is what she centered on. She said I definitely did not have MS. MS Specialists could not believe she missed it.

Alex

Helpful - 0
5112396 tn?1378017983
It is the neurologist who diagnoses. A radiologist just reports what they see. That being said, I would be looking for a second opinion at this point. Even if you don't have MS, I would wish to know in more detail why they thought not given whatever clinical history the report mentions.
Helpful - 0
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