Dr. Quix, Medicine Woman

Hi Dr. Q,

looks like you are popular on the board tonight!  I too have a question or two for you.

I don’t think your medical background is in neurology or radiology, however you do know a lot about this stuff so I have something to run past you.  I’ll apologize in advance as this will be a bit wordy.

I have previously stated that my first abnormal MRI was in Sept 2007.  However that is not exactly true.  When I first experienced Lhermitte's, in summer of 2006, I had a MRI of my cervical spine, followed up by a MRI of my brain 2 weeks later.  

The findings on the first report state: "Equivocal increased signal changes within the cord at the level of the C4-C5 disc space.  This is predominantly on the right side.  The changes are subtle, however, given the clinical history of pins and needles, further evaluation may be warranted.  Demyelination would be a consideration.  MRI of the head and sagittal TIRM imaging of the cervical spine may clarify these findings."  The subsequent MRI of my head stated, in a nutshell, “Normal examination of the head with specifically no evidence of demyelination.”

First question: what is “sagittal TIRM imaging of the cervical spine?”  I have tried googling and it appears to be some sort of specialized MRI?  But I really don’t know.  Anyway, I guess I never did have this done back then, since no further spinal MRI’s were ordered till Sept 2007 when new symptoms surfaced.  However, it clearly was recommended as a follow up to my first cervical spine MRI.  I still can’t fathom how detailed-oriented me (some might say anal) overlooked this till recently, and I never asked my doctors about it.  The neurologist I saw several months after the first two aforementioned MRI’s were done in 2006 did not think I had MS, and stated in her report that “….an MRI of the brain and cervical spinal cord were normal.”

My first clue that something was incongruent was when I saw the on-call neurologist in Oct 2007, and he mentioned my “previous abnormal MRI from 2006.”   That was the first that anyone had described the previous MRI as “abnormal,” but at the time he said this to me, I was in the midst of my first brutal attack, literally on my way to an unplanned LP, overwhelmed with my likely diagnosis, and did not ask him at the time to clarify what he meant.

So anyway, could you explain “sagittal TIRM imaging” and would you have any idea why they would not have done this back in 2006, along with the brain MRI, as per the recommendation stated in the first MRI report?    Also, what do you make of neurologist #1 calling the first MRI normal, and on-call neurologist #2 referring to it as “abnormal?”  I realize different doctors will have different opinions of the same information/evidence, however in this case it really doesn’t make sense to me.

I do plan to review this with my MS specialist at my next appt (neurologist #3), for further understanding, and wouldn’t mind being armed with a bit of knowledge before having this discussion.  Although I would be disturbed, to say the least, if some step was recommended and missed back in 2006 that just may have revealed a CIS (for which earlier treatment may have been an option), I’m not out to sue anyone!  You can’t go back, and I’m not one to dwell in the past.  I just think it’s really important that I understand how I got from there to here.

I must say that by the time I saw neurologist #1, my Lhermitte’s had disappeared, I had never had any other symptoms at that point, and wasn’t at all worried about possible MS.  I guess this would explain why I didn’t pick up on the previous MRI findings, nor push for some kind of dx.  I was just happy to be told that I was fine!  I felt great!

Thanks for any insight you can offer.  Very sorry if the above is disjointed and confusing.  

db1