First MRI

[mathgirl24]

I had my MRI today.  They did one with and without contrast.  I'm anxious to find out the results.  Do you remember how long it took you to get the results of your first MRI before getting diagnosed?

[mathgirl24]

I think I will call tomorrow and get a copy of everything.  

I've only seen the neurologist once.  I think I will get a better feel for how I like her at my next appointment.  I hope she doesn't just dismiss me since my MRI came back clear.  I don't think she will but yet she did say something that makes me think that could happen.  She said that my toe just might go up (positive Babinski) just because (basically saying that it doesn't mean anything that I have a positive Babinski reflex on one side).

Maybe she was just trying not to stress me out or trying to be reassuring.  

[essdipity]

In the US you are by law entitled to your medical records, all of them. For the MRI, contact the imaging center and ask to have a copy burned. I always do that right after the scan--saves coming back. Also ask for the radiology reports.

Same thing goes for any other testing, and even for the notes doctors keep on each visit. Sometimes there is a charge, which usually is reasonable, supposedly to cover costs involved, but the actual info belongs to the patient, so feel free to inquire.

My neuro goes over MRIs with me while I'm there, so I know he looks at them. Any decent neuro, and especially an MS neuro, should be able, willing and even eager, to examine the images of his/her patients. If yours relies only on the radioloogy report, red flag!

The best way to find out is to ask. This neuro is being paid big bucks to interact with you, after all, so you should feel free to ask any questions you have, and 'Where do we go from here?' is certainly a reasonable question.
Don't try to lead the doctor towards a particular diagnosis, don't use much technical terminology, don't come across as 'knowledgeable,' above all don't make it obvious you have been checking the web, just project pleasant, intelligent interest. That's the formula that worked for me.

I suggest going ahead with EMG, etc., as you still could have a peripheral problem. I'd hold off on an LP at least for now. It's invasive and doesn't prove anything. Your doctor may well be unwilling to order one at this point anyway.

If your experience with this doctor has been positive overall, I can only recommend you hang in there and await developments, however maddening that can be. If no other disorders can explain your symptoms at this point and you do have MS, sooner or later that will become more than clear. If you lack confidence in the doctor, the system, etc., of course see someone else, taking all your records with you.

Sending good luck.

ess

[mathgirl24]

Thank you immisceo for your very helpful response!

I also still think I have a positive Romberg as I fall to the right after 20 seconds or less. But the neurologist had me stand there with my eyes closed for like 5 seconds max.

I guess I'm a little afraid to talk to the neurologist much about what I know about these things.  I really didn't say much at the first appointment other than exactly what my symptoms were and answered her questions.  How do I go about questioning the neurologist on the logical and the direction of what comes next?

Does the neurologist look at the MRI?  Or do they just rely on the radiology report?  Also, can I get a copy of the images for my records?

You all have been so helpful!!  

[immisceo]

Well, a positive Babinski is a clinical sign of some sort of neurological issue, but it's not only related to MS. When you speak with the neurologist, I would ask him about this. You have no MRI evidence supporting MS at present, but you do have an objectively observable abnormal reflex. They should offer you a course of action on this basis. If they feel that MS or something similar is still on the table, then an LP can help clarify things further and I personally would go for it. But it's important to weigh the fact that it is also not a homerun test. The diagnostic process is like focusing an old-school camera lens until things come into focus enough to make out. It can take a while to get a clear picture.

Your b-12 results were in the normal range. I'd say they've crossed that one off the list.

EMG and NCV help determine if there are problems in the pathways of peripheral nerves. Positive results point away from MS as the peripheral nervous system is distinct from the central nervous system. But I'd have questions about being given this/these tests as Babinski points to central nervous system. They may want to cover all the bases, and that's fair. I'd still want to be clear on their rationale though.

[mathgirl24]

So what should I expect when I go back to see the neurologist?  

I read my neurological exam report too and it did say positive for Babinski reflex on left side and loss of sensation on left side.  But everything else was reported normal.

Should I get retested for things like B12 deficiency?  My levels were at 388 and the normal range is 200-900.

I'm really confused and frustrated at this point.  It does seem like something is wrong since I do have an abnormal reflex.  I really don't know what to think or what direction to go in.

The neurologist said that if the MRI came back normal then we could do a NCV and/or EMG.  What would that tell me?

Also would it be worth doing a lumbar puncture?

Thanks in advance!!

[kwarendorf]

HI MG -

I'm no radiologist, but I think if you look closely at anyone's white matter you find something that is unperfect :-)

No matter how it's worder, your MRI makes no mention of hyperintensities, demyelination or other MS words :-)

Kyle

[mathgirl24]

I got the results back from the MRI.  

FINDINGS:
. Calvarium/skull base: No focal marrow replacing lesion suggestive of neoplasm.
. Orbits: Grossly unremarkable.
. Paranasal sinuses: Imaged portions clear. Opacification of a few right mastoid air cells.
. Brain: No evidence of acute abnormality. No significant white matter disease. No evidence of acute ischemia. No mass effect, hemorrhage, or hydrocephalus. No abnormal enhancement to suggest neoplasm, abscess, or mass lesion. Grossly normal flow-related signal in the major intracranial arteries and dural sinuses.
. Additional Comments: None

No acute intracranial abnormality. No evidence of demyelinating disease.

The only thing that stands out to me is they say "No significant white matter disease"  instead of how they have said "No evidence" everywhere else.  Could this mean that I did have something show up but they don't think much of it?

Any other insights?

[TLC1104]

Hi again,  
Try to think positively,  and as you said at least by going back to work you will be able to try and take your mind off things, I do hope that helps you.
good luck, take care.
T.

[mathgirl24]

Thanks for all your replies.  I have an appointment on Sept 19 but the neurologist said that if something came back abnormal that they would get me in earlier.  So if they call me to schedule an appointment, I'm going to be worried.  It's one of those things that I want to know the answer but yet I'm scared of the answer.

In the meantime, I'm starting back to work Monday.  So that will take my mind off things.

I'll update as soon as I know more.

[HVAC]

I had to wait 6 days for my first MRI results. The longest I waited was for my LP results that was 6 weeks. Where I am now you have the MRI in the morning and see the neurologist in the afternoon.

Alex

[TLC1104]

Hi, I was sent to a & e by my doctor with my right and left sides of me having different symptoms,  a & e did bloods then a cat scan,   it showed something to the left side of my head, they admitted me that evening.
They did MRI the following day and an xray.
The MRI showed it was inflammation to the nerve endings (i think thats how it was explained. Haha)
The next day I had more bloods and a lumbar puncture.  I then had to wait on the results of the lumbar puncture,  this is the point of a long wait,  I was sent home to wait. It was just over 2 weeks when the consultant phoned me to say that  from the results it looks like I'm dealing with MS. I'm now having to wait on the specialist appointment to confirm this diagnosis.  I'm on a priority list which is (wait for it!) 12 - 16 weeks.

[bbassel]

My first mri was not your typical situation. I had slurring and stuttering every five minutes that would last about 30 seconds and then I would be able to speak normallly.

My doctor saw me right away and did a neurological assessment. The only other thing atm was my balance was a bit off. I was sent to the hospital for an immediate catscan. She stated that she would send me for an mri in the odd time that it could be something like ms but that was highly doubtful. I also had to get blood tests asap.

I heard back about three days later when the secretary called and said the catscan didn't show anything and the only thing with my blood was an almost nonexistent vitamin D.

While I was talking to the secretary my mri results came in and my doctor got on the phone. She said that there were multiple lesions and it looked like ms.

She referred me to a ms specialist who diagnosed me within a month and a half. I had extreme back pain for four years prior and had testing except an mri. I had asked my doc for an mri and she stated that it was all muscular. My spine is filled with lesions as well. Big oops on her end.

For me the diagnosis happened very quickly, but for most it is not the case.

All the best,

Barb

[immisceo]

Thanks for checking back in on this. I was thinking about you! My first MRI was a part of getting diagnosed CIS. It was the follow-up MRI that was (a part) of my concrete MS diagnosis. They're a helpful part, but just a part.

My first MRI wasn't more important than my having two eyes looking a different direction, and my second (five weeks later) wasn't any more important than having the pupil of the opposite eye not react to light. They were all just pieces of the diagnosis.

First MRIs are vitally important however if your doctor doesn't witness any clear-cut relapses like that. Differences in the first one and the second one = objective, undeniable 'dissemination in time' = one of the core tenants of the MacDonald diagnostic criteria.

It will be your MRI results in concert with everything else that will lead to a diagnosis or a wait-and-see or a different line of questioning altogether. Importantly, wait-and-see isn't a fob-off. It's just that for MS to be MS, changes do have to be observed over space (different areas of the CNS effected) and time.

I do commiserate with the wait being really frustrating! If you happen to get the report in advance of meeting with your neurologist, just remember that radiologist report what they see. They don't diagnose. So regardless of whatever language they use, it will be the neurologist who contextualises it and makes the call. I hope your wait goes quickly!