New Brain MRI results; take that, bad neuros!

[Fluffysmom]

Hi, all!  I had my second brain MRI yesterday, and they called today and said that the report was ready.  I got there so fast, they didn't have it out to the admitting desk yet.  It's brief, so I'll type in the whole thing.

FINDINGS:  Multiple mm sized areas of increased and abnormal signal are again noted throughout the supratentortial white matter tracts.  The lesions appear identical to the previous exam.  The number of lesions is great to the point where exact comparison is somewhat difficult, but no new abnormalities are identified.  The brain remains anatomically normal.  Diffusion weighted images remain normal with no evidence of restricted diffusion to suggest an acute ischemic insult.

Post contrast images demonstrate no abnormal contrast enhancement.

IMPRESSION:  No change from previous study.  Multiple mm sized areas of abnormal signal again noted throughout deep white matter tracts.  As was noted this appearance is far-and-away most consistent with multiple sclerosis.


The neuro radiologist that I requested read the MRI.  He also read the one done on 2/22/08.

I guess the event I had a month ago was either too long ago to show up, or it was a pseudo-exacerbation brought on by the 100+ temperature down there in Phoenix.  

These findings contradict what the last two neuros said, which makes me happy.  It doesn't give my a dx, but it pretty clearly states that someone should continue looking in that direction, or so I think.  We'll see what my new neuro thinks, if I ever get an appointment!  They were supposed to call today.  I'll call them again tomorrow.

So, what do you all think?  Thanks for taking the time to read this.

Kathy

[Fluffysmom]

I do understand about the size and number of lesions needed to be diagnosed with MS. At least in some neurologist's book! :o)

I also think that the McDonald Criteria doesn't absolutely need all nine, like if my patchy area in my thoracic spine was actually a lesion, and if more showed up on a 3 tesla MRI.  There is an area in my cervical spine near the C4 vertebra that is filled with a hemangioma that looks questionable, too.  Last (1.5)  MRI said no clear signal abnormality.  I think I have symptoms that could be attributed to cervical and thoracic lesions.  

If the MRIs were done under MS protocol, that could be another whole ball of wax.  With 5 mm slices instead of 3mm slices, I think a lot could be missed.  Heck, there is so much to learn, I'll leave it (for the most part) to the experts.   But, then again, I've learned so much here!

I will review the McDonald Criteria and everything in the Health Pages before my appointment.

Oh, and I don't have any brain atrophy; that was just neuro #1's weird rant.  Neuro # 2, the neuro-radiologist, and my PCP all disagreed with the atrophy theory.

I'm hoping that my new neuro isn't bound by a particular finding that she feels she needs to make a diagnosis.  I hope she looks at everything with fresh eyes, and figures out what is going on with me, no matter what that is.  

Sorry if I'm rambling.  It has been a long day, with good news and getting a fair amount done.  Unfortunately, after 22 years of being a decent typist, it seems that the message from my brain to my fingers is getting mixed up quite a bit of the time, and I have to back up and correct, or find out later that I posted mixed up words.  My vision is blurry and I didn't call the ophthamologist to see why he didn't respond to my letter regarding my concerns with my vision.  I'm on the usual roller coaster ride; just trying to enjoy the few positive bits of news I've received.  Sorry to unload this all now; I should go to bed.

Thanks for being here.

Kathy

[monotreme]

kathy,
  I am glad to hear that the MRI was consistent and the same neuro radiologist read it.

  What ess was saying about the length of the lesions is what Craig was told by Dr. M in Portland.  He wants nine lesions of 3mm or greater in length to diagnose MS.  And brain atrophy doesn't count!

Elaine

[Fluffysmom]

Thanks, I need the patience; this teaching hospital is difficult to navigate.  I tried to get directions and to find out which parking lot to park in if I went up to pick up some X-rays, and gave up after 5 minutes on hold.  Their website isn't the clearest, either.

Oh well, if they have a good neuro for me, I'll love them!

I like the video game idea.  I'm having fun with it; imagining how to show them feeling humiliated because others think they're making stuff up.  Hmmm. Maybe we could have good neuros come in and easily solve medical mysteries and thereby humiliate the bad neuros.

I was glad it was stable, and no vascular events.  It would have been nice if there was an enhanced lesion that could be tied to the weird eye event I experienced last month, but oh well.

I better get off the forum and get some other stuff done.  Like make that appointment!

Kathy

[wonko]

"New Brain MRI results; take that, bad neuros!"

We should design a video game in which we can blast, bake, and nut-crack bad doctors.  It seems so many go through so much, there'd be a good market for it!

Anyways, I'm glad your MRI is stable, though concerned and hoping a better doc helps you interpret what it all means, and how your current and future health may be related.

Good luck with scheduling.  I hate having to be on the phone so much for things like that, so I'm channeling some extra patience your way.

[Fluffysmom]

ess;  from looking at them, some are over 1 mm.  He noted mm sized; if it would have been and MS protocol, he would have had to count the little things, and state the sizes and locations, I believe.  I understand that my MRI is not "textbook", which is why neuros 1 and 2 discounted a brain full of lesions.  They both thought it could be microvascular, and each had their own pet theory of what I had done to cause them.

We've definitely cleared out the microvascular disease; the radiologist doesn't even mention it as a possibility on this MRI.  I have had great cholesterol, healthy blood pressure, no sign of diabetes, great homosysteine level, etc.

I'm hoping the new neuro will be able to think outside the textbook.  My last one gave up after my LP was negative.  I could be the 1 in 25 that Quix mentions that have MS and a negative LP.  I know I wouldn't pass if I get a lesion counter, unless she thinks sheer quantitiy is enough!  :o)

I have my timeline written up in my journal; if you have time, I would appreciate your opinion of it.  Should I add that the tops of my feet have been hypersensitive for years?

Ray;  If you read what I just wrote to ess, you'll see that it doesn't really clearly state that I have MS, doggone it.  The radiologist said the same thing last time, but included the possiblilty of  microvascular disease, though he put more weight on MS.

The first two neuros weren't even on the fence, they were out in left field!  #1 told me I had brain atrophy(?!!) and I had damaged my brain drinking as a teenager.  He dismissed my tremors and I only saw him once.  # 2 thought I lot of my symptoms were in my head, and slanted her chart notes that way, even when I had an irregular neuro exam.  I stuck with her for three visits because she ordered tests.

Thanks for the hugs and prayers.  I'm calling the new neuro's office today.  I was told I would receive a call to schedule yesterday.  Maybe today's the day!

Carol; You know, I think you're right; a lot of neuros are just plain lazy.  If it doesn't fit easily into their classroom description or tight interpretation of the McDonald Criteria, they don't want to take the time to dig any deeper.  The last one, I asked for her help in figuring out my neurological symptoms if they weren't coming from MS, and she said that I have a perfectly good primary care doctor to help me with that.  Grrrrr.

I could go on and on about it too, but no need to raise my blood pressure!  

Thanks for your kind words and prayers.

You're all wonderful!

Kathy

[essdipity]

Being validated is a heady experience for sure. I know exactly how you feel, so hug your arms to yourself and enjoy it. It's been a long road.

On the other hand, unless I misunderstand, all your lesions are of 1 mm size? Can you clarify that? Your neuro might hesitate because they want them bigger, at least 3 mm. And if they're not enhancing, for some reason they want 9 of these (someone pls correct this if I'm wrong) .

So maybe your neuro can think out of the box and put your case in the MS category, given everything else. I really hope he does, since you have seemingly countless lesions. I just wanted to caution you that some don't. Read up again on all Quix's writings on this, so if this all comes up at your next appointment you'll be ready with some facts. Weaving them in tactfully is an art, and one I've gotten pretty good at, if I do say so, having had more practice than I want. But maybe all that won't be necessary!

Anyway, bottom line is, if I can help, just ask!

ess

[RAY911]

Hey there, I was looking this morning for your post!!!!!!!

I'm so glad everything went well for you!!!!!!!!

It is so amazing to me what we all go threw, and the differences in Neurologists.  I mean your MRI clearly states that you do have MS,,which gives you the answers you need about all your symptoms and frustration etc.  But your neurologist is "On the fence for a DX"?  I don't understand this at all.   What else does the neurologist need???
How frustrating!!!!!!!

I'm so glad that your that much closer to some help with your symptoms.  Did you get an appointment with your New Neuro yet?  Your in my prayers and I pray that your New Neuro will give you the support that you Need and Deserve!!!!!

Huge ((((((((HUGS))))))))
Ray:)

[grannyhotwheels]

I agree with you.  I think that your new neuro had better look in the direction of MS.  I cannot believe you are not already diagnosed but I can see them wanting to take their time and cover all their tracks.  What I don't understand is that after this second one taken 4 months later should make their tracks go at least in the direction of MS.  

I'm very glad you are going to a new doctor.  Most of us go through several before we find one that cares enough to dig for the truth.  MS must be extremely hard to diagnose because it seems to me like the majority of neuros don't want to take the time to try and find out.  I could go on and on about that so I'll stop now. haha

Take care dear Kathy and I'm sure your new doctor will give you your answers.

I'll be praying,
Carol