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645800 tn?1466860955

This time they really gave me the MRI of my head.

Today I made the 79 mile trip again to get my MRI's of my head and really got them this time. One is from Nov. 2006 while the newer one is Dec. 2007.

But I still think that 1st Neuro is an idiot. Part of the report from 2007 stated that I had a sinus infection which he never mentioned to me nor Rx'ed anything for it. The head CT was done 2 months later when I had a severe ear infection. If he had mentioned the sinus infection or Rx'ed an antiobiotic maybe I wouldn't have gotten the ear infection 2 months later which required an ER visit.

2006 was done w/o contrast. The first thing I noticed was that they had under history was TIA. I had no prior history of a TIA. So I guess this Neuro was looking for a stroke before the MRI and stated that I had had one. This was after my PCP told him he thought I was very likely to have MS.

TECHNIQUE- Sagittal T1, axial proton density, T2, DWI, ADC map, coronal
FLAIR.

FINDINGS - The ventricles are normal in size and configuration.
Cortical volume loss involves the vertex components of the frontal and
parietal lobes. No acute intracranial hemorrhage or midline shift. No
acute infarct. Multiple foci of mildly hyperintense signal, identified
on proton density, T2 and FLAIR, are present within the white matter of
the frontal and parietal lobes. One focus is present in the right
parietal lobe. Approximately ten foci are present in the right frontal
lobe. Approximately seven foci are present within the left frontal
lobe. Motion artifact is present on the sagittal T1 sequence. Best
possible exam obtained.

Of further note is the doctor told me after this MRI that I had 3 small strokes in the vision center of my brain.  If all of those "foci" are what he was refering to then I count 18 in the report.

Ok now for 2007 MRI

TECHNIQUE- Multiplanar, multisequential MR imaging of the brain was performed both before and after the uneventful intravenous administration of 20 cc of Gadolinium.

FINDINGS- No diffusion weighted abnormalities are identified to suggest an acute CVA. No enhancing lesions are identified in the brain, the brainstem or the cerebellum. No evidence of
intracranial hemorrhage, extraaxial fluid collection or hydrocephalus is identified. The pituitary gland is not enlarged. There is fluid signal in the ethmoid sinus suggesting sinusitis. Chronic plaque formation could be considered in the proper clinical setting.

Ethmoid sinus disease.

NOTE the last line. This is what my Neuro failed to tell me about.

Quix: Now that I have the MRI (yes it really is an MRI this time) Any comments?

Dennis

4 Responses
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645800 tn?1466860955
What do you think about the answers to your questions?
Helpful - 0
645800 tn?1466860955
Ok for the answers to your questions. I'm copying your questions to make it easier to answer them

"Did he place you on stoke preventative therapy or just let it stand that he thought you were having strokes?  Do you have diabetes, chronic hypertension that is poorly controlled?  did he work you up for a clotting disorder? "

he didn't put me on any preventative therapy. I do NOT have diabetes, Uncontrollerd Hypertension. He did not do any work up for a clotting disorder.

I did leve of the mention of the previous MRI (that there was one for comparision) it was listed at the end of the "TECHNIQUE" section. I just didn't bother copying that part as it was the only mention in the report.

I know he is like your first Neuro as he was the one that stated that I couldn't have MS because I wasn't a 35 y.o. female.

The second MRI was done on the same machine as the first one,but I have no idea of what stregth it was.

I was thinking that since the earlier intensities were not mentioned at all that maybe they were the "Chronic plaque formation" that they referred to.

One other thing that bothered me is that N1 said the storkes were in my vision center but the intensities were all over my brain. I'm not even sure if any of them were located in the vision center.

BTW every thing I do is a real pain. I live way out in the country. To get to my new Neuro it is a 2.5 hour drive.

Dennis


Helpful - 0
147426 tn?1317265632
Ooops, I don't understand the mention of "chronic plaque formation."  What plaques?  Where are they decribed?  The word plaque makes you think of MS plaques, but I have never heard of they being described as chronic.  Still mystified.

Q
Helpful - 0
147426 tn?1317265632
lol. What a pain!

Well, though I agree with you that N1 is an idiot, I have to let him off the hook for a couple things here.  The first is that the MRI way OVERcalls sinus disease.  We are all taught to ignore references to sinus infections on an MRI.  The MRI is so sensitive to sinus inflammation that it will pick up residual inflammation from many months before.  If there are problems in the patient that might be referable to the sinuses, then a CT is ordered.

When the reason for the MRI is put down the doc has to put his leading "suspicion."  He suspected TIA, so that is put as the diagnosis.  

Now, onto the meat of it.

18 hyperintensities is a lot,  but, you (and I) are of an age when lazy doctors are inclined to dismiss all hyperintensities as "age-related."  They do this, even though the studies that show many of us have these intensities, but when we do they are without symptoms.  Since you were symptomatic he assumed the symptoms were from repeated strokes.  Did he place you on stoke preventative therapy or just let it stand that he thought you were having strokes?  Do you have diabetes, chronic hypertension that is poorly controlled?  did he work you up for a clotting disorder?

I wouldn't be surprised if he was like my first highly esteemed neuro who believed that MS does not occur after age 50, so anything that does show up on the MRI has to be vascular (stroke) related.  

I agree that the neuro's interpretation of "3 strokes" seems weird and without basis.

I have a real problem with the readings of your 2007 MRI.  The discussion mentions that there are no "enhancing" areas.  Okay, that means there are no active inflammatory areas that lit up with Gad (contrast).  But, the interpretation does not mention at all whether there are any bright or hyperintense lesions.  These are different from "enhancing lesions."  Given that the MRI a year earlier showed so many this should have been a focus of the radiologist's readout.  Since the issue isn't brought up at all we don't know whether those earlier hyperintensities disappeared or whether he just forgot (??) to mention them.  Is what you printed the only "findings" on the report?

Were the two MRIs done on the same machine??  If not, was the strength different?  I can't imagine that all of them simply disappeared.  I am mystified that the earlier 2006 MRI was not mentioned and no mention is made of any lesions.

I think your new neurologist should read these and also have them officially re-read by a different neuroradiologist.

Does all of this make sense?  I'm sorry you had the long drive to rectify a mistake.  Sheeesh!!

Quix
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