is it possible radiologist was wrong?

A repeat of what radiology report says--
""There are focal regions of abnormal signal within the periventrical white matter. The largest lesion is adjacent to the posterior aspect of the body of the right lateral ventricle and is somewhat ill defined and measures 9 mm, ovoid in configuration. Within the right parietal corona radiata, there are two additional rounded foci of white matter signal abnormality measuring 2 mm and 3 mm respectively. There is a 2 mm rounded focus of abnormal signal within the left frontal white matter as well. There is an additional lesion seen within the parietal white matter within the left hemisphere measuring 7 mm just lateral to the atrium of the left lateral ventricle."

"white matter signal changes are noted and described above. these could certainly be significant in a patient of this age and clinical correlation with regard to the possibility of multiple sclerosis or other demyelinating disease is recommended."


My doctor finally called back after the 4th call to him to explain why he said different than what I am reading.  He said he does not see anything significant when he looked at the film, he is the specialist and this is what he is educated in or something along the lines of....He said he does not have enough evidence of time and space to see anything wrong.  I told him he did not see me in the middle of that attack, and why does this say 9 mm and 7 mm if all you see are pinpricks?  he just said he was the specialist and wouldn't even put me in the possible ms at this point bc he doesn't have evidence.  I know what happened to me was real, odd and neurologically related. He is going along with the scheduled VEP and he said to call next week to schedule LT.  He said some people might have one neuro attack and never have another one again and he doesn't know why.  

So I am just so confused at what my mri report says and what he says.  I know there had to have been evidence of something in the brain for whatever happened to me...He also said they did not enhance abnormally.

So I am going to pretend that never happened I guess that is all I can do.  And maybe that will never happen again.  I don't know what else to do other than wait for the other tests, which will cause me to miss some school, so I am going to have to explain something to my professors.  

Is it possible to have such a different report bw a radiologist and a neuro?  I know radiologists don't have expertise in the brain like a neuro does they just write what they find...do you think the radiologist was just off somewhere?  now I fear that I am crazy and what happened to me was me losing it.  Although I don't think you wake up with sudden  urinary retention from going nuts, and everything else that followed just for it to level off if it meant I was nuts.

something happened, something is going on I just don't know what.  I think the best thing for me to do is student teach to the best of my ability and pretend I am ok.  If I get weird results in other tests, I will go to another doc bc if I try to go to one now, it will still take as long.  he mentioned he has no problem sending me to a MS specialist once we get further tests done.

[Heather3418]

Did you know that some Neruologists will ADMIT that they cannot read an MRI as well as the radiologist and rely on the report heavily to sort it all out?  I swear this is true.  Your Neuro seems a little "holier than thou."  My Neuro told me, "Heather, I know what I am seeing on MRI, but when it comes to MRI's of the spine, I am not good at reading them.  I need and value the radiologist, who has years and years of education at reading MRI's, over me."

In total, I think your Neuro is an A S S.  9mm lesions are of significant size.  Nothing to be sneezed at.  If your Neuro is saying "No to MS," then okay doc...what the heck is causing the lesions?  Until he can answer that question, I would stay on him for answers or find another Neurologist.  I really believe after his current comments, that "I" would be looking for another Neuro, post haste.  I wouldn't waste my time, efforts and money in a Neurologist that has this kind of attitude.

You have every right to be concerned and even though I shouldn't say this, I think your MRI's and symptoms ARE indicative of MS.  Please remember that I am only someone WITH MS, I am not a professional by any stretch of imagination.

I am sorry that you are going through so much headache with this Neuro. Perhaps a call to the reading radiologist would give you more information.  I did just that with my radiologist the other day.  Since I called ahead to ask for a few minutes with him for a consultation on my recent MRI, he was more than happy to see me and believe it or not, they did not charge me a cent for meeting with him.  He was most helpful at helping me to understand what we were seeing and how it is totally consistent with someone with MS.

You need the MS Specialist now.  I do not think there is more testing needed if you have already ruled out MS mimics, like Lyme disease for one of them.  I would even let the MS Specialist do the LP.  I would trust his opinion of the results than I would trust your current Neuro.

I guess I should shut up now.  Sometimes I get into trouble giving "my own opinions."  I just try to share what I have learned over the past 13 years having MS.

Hang in there dearheart.  Keep fighting for answers.  I swear it's worth it when you finally know what is wrong, deal with it and learn to get on with your life.

Many hugs and blessings coming your way,
Heather

[essdipity]

If I were you I'd follow Heather's advice. It makes a lot of sense to me.

You may decide to just let it ride, and that of course is up to you. But the thing is, we've seen quite a lot of folks post on this forum with issues like yours, including dodo doctor. Many have made up their minds that they will not deal with things, like you, or they get too discouraged, having been to several neuros. So they opt for mind over matter. They 'will' themselves to function and even to have no symptoms. I guess this works for some, but for lots of others, they come back and tell us they just can't cope anymore, regardless of willpower.

At that point they start looking for another doctor, which can take a good while. The new doc may then order a lot of repeat tests, including MRIs. That's all to the good, but meanwhile a lot of time passes, time in which they are barely holding things together. For that reason we urge people to hang in there until their symptoms and test findings are explained one way or another. Your current neuro isn't doing this now, and who knows if he ever will.

Why not proceed with whatever tests are scheduled, but also with finding a different doctor. You can take the test results to the new and almost certainly better neuro. The one you have now is too busy being defensive and 'a specialist.' Whoopee doo.

ess

[jensequitur]

Yup, yup, yup...  I know it really makes you want to give up when even the neurologist refuses to commit to a diagnosis.  Go ahead and get the LP and VEP done - I'll bet you that you have positive results on both.  And look for another doctor!

(I've been telling myself the same thing for two years now - still don't have a new one.)

[Heather3418]

My mother always said that I was never too big for a spanking...So if you are still telling yourself after "two years" that you need a new Neuro, then I think you are due for a spanking, young lady.  Seriously Jen, you owe it to yourself to get the best quality care and if finding another doctor will achieve that, then you need to set your "New Year's Resolution" to do that TODAY....

Don't make me send you to your room , Jen....start working on getting that New doctor this month...

Big Hugs and Best Wishes,
Heather   :>)

[jensequitur]

Yes ma'am... [hangs head]  ;-)  I should do it now, while I'm in remission!

[jesserose]

This is just all so confusing.  The thing I wonder is how he doesn't see 9mm and 7mm.  There has to almost be a mix up here because that is not the size of a pen tip.

But question--I am also confused because I had the MRI about less than (give or take) 2 weeks after the worse part of the attack. I was still feeling crappy when I had mri, but definately not like I was.  I could function better and so forth.  so why didn't they enhance?  Wouldn't they have enhanced if that really was my first MS attack?  he mentioned that too, 'well they didn't even enhance...'  and he's right, but wouldn';t they have still enhanced seeing as how the worst of it was only a couple of weeks at most earlier if it was indeed MS?

[jesserose]

forgot to add, report says 'no abnormal enhancement' (except for some angioma I supposedly had since birth)

so does that mean the lesions enhanced but not abnormally or it didn't enhance at all?

*bangs head on wall*

[biowham]

Your neuro is trying to cover his *** and being a high-handed jerk while he's at it. I'd get the further testing and then hightail it somewhere else. He screwed up, and he's not man or doctor enough to admit it. Scary.

Bio

[Lulu54]

If I understand it correctly, and I am by far the least medically savvy member here, lesions enhance because you are in an active stage of the disease or have been active within the past 4-6 weeks.  You can have MS and not have lesions enhance on an MRI if your disease is in a quiet phase.  Someone correct me if I am wrong.

Go through with the tests and have those results added to your list of tests and results.  

Listen to your heart - do you think you have something wrong?.........  Yeah, me too.  

Hang in there, Lulu

[jesserose]

That's what I am confused on Lulu.  To have an attack, doesn't that mean active phase?  And if this 1st real attack that I had lasted from approximately dec 7th or 8th(?) until around the 27th of dec. why wouldn't a lesion abnormally enhance seeing as how I just ended an attack about 4-5 days before the actual mri ? (shame on me for not writing dates and then trying to figure out when something happened) It should have enhanced abnormally right?

I'm sorry I'm just trying to figure this out and please excuse me going over and over stuff but you guys are helping me A LOT and I really appreciate it.  Yeah totally something went on but I have read so much about MS from here and Lyme from other places and other disorders that cause lesions and so forth.  The enhancement is something I don't understand still, in relation to my mri findings.

[Amyloo]

Hi,  I had an area of atrophy show up on one MRI, that didn't show up on one that had been done just a month earlier.  My neuro said not everything can be seen each time, in some cases.   Amy

[Lulu54]

I don't know if this will help but here's  an example from me - my damage shows itself in my right leg - I have a foot flop/drop foot  that becomes more pronounced when I get hot or tired.  my foot drop never goes away completely, but is not evidence of an attack.  It is a symptom of my neurological damage.  

Now my question for you is could you be confusing the worsening of symptoms with new attacks?  It's confusing enough on its own let alone throw in these differences.  

anyone else out there that can help with this, please jump in ..........

do try to read the health page that Quix referenced about MRI's and lesions - it might help as well.  This is such a complex disease most of us only process little bits of information at a time ....

Keep asking us questions - it's the best way to learn!
Lu

[doni54]

I'm in total agreement with Heather.  This guy sounds like a real jerk and you need someone who will work with you, not against you.

Also talking to the radiologist sounds like a very good idea.

Take care and good luck.  Keep us informed on what's happening.

We're all here to help you get through all this with support and any knowledge we posess.

doni

[jensequitur]

I think it's a real possibility that your brain had no fresh lesions when your MRI was taken.  Finding something depends on a lot of factors - slice depth, strength of MRI, how much you moved during the scan, how long they waited before scanning you after administering the gadolinium...  there are so many things that you really want an imaging clinic that knows what it's doing.

And it sounds like you found one - it's too bad your neuro is so terrible!  

[PastorDan]

That is, by far, the most detailed information I've heard fom anyone's radiology report.  I do wish mine would include as much as a quarter of that much detail.

I also like the idea of talking to the radiologist who read the scans and wrote the report, so I hope I get a chance to follow up on that this week.

[Quixotic1]

This is a great thread and I second everyone's remarks.

Heather is right on the money when she urges you to move along.  Your Neuro is a jerk and his words don't make sense.  The kind of wording used in the radiology report is very specific.  He saw Something big enough to measure!

I think you should begin looking for a new neuro.  You can also request a second opinion on the readout of your MRI by another neuroradiologist.  There is no problem in calling the radiology department and asking to speak to the radiologist that read your report.  Explain that the neuro stated that there was nothing important on the images and you would like a third opinion, because you have serious neuro symptoms and are very worried.  Everyone that mentioned this was spot on also!

To all: The radiologist can only offer a diagnosis when the condition is actually  diagnosed by the appearance of the imaging.  MS is NOT an MRI diagnosis!!!!!   It is a clinical diagnosis with the MRI adding supportive evidence.  The radiologist can say at most that in a patient of this age and with these symptoms (if the request listed the patient's symptoms) MS should be considered.  

Quix (I sign off as Quix because I can't spell Quixotic)

[Quixotic1]

And, Jen, - what Heather said!

[Fluffysmom]

I was also impressed by the thorough radiology report.  From my reading of the MS Protocol, aren't radiologist's supposed to note the size, location, number, shape, and all that of lesions?

It sounds like it's more common to get a less detailed report; don't radiologist's follow the MS Protocol?  Just curious.  I know that a good neurologist will read the MRI themselves, but not all neuros are good, as we've seen again and again.

Find a good one, jesse!  Good luck.

Kathy

[risnerrose]

Okay . . . I would like to jump in here.  I may very well be confused in my thinking (no wise cracks, please ), but  if the MRI shows lesions that don't enhance, doesn't that mean those lesions are older?  Would they still be the cause for new symptoms or would new symptoms be the result of new inflamation (inflammation) (perhaps not showing at all on the MRI)?  It just seems that this indicates two separate attacks??????

Sherry

[Karen99]

I count 5 lesions as reported by the radiologist report.  Uh duh!  That is significant given  your symptoms.  I guess if you are 105 years-old that many lesions could be expected with no particular significance.  

If I remember your initial post on this subject, you did have a history of leg weakness or loss of use and other symptoms adding on over time.  So that blows out his statement of time and space.

Time for another neuro.  Continue with the other testing.  As someone else said, you can take those results to another neurologist.

Have faith in yourself.  It's your body and you know that something is amiss.   As Quix said "MS is NOT an MRI diagnosis!!!!!   It is a clinical diagnosis with the MRI adding supportive evidence. "