Time for another opinion?

[pokey]

A recent visit to neuro left me feeling very uncomfortable. Not sure if I should mention this, and if I should, even how to approach it. I went for a patch of numbness in left arm. In the notes, there were several things mentioned that were not assesed. For example no intranucluear opthalmoplegia or afferent pupillary defect. Does this not require a light to be shown into the pupil? I feel very uneasy about these "findings" being part of a permanent record that were not checked. I had an episode of blurred vision in the left eye and without seeing neuro, he sent me for repeat VER. The original VER done 2 months prior was slightly delayed on right and boarderline on the left. The repeat was abnormal bilat. I am concerned this could of been another episode of ON, but w/o the exam this could be missed. Appt next month w/opthamologist. I am seriously considering asking for a 2 neuro consult thru my eye doctor. Does that seem reasonable? Should I mention the notes?

I tried to explain a symptom to neuro at last appt, but it's kinda strange and difficult to explain. In Jan 01, I had  hemiparsis on R. Summer and during exercise my right side becomes weaker feeling. I drop things in my hand and trip over my foot, this is not always present. When I mentioned this, neuro said it could be anything and wasn't overly concerned. My guess is since I can squeeze his fingers for 2 seconds its not a problem. It don't happen that quickly, and I just don't think I got my point across. Maybe I should of said lets go for a walk!

Thank you for taking the time to answer my questions.

[CCF-Neuro-M.D.-JT]

I'm sorry your neuro visit did not go well. First, a light is shown in the eye to assess pupil size and reaction which would be necessary for examining afferent pupillary defects but NOT internuclear ophthalm. which is a problem with the movement of the eye muscles. Something  else that should be assessed is a fundoscopic exam that requires an ophthalmoscope to look carefully in the patient's eyes during routine neuro exams for any optic nerve damage. Also, a thorough motor examination is in order to look at the strength of your right side.

Seeing an eye doctor is the right thing to do next. And I agree, you should get a second opinion from another neurologist, especially if your eye exam is abnormal and/or suggestive of MS.If you're not comfortable with the prior neuro doc, there is no need to confront him/her with your concerns (unless you want to)otherwise they may become defensive. Just get another neuro doc that hopefully you will be comfortable with.It's important to find someone you can really talk to. Best of luck.

[To CCF Neuro MD From Pokey]

Thank you for taking the time to answer my posting. I had more or less come to the conclusion of not saying anything to neuro about the notes, but I was thinking of talking to my  opthamologist about them. I don't really want to confront anyone about it, but if I don't would I get the help I need? That is the question I ask myself over and over.

Vision has been a problem for the past few years. Beginning with diplopia, then a episode of what 3 doctors thought was ON (opthamologist, neurologist and retina specialist)optic disc normal. I did not have a MRI at that time - was relocating to another state. Prior MR had one hyperintensity adjacent to the left frontal horn (I believe thats where it was) and MRI done this year did not show any abnormalities. I do have congen nystagmus (occlusion type) but recently on lateral gaze I will have it - this is new - since March, also comes and goes.

I think I will make an appt with my PCP about my right side and see what he recommends. My PCP is very easy to talk to. I don't know if you read these comments on the posts, but again, I just want to say thank you.