MRI Scan abnormal?

[dadio]

Hi, I have just had multiple tests (again) to try to decipher why I have progressive small fibre neuropathy.  Two years ago I had an MRI scan which showed no abnormalities but recently another MRI scan says "MRI scan of brain showed only several smalll foci of non-specific signal change within the subcortical white matter".  My question is why are the neurologists not concerned about the change in the MRI in only two years and in your opinion could this be significant.  
Also in your experience is small fibre neuropathy always progressive?  According to the sensory testing (thermal) my abnormalities are only "mild" but the burning and stabbing sure doesn't feel mild.
Many thanks for you help.

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

1) whether the MRI changes were there or not previously, they still do not carry much significance, although I have not seen your MRI. Usually they are age related changes from hardening of the arteries. As in different MRIs slightly different 'slices' of the brain are looked at (seperated by about 10mm) the tiny spots could just not have been in the slices in teh previous scan

2) small fiber neuropathy - whether it is progressive or not depends on the underlying cause, for example if due to diabetes, will be slowly preogressive over time, unless sugar control is very tight. Usually it is progressive, but is slow over months or years. Thermal testing is limited and only tests one modality of sensation - unfortunately there is no good specific test for small fiber neuropathy. A test which has reently proven very useful in this condition is a skin biopsy for epidermal nerve fiber analysis and density - this can be done at specialized neuromuscular centres around the country (such as the Cleveland Clinic)

[RunningL8]

In case it's helpful, I also have a mild case of small-fiber neuropathy affecting the soles of my feet and palms of my hands, and it has not progressed further in 9 years (although the pain has become more chronic).  Doctors think the s.f.n. is "post-viral" since the symptoms began after a mild virus and all other causes have been ruled out.  I also have some nonspecific white spots on my brain MRI; I was told these are common and can be caused by migraines, aging, or just "good living."  (I'm not sure what "good living" means exactly:  I'm 44, and I eat healthfully, exercise regularly, and never drink or smoke.) Are you taking alpha-lipoic acid for your small-fiber neuropathy?  Even though I definitely don't have diabetes, I've been taking 600 mg. in divided doses daily for a year at the recommendation of a top PN doctor, and it has indeed helped the pain somewhat.

[dadio]

Thanks for your reply - always nice to know there are others out there in the same boat!  Yes, I do take ALA so hopefully that will help.  You mention in your post that you exercise regularly, tell me doesn't it make the burning in your feet unbearable?  What type of exercise do you do?  Before getting this I went to the gym 4-5 times a week but not really struggle with any exercise as getting my body temperature up in anyway seems to aggrevate the PN.
Thanks

[RunningL8]

I go a health club 2-3 times a week and spend 1/2 hour on the cross-trainer and another 1/2 hour on a bike.  I also have a stairmaster at home and do that twice a week.  Yes, exercising does make my feet feel worse, but my parents both have had major weight and heart problems, so I'm trying to avoid those problems through exercise and diet.  Probably the biggest lifestyle factor for me, though, is that the pain gets significantly worse if I'm short on sleep (i.e., I have to get at least 8 hours every night).  Also, in case it's helpful to you: oddly, a few years ago I found that I had significantly less s.f.n. pain when I started Zyrtec antihistamine for some respiratory allergies; neurologists have not been able to tell me why Zyrtec would help the pain, but one of my other doctors looked into it, and apparently Zyrtec has some sort of pain-relieving ingredient.  (Other antihistamines don't have the same effect on me.)  My particular s.f.n. pain feels "prickly," and so somehow Zyrtec must block that sensation.  BTW, I also tried acupuncture through a major hospital, and that helped the pain somewhat, but afterwards my hands and feet fell asleep constantly, and that was so disconcerting I decided I'd rather have the pain.  But I've heard acupuncture works for some people.  I hope you soon find the combination of remedies that works for you....

[dadio]

Thanks for you reply - just one more question if you don't mind!  You say you need a good night's sleep, me to but how do you get it?  My feet burn worse at night.  Are you on any regular medication for the PN?  I am currently trying Lyrica (same family as Neurontin).  Thanks so much for your help.

[RunningL8]

In the past, I have also had problems going to sleep due to the pain (I especially feel the burning/stabbing pains in my feet at night).  Currently I’m taking 30 mg. of Cymbalta (both for the s.f.n. and chronic migraines), plus the Zyrtec antihistamine; both of these can cause drowsiness, and together they make me very, very sleepy no matter how much pain I'm in.  BTW, on the subject of exercise:  I find that simple walking (i.e., doing something like shopping) makes my feet hurt much worse than actually working out on the cross-trainer or bike; in general, the arches on my feet particularly hurt after walking, so I guess different types of exercise stress one's feet differently.  Also, I found that I had much less foot pain generally after I had my feet analyzed at an orthotics shoe store; I was surprised to learn that my feet were actually slightly different sizes (and both were a 1/2 size larger than 5 years ago), so that I was actually wearing the wrong size shoes; also, I learned that you can now get very stylish shoes with special inserts that make the shoes conform to your feet.   And I also wanted to say that I initially was told by a top PN doctor that I had a progressive, idiopathic s.f.n., which was just devastating news (and I became even more terrified the more I read about neuropathy!).  Over time, however, my s.f.n. actually has not progressed, as I think I mentioned, and in the last year I would have to say it’s actually been getting slowly better.  My understanding is that small-fiber nerves can regenerate given time, and now neurologists are saying that I can hope to feel normal again at some point.  So if they’ve told you they don’t know the cause of your s.f.n., I think you can also hope that in time your s.f.n. will become better too.  :)

[dadio]

Many many thanks - you have been infinitely more informative than any of the neurologists I've spoken to.  I guess you don't really know until you have it!  Thanks again.  Pauline

[RunningL8]

Pauline--I’m glad that my experience has been helpful to you.  And I agree that most neurologists aren’t all that helpful re. idiopathic s.f.n.!  But however frustrating the idiopathic diagnosis can be, the bright side is that there are a lot of dreadful diseases you don’t have.  So ironically the idiopathic label is kind of a blessing here, as you have no definite bad news about your long-term prognosis.  Take good care!

[suzyqhowudo]

I have been batteling with sciatic nerve pain for two years now with no relief. I have had multiple mri's and xrays wchich according to the radioloigst were normal. One day my primary care physican who specializes in spinal disoreders looked at the scan and saw a abnormality suggesting a conjoined nerve root. He then called the radioloigist to have him re-read the exam. The radioloigist still claimed it to be normal even though by looking at the exam myself I could see the obvious conjoined nerve root staring me and my physican in the face. Could the radioloigist be wrong but not wanting to change his results in case of malpractice lawsuit? I would think if this mri shows the problemand the radioloigist changes his result to the correct one then my doctor could have a easier explaination of my problem to the insurance company so the next options could be done to try to help treat me. We have tried physican and massage therapies, trigger point injections, and chiropractice care with no sucess. I am scared I will never have relief and all I want is to be better not sue someone