Re: Should I seek a second opinion?

Posted By CCF Neurology MD - AY on October 13, 1998 at 00:36:22:

In Reply to: Should I seek a second opinion? posted by SPINAL NEGATIVE???? on October 12, 1998 at 22:00:47:






: My MRI shows lesions "too numerous to count" according to the report.  I also have had episodes of, among others, vertigo and one pupil dilating completely while the other eye did not dilate, for no apparent reason.  My neurologist did a spinal tap on me and dismissed me with, "we've tested for all the bad stuff, go home and don't worry."  I continue to have minor vertigo and other symptoms yet I'm relunctant to go back to this doctor because she made me feel as if I was exaggerating or imagining my symptoms.  If I don't have a legitimate concern, then why is my MRI positive?  When I go visit family in Albuquerque next summer, I'm considering going to the MS clinic there.  Do you advise this?  What if any other steps should I take to try to get a diagnosis?  Would you advise repeating the MRI and if so, how long should I wait?  The first was done in February 1998.




Thanks for your question.  It is always of concern when an imaging study
shows lesions that are "too numerous to count".  It is difficult to decide
from reading your message if all the investigative studies have indeed been
pursued.  It is, however, quite clear that you do NOT feel comfortable with
the lack of a proper diagnosis and that your symptoms are is bothersome to
you.  In this current scenario, you might feel more at ease in having a
second medical/neurological opinion, particularly one from a neurologist
specialized in MS.  The results from a spinal tap can be "negative" if
the procedure was performed during a remission stage.  Unless your current
symptoms are significantly different from those at the time of the first
MRI scan, there would not be a reason for a repeat MRI scan before the
evaluation by the second neurologist.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.



=
CORRECT ME IF I AM WRONG PLEASE, OLIGOCLONAL BANDS (PRESENT IN 90% OF MSER'S)
ARE PRESENT IN CFS EVEN DURING A REMISSION. THEY DON'T DISAPPEAR DESPITE A REMISSION!!
HECK, I KNOW THIS AND I'M NOT EVEN A DOCTOR!!!!!!!



  


Thanks for your input.  The answer is actually in your own statement.
When oligoclonal bands (OCB) are present in a MS patient they will remain
"positive", however the absence of OCB does not exclude MS, although the
percentage of OCB-negative patients is small (5-15% depending on the different
studies).  If your are interested, here are some clinical reports/studies
on the subject:
Lack of both spinal fluid oligoclonal bands and complement 4A protein in an MS patient.
Acta Neurol Scand 1994 Jan;89(1):72-4   (ISSN: 0001-6314)
Value of visual evoked response and oligoclonal bands in cerebrospinal fluid in diagnosis of spinal multiple sclerosis.
Lancet 1987 Apr 4;1(8536):769-71   (ISSN: 0140-6736)
MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT.
Neurology 1988 Feb;38(2):180-5   (ISSN: 0028-3878)
A study of oligoclonal band negative multiple sclerosis.
J Neurol Neurosurg Psychiatry 1996 Jan;60(1):27-30   (ISSN: 0022-3050)