Should I go to the A&E / ER department?

I've had escalating neurological problems now over the past ten months - confusion, memory loss, muscle twitching, blurred vision, shooting pains, etc. Had an urgent GP referral this week, back to a neurologist I'd seen earlier in the year. When I saw him initially, he wasn't that concerned, but requested an MRI for me to be on safe side. As the scan was normal, he told me this week, that my symptoms were psychological and I was wasting his time, despite them having got much worse.

I'd sought a second neurological opinion in August, and was told my symptoms were the result of depression (which I don't actually have!) and that no further investigations were warranted.

Over the last couple of days, I've fallen over twice due to losing my balance, feel completely spaced out, along with not really understanding much that my flat mate is talking to me about. As my family doctor is not around until next week, I'm seriously contemplating getting myself along to A&E/ ER. However, my GP advised against this some time back, unless I actually collapsed, as she said they would just discharge me back into her care.

Anyone had any experience of neurological problems actually being looked into, upon visiting a U.K casualty department?

[Dr Rajgopal]

Hi,
The possibility that may be very close to your symptoms could be Multiple sclerosis. It is a demyelinating disease that affects the nerves of brain and spine. The symptoms are loss of  balance, headaches, vision problems, muscle twitching and weakness, and many others. The disease may not be diagnosed in a single MRI. A series of MRI may be required. Lumbar puncture may be necessary to rule out the disease. Please discuss the possibility with your neurologist and go for further investigations. Hope this helps you. Take care and regards!

[caregiver222]

As Dr Rajgopal points out multiple schlerosis is a definite possibility. It is also true that your symptoms are characteristic of diabetes, and an hbca1c test is definitely indicated. A single blood sugar reading is meaningless. In terms of MRI's you need a 3T MRI with contrast to obtain definitive results. Do not accept a 1T or 1 1/2 T machine test. Most times the lower rated machines are acceptable, however in your case you already drew a blank and require more definition.

[cognitivelykaput]

Thanks for both of your replies.

I went to A&E / ER yesterday, and whilst they weren't able to perform any tests, strongly hinted at M.S being the possible cause of all my symptoms.

However, given that whilst many physical symptoms I'm experiencing would fit a diagnosis of M.S to a tee - the blurred vision, muscle twitching, spasticity, etc - I seem to be getting more confused and muddled on a daily basis, along with rapidly deteriorating short term memory, which to me and others I've spoken to with an understanding of M.S, doesn't really seem consistent with the condition, given it normally only results in mild to moderate levels of cognitive impairment.

I've now managed to secure another urgent neurological referral, to try and get to the bottom of things, although given my experiences with the two previous neurologists I've seen already this year, am not that hopeful. Still, we shall see...

I've had a blood test for  HbA1c, along with tests for: Thyroid Profile / T3 / Cortisol / Glucose /  ACE / ANA / ESR / CRP / Lyme / Calcium / B12 / PTH / Folate. All of which came back normal.

[Charley123]

Your symptoms do sound like MS to me.  I was recently diagnosed and also have been a member of the multiple sclerosis forum,  http://www.medhelp.org/forums/Multiple-Sclerosis/show/41?camp=msc
for a year or so.  I think you would get a lot supporting help on that site.  I can only tell you definitely from my own experience that cognitive impairment can be mild and it can also be severe.  
Many of us have been to several neurologists and we all write about our experiences with them.  
There is so much loving support on that site to help you get through all this that I hope you'll try it out.  I also find this site and the dr's replies to be really helpful.  
That's good advice about the 3T mri's.  Some members of our group went for years without a diagnosis until they had a 3T mri.  It seems that some of us have tiny leisons that cannot be picked up by the other mri's.  
The health pages, http://www.medhelp.org/health_pages/list?cid=36  can help you see the wide variety of symptoms that MS presents.  I wish you good luck with all of this,
Charley.

[cognitivelykaput]

Hi Charley,

Thanks for your reply,

Have already popped over to the MS forum, and basically posed the same question about cognitive impairment there: http://www.medhelp.org/posts/Multiple-Sclerosis/MS-and-Cognitive-Symptoms/show/1073264. You all seem like a very friendly bunch :)

I think I would be totally sold on a diagnosis of M.S, if my cognitive problems hadn't been so unrelenting in their progression over the last ten months, and had shown some sign of fluctuation over this time - as you say - sometimes mild, sometimes severe.

Obviously more a question for an empathetic neurologist, one of whom I've yet to find, but with seemingly everyday that's passed over recent weeks, my thought process just seems to be breaking down more and more, with my short term memory not far behind.

I had no idea about the different types of MRI scanners - i'd imagine I'll pretty much have to accept whatever's deemed appropriate by the treating neurologist here in the U.K on the good old NHS.

[Charley123]

Thought you might like to see this article.  Looks like there is a 3T MRI in the UK.  Good luck, Charley

http://www.medicalnewstoday.com/articles/164719.php