Neuro visit: Occipital neuritis??????

[Joiedecour]

Hello everyone, I had follow-up visit with neuro after second brain mri. She said no changes after 5 months, and the lesions there - all subcortical - two parietal, left side, one frontal right side and one parietal right side - are non-specific. She seems to be totally convinced it's not MS, giving me every explanation under the sun for a bunch of symptoms, or telling me that nothing really jumps out at her. But she wants to do a cervical and thoracic mri, saying that she'd feel more comfortable ruling out MS after those. In the meantime, she has dx'd occipital neuritis, saying it explains headaches and dizziness, and is sending me for physical therapy. Is occipital neuritis related in any way to MS?
Apparently the neuro exam is fine, although slightly hyporeflexive in arms, so I'm not sure why I'd have to have the spinal mris, and with contrast. Do spinal mris generally show lesions on 1.5 machines?
She's attributing urinary issues to age. I'm 42.
I also told her about a weird incident where I coughed and suddenly had a vision disturbance as if someone had shaken my head and all the things in front of me were loose and in pieces. I thought I was going to have to go lie down. But she didn't seem to think that was strange.
What do you all, the experts think? My own thinking is that spinals will show nothing and I'll be stuck with an occipital neuritis dx which explains some things but not others. Does it really make sense for a neuro to take different explanations for different symptoms? How much coincidence can there really be? Kinda confused here!

[Joiedecour]

Kyle, thanks. It does seem interesting to choose multiple concurrent explanations, when one, admittedly rare, would do! So I guess I'll see what happens with more mris. In the meantime I am just sick of earache, jaw ache and headache : (
I'll report back after mris. Thanks again : )

[Joiedecour]

Thanks, guys!!! Hope humidity clears soon JJ and that birthday dinner was success!

[supermum_ms]

oops lol i read that 3 times and still didn't see the difference between 'occipital' and 'optical' - darn it! sorry

I tried to find something relevant with 'occipital neuritis' and about 99.99% of what I can find, is listed under the name 'occipital neuralgia' some articles do 'briefly' mention neuritis with in but very little specifically under than name.

This is quite detailed -

Essentials of Physical Medicine and Rehabilitation: Musculoskeletal ...
edited by Walter R. Frontera, Julie K. Silver, Thomas D. Rizzo

http://books.google.com.au/books?id=FiMoQ-OtbB0C&pg=PA485&lpg=PA485&dq=causes+of+occipital+neuritis&source=bl&ots=GdYEDyqRjg&sig=fu4OBTodhETCYJ3GuyhEIdUf9Oo&hl=en&sa=X&ei=51NVUoa8GoPOkwWdl4CIAQ&ved=0CCkQ6AEwADge#v=onepage&q=causes%20of%20occipital%20neuritis&f=false

To me neuritis is different to neuralgia though, neuritis being 'inflammation' of the nerves and neuralgia being a commonly used term for pain coming from a nerve (burning or stabbing) more irritation to a nerve. Neuritis can permanently damage nerves but neuralgia doesn't usually eg pinched nerve.

lol so is that as clear as mud for your too?

Sorry again, probably the wrong day to add my two cents, its been humid down under and loooooong with DH and MIL birthday dinner tonight, aaaannnd i've not got use to day light savings as its heading for 1am - poor excuses though they are mine lol

Cheers.......JJ

[kwarendorf]

If she has decided on a diagnosis, using some of your symptoms to confirm it and dismissing other symptoms it may be time to find another neuro.

I'm not saying you have MS. I am saying that MS can be the great connector of dots. In my case, seemingly unrelated symptoms that appeared with varying frequency over 20 years were all connected to and cause by MS.

Because MS affects the central nervous system it cause symptoms to appear just about anywhere, including the occipital nerve. Occipital neuralgia is not uncommon in MS.

At this point you are in the info gathering stage. More information is better than less. Yes, spinal lesions do show up on 1.5T machines, several in my case :-) As to the LP, again, more info is better than less. I've had 3 in the last two years and have never had any problems.

My two cents...

Kyle

[Joiedecour]

Hey Supermum, thanks for helpful reply. I think you're reading "occipital neuritis" as "optical neuritis" which is what I did myself initially. However, it's not the same. It's the occipital nerve (cranial, I think), not the optical. But I'm trying to find out how much of a link exists between occipital neuritis and ms.
As for the spinal, neuro didn't give me any reason for the spinal other than thinking it was better to have them so she'd be more comfortable ruling out ms. What makes me think this is all very strange is that the brain mri and symptoms make her do more mris, but if the spinal mris are negative, then the brain mri and symptoms are unimportant.
Hope it's a good day for you in Australia!

[supermum_ms]

Hey there,

Q:Is occipital neuritis related in any way to MS?
A: ON is one of the most common visual sx's, ON is often the 'first' recognised sx's prior to dx of MS

There is a lot (huge amount) of research on ON and MS, i havent checked this one to see if its relevant to you but it might give you something useful.
http://www.ccjm.org/content/76/3/181.full

Q:Do spinal mris generally show lesions on 1.5 machines?
A: A 3T is better because there is something like 25% more lesions discovered on a 3T compared to a 1.5T BUT it can get very complicated because the software makes a difference, as does the slice size etc
Your spinal MRI is because of having 'slightly' hypo reflex and the possible urinary sx, all connected to spinal cord lesions but also other things too.

Q:Does it really make sense for a neuro to take different explanations for different symptoms?
A:I think that really depends on the sx, and sometimes the neuro. One of the problems is when there isn't the clinical evidence and or test evidence to substantiate the anecdotal. I gather your neuro testing didn't highlight any 'clinical' signs of spinal cord lesions and with out having a spinal MRI, your thoughts of urinary issues is still only anecdotal.

Being a women of a certain age, with or without children, is probably one of the most common for urinary issues, so without having evidence etc it kinda is a plausible explanation, though it still doesn't make it the correct one.

Hope that helped some what :o)

Cheers........JJ