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Most recent visit with Cleveland Clinic MS Neuro July 30th 2014

Aug 25, 2014 - 0 comments

Not sure I've edited this enough.  Somebody warn me if I left anything in here that could later prove embarrassing!


Vitals - Last Recorded as of 8/25/2014  5:35 PM (????)  Computers.  Go figure.
Smoking Status
Former Smoker

Allergies
CAT/FELINE PRODUCTS; CHERRY; DOGS; SHELLFISH

Diagnoses
Abnormal MRI of head   - Primary
Dizziness

Problem List as of 7/30/2014
Abnormal MRI of head
Abnormal walking

Progress Notes
Dr. O., MD  7/31/2014  8:58 AM  Signed
CCHS STAFF PHYSICIAN NOTE OF PERSONAL INVOLVEMENT IN CARE
I have reviewed the follow-up note obtained and documented by the advanced practice nurse and I personally participated in the key components and have answered all the patient's questions.

57 year old male with non specific MRI findings which have not changed over time. The etiology of his symptoms is still not clear to me. He has on-going neck pain, dizziness, and poor balance. Will refer to neuro-otology and recommended neck physical therapy. Follow-up in 6 months and repeat brain MRI in 1 year. All questions answered.  (HA!  What in the world's wrong with me, doc?  Answer that one!  How to treat it?  That's another real poser, ain't it?)

Dr. O., MD
Mellen Center Staff
  
Marie N., RN CNS  7/31/2014  8:58 AM  Signed
(Nurse Marie seems like a pretty sharp cookie, IMHO.)
MELLEN CENTER FOR MULTIPLE SCLEROSIS
FOLLOW UP  APPOINTMENT

PERSONS PRESENT IN THE ENCOUNTER: patient

PRINCIPAL NEUROLOGIC DIAGNOSIS: Possible demyelinating disease
Huh?  

Latest MRI report

Aug 25, 2014 - 4 comments

Been sooooo busy I hadn't even checked to see if they had posted this report to MyChart.  Not that there's much to see.

* * *Final Report* * *

DATE OF EXAM: Jul 30 2014 2:27PM

UMM 0474 - MRI BRAIN WWO CONTRAST / ACCESSION # 999999999

PROCEDURE REASON: Abnormality of gait
* * * Physician Interpretation * * *

MRI BRAIN WWO CONTRAST

HISTORY: Abnormal gait. Clinical concern for possible demyelinating process. Routine follow-up

TECHNIQUE: Brain MRI with demyelinating disease protocol with and without gadolinium.

MR Contrast: Gadavist
MR Contrast Volume (ml): 10
MR Contrast Route of Administration: Intravenous

COMPARISON: MRI Brain on 09/14/2013

BRAIN RESULT:

Findings: Few foci of T2/FLAIR hyperintensity scattered in the brain parenchyma, along the periventricular, and asymmetric T2/FLAIR hyperintensity adjacent to the right occipital horn. There is corresponding T1 hypointensity and no enhancement. Extent of signal change is very limited, but this appearance can be seen as a sequela of
previous demyelination.

New T2 Lesions: Zero

Interval Improvement: Not applicable.

New Enhancing Lesions: Zero.

T2 Burden of Disease: Mild.

Parenchymal Volume Loss: None.

Other Significant Findings: Morphology the brain is otherwise normal.  Major intracranial arterial structures and dural venous sinuses show typical flow void consistent with patency by spin echo criteria.

IMPRESSION:
Stable, nonspecific intracranial deep white matter lesions can be seen in the setting of multiple sclerosis. No new T2 lesions or enhancing lesions.

Stiff neck.  Radiologist's report.

Dec 25, 2013 - 0 comments

This was in September of 2013.

Cervical spine:

Counting reference: Craniocervical junction.

5 mm retrolisthesis of C6 over C7. Multilevel disc bulging, endplate and
uncinate osteophyte. Ventral cord contact at C3-C4 and C6-C7, but no
gross compression or myelomalacia. No grossly abnormal cord signal or
abnormal cord enhancement.

Canal and foramina are patent at C2-C3. Severe right foraminal narrowing
at C3-C4 primarily related to uncinate osteophyte and facet hypertrophic
change. Canal and foramina are patent at C4-C5. Annular bulging,
endplate and uncinate osteophyte at C5-C6. Canal is grossly patent, and
there is moderate to severe right foraminal narrowing. Broad
disc-osteophyte complex at C6-C7. Limited CSF space surrounding cord,
but no gross compression or myelomalacia. Relatively severe foraminal
narrowing bilaterally, particularly on the left.. Canal and foramina are
patent at C7-T1.

Canal and foramina are patent at upper thoracic levels through T5-T6.
There is disc bulging at T3-T4, but the canal remains normally patent.

Thoracic spine:

Remainder of the thoracic spine shows normally patent canal and neural
foramina. Cord signal is normal. Conus terminates normally at the upper
one third of L1. No abnormal signal involving the substance of the cord,
and no abnormal enhancement after gadolinium.
IMPRESSION:

Relatively nonspecific white matter changes as noted, stable since the
prior exam. This appearance can be seen in the setting of multiple
sclerosis.

Cervical spondylosis as noted. Particularly severe foraminal narrowing
on the right at C3-C4 and on the left at C6-C7.

Thoracic spinal canal and neural foramina are patent.

No focal cord lesions identified, and no abnormal cord enhancement.

Cleveland Clinic - 1srt visit

Aug 10, 2013 - 11 comments

Decided to bring my rrcent posts fron the  boards together here.  

I definitely felt that this young neuro is a keeper. He asked me to stick around while he saw another patient for a quick appointment, explaining that he knew we had more to cover than the time we had would allow. He listened carefully to my history, asking quite a few questions as we went along. He took copies of many of my reports, as well as the CDs. I must've misplaced my 2010 LP report, but he looked through the hundreds of images on the newest CD, and copied the older ones into their system. Funny, but he saw thin