Neuroligist

joliea

I have an appointment to see a neuroligist soon as I have been having symptoms of maybe MS ie vertigo, neuralgia, numbness of limbs on one side of my body also limbs feel heavy. My problem is when I am face to face with a Doctor I forget half of what I want to say, I stammer and my words get muddled. If I write things down will he think I'm a hypochondriac or a smart-ass? What questions do I need to ask as I know that its an important appointment. What am I to expect on my first appointment? I'm also worried that I have so many symptoms that he might think it all in my head as I have been treated for depression in the past.

John

He won't think you're a hypochondriac, relax. Maybe keep a concise daily diary of the next while before you go. Keep a list of what symptoms you've noticed and how often you get them. Also list what you have been treated for in the past as they may be relevant in diagnosing whatever you may or may not have.

Above all, try not to worry or get yourself upset over it. I know that's easy for me to say but the stress won't be worth it. I hope it turns out well for you.

DrIndy

List of problems showing concisely the sequence of events along a timeframe can often be hugely helpful. I knew a patient who kept a diary of each admission and discharge and what the conclusion was and the medications given which was tremendous in helping to paint a picture.

It is dead easy to smell a hypochondriac from a genuine interested person in their condition and if you are don't worry.

It is particularily important in neurology to have a time frame and events.

Doctors are good at discerning what is important and what is not, let them lead the meeting, but the book to refer to is a very good idea.

joliea

Thank you, had my appointment today and wasn't nearly as scary as I thought it would be, he just belted me with a hammer a few times and tried to tune me in with a tuning fork.
Now I have to have an MRI and lumbar puncture, so please excuse my ignorance when I ask what will the MRI tell him that a physical examination can't?
What is the difference between an MRI and a CAT scan?
Where is the best place to go, I have been gven a choice of Waterford, Kilkenny or Dublin.I presume the only difference is of a geographical nature.
I have a friend who had a lumbar puncture before and was quite sick afterwards, is this always the case with LCs?
I know I should have probably asked him all these questions but they have only come to mind now!As you may have guessed I am a worry wart!:o

wheresthebeef

How Stuff Works.com wrote:

In conjunction with radio wave pulses of energy, the MRI scanner can pick out a very small point inside the patient's body and ask it, essentially, "What type of tissue are you?" The point might be a cube that is half a millimeter on each side. The MRI system goes through the patient's body point by point, building up a 2-D or 3-D map of tissue types. It then integrates all of this information together to create 2-D images or 3-D models.

MRI provides an unparalleled view inside the human body. The level of detail we can see is extraordinary compared with any other imaging modality. MRI is the method of choice for the diagnosis of many types of injuries and conditions because of the incredible ability to tailor the exam to the particular medical question being asked. By changing exam parameters, the MRI system can cause tissues in the body to take on different appearances. This is very helpful to the radiologist (who reads the MRI) in determining if something seen is normal or not. We know that when we do "A," normal tissue will look like "B" -- if it doesn't, there might be an abnormality. MRI systems can also image flowing blood in virtually any part of the body. This allows us to perform studies that show the arterial system in the body, but not the tissue around it. In many cases, the MRI system can do this without a contrast injection, which is required in vascular radiology.

http://health.howstuffworks.com/mri.htm/printable
This article is quite technical, and probably geared more towards science people than patients, but it might be useful to understand what is going on.

From a comfort point of view, the bore of an MRI can be small, and may be uncomfortable for people who are a bit claustrophobic. Also the machine is very loud, and you will be given ear plugs or ear protectors. You have to careful making sure you disclose the correct information to the Radiologist/Radiographer about any possible injuries involving metal shards, or working with metal in the past. You need to remain really still on the MRI Machine, and in the experience of some patients, its difficult and uncomfortable to remain still for long periods.

MRI is one of the best imaging technologies out there, if there is something wrong chances are the MRI will find it.
CAT Scan is just a series of 2Dimensional X-Ray images which take cross sections of the body. (Theses images can be used to build 3D images if neccesary) . They show structures in terms of density, so bones are more dense than muscles, so bones are more white on the images. CAT scan cannot give the same level of information as MRI, it cannot ask "What type of tissue are you?". CAT Scan also involves radiation, which is potentially harmful in large quantities or uncontrolled doses. MRI is a magnetic system which does not use radiation.

The reason why Lumbar Puncture makes you sick is because it lowers the pressure in the fluid around your brain (intracranial pressure). This can cause nausea, dizziness and headaches until your body compensates and replaces the fluid. Its important to stay lying down after you have had the lumbar puncture.

(I await Dr. Indy to correct me, I hope i am right.)

DriftingRain

Don't forget to get those medical records too....From places you have been appearing with the same symptoms. Sometimes those are helpful when being seen by a new doc. He will know what you have already been treated with and where to begin!

Hope things work out!

DrIndy

MRI is excellent at looking at soft tissue, thus is the ideal modality to look at the brain. There are very clear and categorical brain changes which significantly move for a diagnosis of MS (called periventricular changes) and the extent can guide extent or lack of the disease. CT is also good at looking at the brain, but is better for strokes or for brain bleeds as blood lights up brightly on CT.

CT's are also very good at looking at bone.

Lumbar punctures - people react differently to them. It is common to have a slight headache, but most people don't. In MS - there are certain proteins that are elevated in MS which also point to a diagnosis. (although having the proteins, but NO symptoms does not make a diagnosis).

Tests are additional tools used to confirm a diagnosis which is primarily made on a clinical exam and a clear history.