Aa
Barkhof's criteria? Huh?
I received the chart notes from my visit with my MS specialist. Pretty much what I expected; she only noted a few small abnormalities in my neuro exam, like "the rapid alternating movement is slightly diminished on the left side, but there is no ataxia. Vibration is mildly impaired in all 4 extremities. Tandem gait is a little hesitant (she had me take four step)". If she would have done the Romberg test, she would have seen that I do have balance issues.
Is it normal to test for plantar reflex so hard that it hurts? My right foot hurt for hours afterwards.
So, for her assessment:
1. Abnormal brain MRI, nonspecific, cause most likely small vessel ischemic disease rather than demyelinating disease.
2. Multiple neurolgical symptoms; however, no myelopathic signs on exam or any other signs of upper motor neuron dysfunction.
3. Negative CSF studies as well as negative cervical and thoracic cord imaging.
The pateint's multiple neurological symptoms are noted as well as the abnormal brain MRIis also noted..However, for the lack of clear pathological signs as well as nonspecific MRI findings and negative CSF, the diagnosis of multiple sclerosis cannot be made at this time. It will remain in differential, however. The pateint does have a risk factor for small vessel ischemic disease that has included cardiac arrhyhthmias, notably PSVT in the past, and I wonder if some of this could be truly ischemic in nature. She has not had a MRA of her brain which may not be unreasonable in her case to be done to ensure that she does not have any large vessel disease; however, the likelihood of that bein positive is unlikely considering her young age. I would recomment the patient go on aspirin 1 a day at least for right now. I would also recomment the patient have another brain MRI done in 1 year and subsequently if needed if she continues to have new symptoms which remain unexplained. I would also check for thyroid antibodies as part of workup for the abnormal brain MRI. The plan at this time is to see her back after all these testing.
Then she cc'd a copy to my first bad neuro, the one I saw only once and made clear to her that I would never be seeing him again. She also listed my second neuro as someone I had never heard of before, although I had faxed her complete chart notes from neuro #2.
She said that my brain MRI "showing several T2 hyperintense lesions in the subcortical white matter which are mostly periperal, not periventricular. There are no lesions seen int he corpus callosum or infected dural lesion, and this will not meet the Barkhof's criteria for MS on MRI".
What the heck is the Barkhof's criteria? I've googled it, but I mostly found articles about cases where people had met the Barkhof's and McDonald criteria. There is a lot of stuff about the McDonald Criteria. I think that maybe the Barkhof criteria is taught in Asian countries, as one site said. Is it similar to the McDonald criteria? There were many mentions of dissemination in space.
She misunderstood some of my symptoms, downplayed others, and never mentioned the fact that she referred me to a urologist at OHSU for testing to see if my bladder symptoms were neurogenic. After making that appointment, I discovered that there would be no testing done, it would be a "talk" appointment. I'm calling to find a new urologist tomorrow, then will cancel with the one at OHSU.
Isn't it kind of funny that she's sending me for a test that she considers that will be unlikely to be positive?
Are mild cardiac arrhythmias a risk factor for small vessel ischemic disease?
So many questions!
Anyway, I had a really good day yesterday and am recovering from putting 10,000 steps on my pedometer. I went and watched both golf and soccer. After the soccer, there was a great fireworks show. I felt really great. Tired and sore, but great. I took a nap today; actually felt like staying in bed, but got up anyway as my roommate was buying breakfast! :o)
Hugs to you all,
Kathy
Is it normal to test for plantar reflex so hard that it hurts? My right foot hurt for hours afterwards.
So, for her assessment:
1. Abnormal brain MRI, nonspecific, cause most likely small vessel ischemic disease rather than demyelinating disease.
2. Multiple neurolgical symptoms; however, no myelopathic signs on exam or any other signs of upper motor neuron dysfunction.
3. Negative CSF studies as well as negative cervical and thoracic cord imaging.
The pateint's multiple neurological symptoms are noted as well as the abnormal brain MRIis also noted..However, for the lack of clear pathological signs as well as nonspecific MRI findings and negative CSF, the diagnosis of multiple sclerosis cannot be made at this time. It will remain in differential, however. The pateint does have a risk factor for small vessel ischemic disease that has included cardiac arrhyhthmias, notably PSVT in the past, and I wonder if some of this could be truly ischemic in nature. She has not had a MRA of her brain which may not be unreasonable in her case to be done to ensure that she does not have any large vessel disease; however, the likelihood of that bein positive is unlikely considering her young age. I would recomment the patient go on aspirin 1 a day at least for right now. I would also recomment the patient have another brain MRI done in 1 year and subsequently if needed if she continues to have new symptoms which remain unexplained. I would also check for thyroid antibodies as part of workup for the abnormal brain MRI. The plan at this time is to see her back after all these testing.
Then she cc'd a copy to my first bad neuro, the one I saw only once and made clear to her that I would never be seeing him again. She also listed my second neuro as someone I had never heard of before, although I had faxed her complete chart notes from neuro #2.
She said that my brain MRI "showing several T2 hyperintense lesions in the subcortical white matter which are mostly periperal, not periventricular. There are no lesions seen int he corpus callosum or infected dural lesion, and this will not meet the Barkhof's criteria for MS on MRI".
What the heck is the Barkhof's criteria? I've googled it, but I mostly found articles about cases where people had met the Barkhof's and McDonald criteria. There is a lot of stuff about the McDonald Criteria. I think that maybe the Barkhof criteria is taught in Asian countries, as one site said. Is it similar to the McDonald criteria? There were many mentions of dissemination in space.
She misunderstood some of my symptoms, downplayed others, and never mentioned the fact that she referred me to a urologist at OHSU for testing to see if my bladder symptoms were neurogenic. After making that appointment, I discovered that there would be no testing done, it would be a "talk" appointment. I'm calling to find a new urologist tomorrow, then will cancel with the one at OHSU.
Isn't it kind of funny that she's sending me for a test that she considers that will be unlikely to be positive?
Are mild cardiac arrhythmias a risk factor for small vessel ischemic disease?
So many questions!
Anyway, I had a really good day yesterday and am recovering from putting 10,000 steps on my pedometer. I went and watched both golf and soccer. After the soccer, there was a great fireworks show. I felt really great. Tired and sore, but great. I took a nap today; actually felt like staying in bed, but got up anyway as my roommate was buying breakfast! :o)
Hugs to you all,
Kathy
Brain working again; so, a MS specialist that goes by the Barkhof criteria might not be the best choice, since MS is not an MRI diagnosis?
If it's so clear that I don't have MS, why did the neurologist that I had requested to see decide that I should be seen by the MS specialist after she had gone through my records? I just don't get it.
Kathy
If it's so clear that I don't have MS, why did the neurologist that I had requested to see decide that I should be seen by the MS specialist after she had gone through my records? I just don't get it.
Kathy
Thanks, you know the best places to find the information!
Hey, and I still have the differential diagnosis possibility of MS, so I still belong here.
Just joking, I know the Mob Rules; I'm here for life!
Kathy
Hey, and I still have the differential diagnosis possibility of MS, so I still belong here.
Just joking, I know the Mob Rules; I'm here for life!
Kathy
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