Information on neurological exam

[Joiedecour]

It is often said here that the neurological exam is above all the most important thing in determining neurological deficit. Apparently, it is not. I was told by my neuro today that the neurological exam is insensitive as a measure in diagnosing ms and that what matters is change on the MRI. Let the games begin.

[essdipity]

His nurse or whoever does the paperwork. And who cares what he thinks, if he thinks at all :-) I doubt if he'd even know, and he's probably been through a bunch of patients since you, most if not all of whom he's also shown his uncaring attitude. You may be just a blur.

In any case, if you take the advice of several here including me, you'll be ditching him for someone halfway human. If you ever get a firm diagnosis, would you want this sweetheart of a guy treating you?

[Joiedecour]

Thanks, Ess. So probably his nurse? Then he'd get to know probably and I think he thinks I am anxious and obsessed already

[essdipity]

J, since you're in the US, you definitely have a right to notes, by law, though you might have to pay a bit. If your neuro is at a big medical center the bureaucracy can be daunting, but start by calling his office and making the request.

I did this in my pre-diagnosis days and found the notes most helpful, as like many if not most MSers, I went thru a bunch of neuros and several years before getting an answer. Since then I haven't really bothered, but I could. BTW, this applies to any and all doctors, testing results, etc.

[Joiedecour]

Rest of message disappeared! I was wondering how you all get access to your doctor's notes when I can't even get him to give me answers on my neuro exam! Thanks for support and help.

[Joiedecour]

Thanks for replies everyone. I definitely think our neuros studied together, aspen too

[aspen2]

I'll add to what Joiedecour is saying ... I've had a babinski in my weak leg since 2013 (it did disappear for a while in 2014 but is back) ... but my neuro, because he could not SEE a lesion on my corticospinal long tracts, minimizes the pyramidal signs I have.  I.E. if there is not MRI proof, then the sign doesn't exist.

I've also had signs of a brainstem lesion which all were concerned about ... until he couldn't find the lesion on my mri.  At this point, the signs and symptoms don't seem to matter any more ... except where they are messing with your quality of life.

Yet there are lesions in other areas, that change ... including 2/4 McDonald areas ... I see my neuro tomorrow.  I'd rather have dental surgery at this point :P.

Sorry for the hijack, J. -- all this to say that I believe our neuros were trained at the same school :P.  I'm so sorry your appointment was discouraging.  He is still following you, but it's hard not to feel shelved.

[immisceo]

Ess and DV are both spot on. No one has time for old school paternalistic doctors.

As for the exam itself, a simple car key run up my foot in the emergency room told the doctor I had a neurological problem and triaged me immediately to the right department. (positive for Babinski's) This is what we mean about its importance. It did not diagnose me with MS, but it narrowed the possibilities and put me in contact with the right people from the very beginning all without a wait or expensive testing.

[doublevision1]

Yes, I'd be searching for someone more helpful than this one. I'd also get a copy of your record of this visit to see if he recorded his observations made during your exam. My neuros have all taken quite a bit of time with the exam and note all sorts of things that they seem to think are pretty relevant.

[essdipity]

Wish you'd said this in your first post--my response would have been a lot shorter. A neuro who refuses to talk/answer questions is one who should be history. I don't care where this one works or how 'good' he is s'posed to be, he's a jerk. Deal with him accordingly.

[Joiedecour]

None. No explanation for anything. i asked the question 'does my neurological exam show anything abnormal' and he replied without replying as above. I know I have at least RAPD and retinal nerve fiber thinning and abnormal white matter lesions. But none of that matters apparently. See me in a year and by the way get lost. Having a hard time with this. I do not understand.

[essdipity]

I'm thinking that when your neuro said the exam is insensitive for diagnosing MS, he meant that any abnormalities cannot automatically be attributed to MS, and of course that's true. A lot of conditions can cause abnormalities upon exam. 'Neurological deficit' and MS are not synonymous.

But if the exam is normal, a neuro is not likely to pay a lot of heed to symptoms described by the patient. This can be unfair, since sensory symptoms can't be demonstrated, yet without MRI evidence, the doctor has no basis for a diagnosis in these circumstances. Even if an MRI shows some sort of lesions (things that shouldn't be there), if their cause is open to interpretation, few neuros will diagnose MS when the exam is normal. Not the most imaginative stance, but the most frequent.

What the neuro wants and needs is evidence of lesions caused by MS. This can happen if there are MRI changes (thus fulfilling the 'multiple' part of an MS diagnosis), and it can also happen if a previously normal exam becomes abnormal, all provided there is no better explanation for abnormal findings. So really, it is a big oversimplification to use a short phrase to define MS diagnosis.

I have to agree with your neuro in one regard--if you have MS, your MRIs will eventually show it. But if he's found abnormalities upon exam, what explanation does he give for this?

ess