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Thread: Not happy with neuro report

  1. #1
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    Default Not happy with neuro report

    Just received a report from the day I see the neuro. Heres an excerpt..

    'This lady complained of a number of subjective symptoms. On examination the remarkable findings were hyper-reflexia in the upper limbs on deep tendon jerks and areflexia in the lower limbs. There was also toe fanning on the right side and equivocal plantar response on the left. The rest was unremarkable.

    Overall I am not sure sure whether there is an organic origin to the complex combination of symptons reported by this patient. I would think it be useful to rule out any posteria fossa structural lesions or abnormalities in blood vessels possibly related to ehlers danlos syndrome. Having noticed some peripheral nerve signs, mainly the reduced deep tendon jerks in lower limbs, I think it would be useful to have an EMG......'

    So maybe it seems it could be non organic and all in my head lol!! Makes me feel like I do not even want to bothered to go through the EMG, MRI/MRA if they are going to tell me its all in my head which I have heard some other people say they was told on here. I really do not feel it is as have not felt right for some time.

    Really not sure how to feel right now.

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    doesn't sound like neuro is saying it is in your head.

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    If he thinks that it is not organic origin I would have thought that he means it is psychological?

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    Distinguished Community Member agate's Avatar
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    Some doctors apparently assume that your symptoms might not be organic until/unless they have very clear evidence of something organic going on. If a patient comes in reporting a list of symptoms that don't point clearly to one diagnosis, the red flag goes up.

    From the report you quoted, though, it looks as if he's found several indicators of something organic. You may have had a positive Babinski sign. That is always pathological, and it can't be faked. It's often "equivocal," though, and so he isn't sure.

    He's in favor of ordering an EMG. He's talking about posterior fossa lesions and Ehler-Danlos syndrome as possibilities. These are organic, not psychological.

    If he'd thought your symptoms were all in your head, he'd have sent you on your way. Instead he'd like to explore the possibilities for a diagnosis.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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    Hi Agate.

    He did write on the MRI form positive plantar response right, equivocal left. What does equivocal mean?

    What I do not understand, is in one breathe he is saying he is not sure if it is something 'organic' going on and then the next breathe he is quoting reflex findings (which as you say cannot be faked and as if I would want to anyway!). Just find it a bit confusing.

    I think the previous experience I have had with my local GP who basically took the mickey and made jokes when A and E wrote to him saying they recommended a neuro referral has not helped as I felt then that I wasn't being taken seriously then.







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    Distinguished Community Member agate's Avatar
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    A and E = Accident and Emergency? Is that what those in the US would call the ER (Emergency Room), maybe?

    To answer your question, "equivocal" means that the doctor wasn't sure whether there was a positive Babinski response on the left. Maybe, maybe not.

    If you've ever watched your toes when this test is done, you've probably noticed that what they're doing isn't always so clear.

    I don't see how any doctor could seriously believe that your symptoms are psychological. You've had projectile vomiting when brushing your teeth. You've had postural headaches. (I looked at some of your earlier posts.) The doctor who wrote the report seems to acknowledge your diagnosis of Ehlers-Danlos syndrome.

    I think you're worrying unnecessarily. Doctors dictate these reports and sometimes use standard sentences and phrases in them without giving a lot of thought to the matter.

    Overall I am not sure sure whether there is an organic origin to the complex combination of symptons reported by this patient.
    That looks like one of the standard sentences a doctor tosses into a report. I've heard doctors dictating their notes. They're often in a hurry.

    You could always ask the doctor about that sentence. Ask him if he thinks there's a possibility that your symptoms could be "all in your head." You might want to ask if you have other indications that you're being brushed off.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
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    Maybe I am worrying too much Agate....I just want to find out what is going on with me and do not want to be brushed off I suppose. I do not think the symptoms are all in my head at all as they are happening and if push comes to shove will have to go private, but I hope it doesn't come to that.

    Yes A and E is ER - I forget this is a world wide site. I did tell him about the vomiting and headaches and some of the other things that I could remember. My MRI is due at the end of the month and I will be going.

    You are probably right that it is just a 'saying' that they use and I have read too much into it. Thanks again.

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    Hi Peglegs,

    I'd be really annoyed too if a doctor even made a suggestion that anything I complained of wasn't organic in origin, I might not go back to someone who would even contemplate that without any evidence to suggest it was all in my head or even running a test to find out if anything showed up. So I understand how you feel.

    That said, your objective is to try to get to the bottom of this. And since he's willing to order some tests, I'd atleast go for the tests because they may show some abnormality.

    But I doubt I'd return and become a regular patient of any doctor who automatically questioned the legitimacy of my symptoms, that's for sure. But I'd probably go for the tests just to prove the bugger wrong and show him that yes, something WAS actually wrong and he was wrong in his assumption. :) The tests might tell you something, and his other ideas seem good at ruling in or out some decent possibilities. I'd go for the tests and get the results. I don't know if I'd go back to the doctor. Then again, he DID find some of the neurological exam to be off. Sometimes we can freak out when something IS wrong and think other symptoms, even benign things, are related as well, when they are actually fine. Maybe that's all he's saying is that some of the symptoms aren't consistent with the other symptoms to form a whole picture.

    Maybe I'd give him the benefit of the doubt after all. Now that I think about it, maybe he was just saying that some of the things don't fit within the symptom list of what he's actually thinking is wrong. Maybe just do the tests and see where it leads, decide later if you're a "fit" with him on a continuing basis. After all, he did find some neurological deficits, so he can see that something is wrong that IS organic since they can't be faked. Yes, as agate says, "equivocal" means it wasn't an obvious "normal" or "abnormal" response, it was uncertain but not "normal" anyway.

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    Hi Suze

    Yes I am going for the tests - think I was a bit fed up after reading him being ambiguous in the space of 2 sentences!

    As Agate said, maybe it is just standard stuff that he wrote without thinking as there were physical things going on. I have been honest with him and told him the things that have been happening that are not the norm for me - whether or no they may be relevant - so he could make his mind up. I am not the best at explaining myself and I told him that I was a bit nervous on the day too, because it is unusual for A and E to do a direct referral.

    MRI is on 30th so I will be going. Thanks Suze. Happy holidays and Merry Christmas :)

  10. #10

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    And Happy New Year, and let us know about results of the tests.

    For me life was a process of coming up negative on all tests until I came up positive on many tests. I have a dim opinion of doctors' ability to diagnose. But I do not say it as if I think they are bad people to be so lacking in information. It is just that we must realize that their information is limited. Very few are geniuses. Your doctor, Peglegs, is just ruminating about what may be.

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