I am a nurse practitioner who is going through a nightmare. I saw a neurologist last week after having an MRI for a 20+ year history of intermittent vertigo that has been considered a migraine headache variant. It occurs once every three months and lasts two to three days and is brought on by stress and lack of sleep. Since taking Lamotrigine 200 mg daily, the occurrence, length of episodes, and severity has been well managed. My 27 year old daughter has had two episodes of vertigo that lasted a week in the past three years so I wanted information from my MRI.
The MRI W/WO Contrast
Unremarkable MRI brain without findings to account for patient’s symptoms (vertigo).
On the exam day, the neurologist entered the room and told me that I was not at all what she expected when she looked at my MRI. She asked me what I knew about the result and I repeated the reading. She said that reading is wrong. She reported that my cerebellum was practically non-existent and that my cerebrum was shrinking as well and she was concerned about changes in my temporal lobe. Based on what she saw, she was surprised that I could sit up, had no shaking, did not report dropping things, and could talk. She proceeded to show me a film that was according to her my cerebellum in a huge dark space. It took up approximately 5% of the area if it was my cerebellum.
As a nurse practitioner, if I saw a test result that did not fit a patient’s presentation, I would not have acted in this manner and would have spoken to the radiologist directly and reviewed the film with her. Instead she continued that this was probably an autosomal dominant disorder that I should be tested for and that insurance would probably not cover it. She pulled up my daughter’s MRI and said that the cerebellum showed some shrinkage and that this would correlate since her MRI showed non-inflamed lesions that had been described as suspicious for MS. This movement disorder she stated was associated with autoimmune disorders like MS. My daughter’s reading by the radiologist and this neurologist’s senior partner had not reported any cerebella problem. This neurologist reported that her partner was looking specifically for signs of MS. Since no one in my family has ever had vertigo or a movement disorder, I asked how it could be an autosomal dominant disorder. She stated that I could be the first mutation.
Post Reading Addendum (requested by me): Request was made to specifically comment on the cerebellum. Cerebellum is unremarkable without lesion or abnormal signal. There is a slight mass effect on the posterior cerebellum from the arachnoid cyst but this is of doubtful significance. I have shown the case to another radiologist who concurs.
I have directly spoken to two radiologists with a review by another. They concur that I have a normal cerebellum and it is not atrophied.
When I contacted my neurologist with the info provided by the three radiologists, she was apparently upset that I was challenging her findings. She had shared her interpretation with her two partners who were “impressed” with her evaluation. On the day of the exam she reported that I had slight ataxia and slurring. When I questioned this, she said that she was able to more closely observe these things. The head neurologist at the office had requested the radiologist reread the film (as did I) and was upset that the radiologist did not change her reading so requested another radiology reading. I do not know what this result was. The neurologist who saw me hung up on me since she could not understand how I was put through to her private number. (I was not transferred to her; I kept pushing “0” and “1” to get back to the front desk since they transferred me to the wrong nurse line.)
Interestingly, the gentleman who had an MRI before me had a movement disorder and was not able to dress himself. I don’t know if there was some mix up in what she was able to pull up as my MRI. Could contrast be used to highlight my cyst and this was perceived by her to be my cerebellum? This is a nightmare. Carolead