6 thoughts on “Second opinion-how, when and why? Prahlad K Sethi, MD, FAAN”
Hi Dr Sethi,
I’ve continued headaches on the right side of the head, mostly right forehead and back of the head. Doc suggested MRI and following is the result. I’m looking for second opinion and what are the suggested next steps.
MRI BRAIN WITHOUT CONTRAST
** HISTORY **:
Recurrent headache.
** FINDINGS **:
Technique: Multiplanar multisequence MR images of the brain were
obtained without intravenous gadolinium.
There is linear increased signal over the surface of the right
temporal lobe on the axial and sagittal FLAIR sequences as well as
the sagittal T1 sequence along the expected course of the vein of
Labbe. No blooming is seen in the gradient sequence to suggest
thrombosis and this most likely represents slow flow. Normal flow
voids are seen at the dural venous sinuses.
There is a small mucous retention cyst at the inferior left
maxillary sinus. There is a small T2 hyperintense focus in
periventricular white matter of the left frontal lobe which
measures approximately 6 mm. No intracranial mass is identified.
No extra-axial collection or hydrocephalus is seen. No abnormal
restricted diffusion is identified.
** IMPRESSION **:
Increased signal at the right vein of Labbe which most likely
represents slow flow. Small nonspecific T2 hyperintense focus in
left frontal lobe white matter. Otherwise normal MRI of the brain.
I’ve been looking for over a year for someone to help me. I have 2 brain MRI’s that show ‘mild’ findings’ that may be early onset of dimyalating disease, but said it was up to my PCP to proceed on clinical grounds. I’ve also had 2 spinal MRI’s, one leading me to surgery which has now made things worse. The other MRI shows significant findings that no one will address. Im tossed around to doctors and im getting worse. The MRI’s were done by all different doctors (neurologists at Froedtert Medical College) and they only focus on their one specific specialty, but no one is looking at them as a whole to get the answer.
I see several ‘puzzle piece’ findings that may actually fit and give an answer. MS is one of them I believe fits and I know you have vast knowledge in that area. Others may be lupus or other autoimmune, or mini strokes. And the worst part, not one of the doctors I’ve seen seems to care that my BP has been around 180/120 for almost 3 years now. No one even tries to find out why! All my life its been 110/60-120/80. I’m scared I may have a stroke and I’m only 37, single mother to 2 kids, one whom is autistic and I’m all they have.
Sorry this is so long, but can you kindly reply to me via email, venus_photography@ymail.com and tell me if you’d be willing to discuss my concerns about my MRI and health. I understand if you won’t/can’t, but it never hurts to ask. Please put MRI in subject line so it won’t go to my junk mail. I’d appreciate an answer whether its yes or no.
My doctors have the most annoying tendency to enter new diagnoses on my record without ever telling me, or running tests and never explaining the results. What does this mean? Multiple periventricular T2 signal alterations are again noted, particularly in the peritrigonal and occipital horn areas. There is also some T2 signal change in the periaqueductal gray matter of the midbrain.
I have been suffering from an unknown disease or issue for over 3 years now. It’s of neurological origins but have issues throughout my body. I am one of the lucky few that second opinions didn’t become fruitful unless you count a orthopedic surgeon I saw for an unrelated issue which was happily resolved. I do support second opinions, but feel it is good to do research before charging into the first doctors office you get referred to. In my experience, all I have been met with is either being dismissed and told to just accept whatever progression of it comes next, or belittlement and dismissal.
I just ran across your blog and you are so correct on the over use on analgesics. I find myself in that pattern right now. Thank you for all your expert information. I will be spending a lot of time here reading and trying to decipher my MRI findings and what white matter really is.
After a fall and loss of consciousness for less than 5 mins. a suspected concussion (with no images taken), nostagmus for several days and slowly recovered from the concussion with in a year, I started feeling as though my cognitive abilities were worsening slowly seeming to loose memory and self and surrounding awareness, becoming clumsy and my gait was all over the place. with in a few years I began having severe back spasms and then developed a stiff neck and ear pain. I have had hearing loss of 30% in just 4 years as well as vision changes like double vision or blurry vision. I’ve had no fevers but do have sweats then chills. They did have an mri and they ruled out ms but there is a bright white spot in the inner ear which is where I hit my head when I fell. It also looks like the mastoid was damaged but my doctor doesnt believe this is the cause of my decline. Last spring my neck was so rigid and my head was perched forward that my doctor sent me to physical therapy to help loosen muscles, however I ended up having a shoulder denervation after several cessions of stretching and manipulations. As I was recovering from this I began having sever pain at base of my skull just above my spine. My doctor was rubbing back of neck and base of skull, as I layed on my back and he touched the 4th ventricle and mastoid on opposite side and I felt something weird and I bolted upright instantly. Nothing else was felt but a few days later my sweats and chills became very intense and I became very nautious and suddenly developed severe head pressure for the first time ever. He put me on 1700 mg of antibiotics for two weeks and then sent me in for a spinal tap. He wanted to rule out Lyme disease and the tests showed there is no reaction. I must admit that the antibiotics seem to have helped clear up a lot of my symptoms but I don’t now why nor if they will return. Currently the only symptoms I’ve had are the vision blurriness, gait unsteadiness, if I do my workout I begin to feel the head pressure and most days I have this weird burning sensation above right ear. My kids and I would appreciate any help, ideas. I had a business for 25 yrs and have had to close up shop sadly, I am 51 now and would love to get back to work!!
Braindisease's Weblog 
Hi Dr Sethi,
I’ve continued headaches on the right side of the head, mostly right forehead and back of the head. Doc suggested MRI and following is the result. I’m looking for second opinion and what are the suggested next steps.
MRI BRAIN WITHOUT CONTRAST
** HISTORY **:
Recurrent headache.
** FINDINGS **:
Technique: Multiplanar multisequence MR images of the brain were
obtained without intravenous gadolinium.
There is linear increased signal over the surface of the right
temporal lobe on the axial and sagittal FLAIR sequences as well as
the sagittal T1 sequence along the expected course of the vein of
Labbe. No blooming is seen in the gradient sequence to suggest
thrombosis and this most likely represents slow flow. Normal flow
voids are seen at the dural venous sinuses.
There is a small mucous retention cyst at the inferior left
maxillary sinus. There is a small T2 hyperintense focus in
periventricular white matter of the left frontal lobe which
measures approximately 6 mm. No intracranial mass is identified.
No extra-axial collection or hydrocephalus is seen. No abnormal
restricted diffusion is identified.
** IMPRESSION **:
Increased signal at the right vein of Labbe which most likely
represents slow flow. Small nonspecific T2 hyperintense focus in
left frontal lobe white matter. Otherwise normal MRI of the brain.
Much appreciate your response.
I’ve been looking for over a year for someone to help me. I have 2 brain MRI’s that show ‘mild’ findings’ that may be early onset of dimyalating disease, but said it was up to my PCP to proceed on clinical grounds. I’ve also had 2 spinal MRI’s, one leading me to surgery which has now made things worse. The other MRI shows significant findings that no one will address. Im tossed around to doctors and im getting worse. The MRI’s were done by all different doctors (neurologists at Froedtert Medical College) and they only focus on their one specific specialty, but no one is looking at them as a whole to get the answer.
I see several ‘puzzle piece’ findings that may actually fit and give an answer. MS is one of them I believe fits and I know you have vast knowledge in that area. Others may be lupus or other autoimmune, or mini strokes. And the worst part, not one of the doctors I’ve seen seems to care that my BP has been around 180/120 for almost 3 years now. No one even tries to find out why! All my life its been 110/60-120/80. I’m scared I may have a stroke and I’m only 37, single mother to 2 kids, one whom is autistic and I’m all they have.
Sorry this is so long, but can you kindly reply to me via email, venus_photography@ymail.com and tell me if you’d be willing to discuss my concerns about my MRI and health. I understand if you won’t/can’t, but it never hurts to ask. Please put MRI in subject line so it won’t go to my junk mail. I’d appreciate an answer whether its yes or no.
Thanks for your time,
Natalie Jo
My doctors have the most annoying tendency to enter new diagnoses on my record without ever telling me, or running tests and never explaining the results. What does this mean? Multiple periventricular T2 signal alterations are again noted, particularly in the peritrigonal and occipital horn areas. There is also some T2 signal change in the periaqueductal gray matter of the midbrain.
I have been suffering from an unknown disease or issue for over 3 years now. It’s of neurological origins but have issues throughout my body. I am one of the lucky few that second opinions didn’t become fruitful unless you count a orthopedic surgeon I saw for an unrelated issue which was happily resolved. I do support second opinions, but feel it is good to do research before charging into the first doctors office you get referred to. In my experience, all I have been met with is either being dismissed and told to just accept whatever progression of it comes next, or belittlement and dismissal.
I just ran across your blog and you are so correct on the over use on analgesics. I find myself in that pattern right now. Thank you for all your expert information. I will be spending a lot of time here reading and trying to decipher my MRI findings and what white matter really is.
After a fall and loss of consciousness for less than 5 mins. a suspected concussion (with no images taken), nostagmus for several days and slowly recovered from the concussion with in a year, I started feeling as though my cognitive abilities were worsening slowly seeming to loose memory and self and surrounding awareness, becoming clumsy and my gait was all over the place. with in a few years I began having severe back spasms and then developed a stiff neck and ear pain. I have had hearing loss of 30% in just 4 years as well as vision changes like double vision or blurry vision. I’ve had no fevers but do have sweats then chills. They did have an mri and they ruled out ms but there is a bright white spot in the inner ear which is where I hit my head when I fell. It also looks like the mastoid was damaged but my doctor doesnt believe this is the cause of my decline. Last spring my neck was so rigid and my head was perched forward that my doctor sent me to physical therapy to help loosen muscles, however I ended up having a shoulder denervation after several cessions of stretching and manipulations. As I was recovering from this I began having sever pain at base of my skull just above my spine. My doctor was rubbing back of neck and base of skull, as I layed on my back and he touched the 4th ventricle and mastoid on opposite side and I felt something weird and I bolted upright instantly. Nothing else was felt but a few days later my sweats and chills became very intense and I became very nautious and suddenly developed severe head pressure for the first time ever. He put me on 1700 mg of antibiotics for two weeks and then sent me in for a spinal tap. He wanted to rule out Lyme disease and the tests showed there is no reaction. I must admit that the antibiotics seem to have helped clear up a lot of my symptoms but I don’t now why nor if they will return. Currently the only symptoms I’ve had are the vision blurriness, gait unsteadiness, if I do my workout I begin to feel the head pressure and most days I have this weird burning sensation above right ear. My kids and I would appreciate any help, ideas. I had a business for 25 yrs and have had to close up shop sadly, I am 51 now and would love to get back to work!!