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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I've got conflicting diagnosis, I've seen 2 neurologists and

Customer Question

I've got conflicting diagnosis, I've seen 2 neurologists and one says stroke, the other thinks I'm faking it (didn't come out and say that but none the less that's what he believes) because my mri (3 of them, one with contrast) have all come back clear... but I have left side weakness, clumsy hand, trouble with memory, finding words, and understanding language. What can you tell me about strokes that don't show up on mri? Is there such a thing?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hi. Yes, there are stroke that do not show up on MRI scans. They are called Lacunar strokes, caused my microvascular disease in the thalamus, or internal capsule, or pons/cerebellar peducles. (Those are brain areas of predominantly white matter or tracks, so you cannot see the change well on MRI). To get a picture if you need that (may not change management), you get a CT scan with thin cuts though those regions, and you will hopefully see the lacune. Stroke is a clinical diagnosis made by reported symptoms and signs or findings seen on (or not seen on) neurological exam. It is not an imaging diagnosis. Tell the neurologist that. I cannot diagnose you from here obviously without an examination, but there is a lacunar stroke syndrome called "clumsy hand dysarthria syndrome" where you have a lacune in the cerebellar peduncle or internal capsule that is hard to see. Maybe you have that? Please get back to me to discuss this further if I can help, or rate my service if satisfied by clicking on the stars as that is how I am compensated for my work Thanks *****

Customer: replied 1 year ago.
My symptoms include left foot drop, left leg and arm weakness, although it has gotten much better over the past few months with physical and occupational therapy. What is troubling me now is I had a secondary diagnosis of post stroke pain syndrome or peripheral neuropathy and take nurontin for the nerve pain. And now have a new neurologist who is questioning me like I'm lying... how can I handle this?
Customer: replied 1 year ago.
I'm 36 years ,never had any of the factors that would cause stroke, normal blood pressure, Cholesterol, blood sugar, not overweight
Expert:  Dr. Frank replied 1 year ago.

You need to stay away from the neurologist who thinks you are lying. In lacunar infarctions involving the thalamus you can have central pain syndrome as a result of this stroke. I do not believe you thought this all up in an organized fashion. It just doesn't happen that way unless you are a neurologist and know the pathways and evolution of these problems. I would get another opinion, and ask for a CT with thin cuts through the thalamus (a lacunar infarction protocol, the neuroradiologists know what I am talking about) . Don't believe someone with a subjective sense, try to get some positive imput, ok? You should also be considering an antiplatelet regimen like 81 mg aspirin, or clopidogrel (plavix) to improve microvascular perfusion. Dr Frank

Expert:  Dr. Frank replied 1 year ago.

There are genetic factors, (family history, on disorder called CADASIL for example) there is smoking. People get lacunar infarctions from stress at work without risk factors, The risk factors only increase your risk. Dr Frank

Customer: replied 1 year ago.
I'm on Plavix (due to my aspirin allergies). My original Nero dr diagnosed me with an ischemic stroke and said she had seen it before that nothing showed up on mri, but gave no indication on what it was called - she (Dr Bridget Marshall - Patterson) never put a name on it. Since then I had to change Nero dr to someone local. (Dr Matthew Roller) I seen his PA first (Dr. Valerie Tuseth) and she gave the diagnosis of peripheral neuropathy... today I seen Dr Roller and he sat and questioned me for half an hour about what has already been determined. He never came right out and said it but the way he questioned me made me believe he thought I was lying. I will take your advice and seek out another neurologist for another opinion.
Expert:  Dr. Frank replied 1 year ago.

You may not see the lacune even with the CT scan, but it does not matter in terms of management. One other point I would like to bring up. If you have lacunar disease, then your risk for another lacune (meaning potentially another stroke) in the next 5 years is around 50/50, even with treatment, although treatment lowers the risk in most individuals. The fact that you do not have major risk factors may mean you are not well protected with current medications, so I would encourage you to take your Plavix. I hope I was able to help answer your question. Please remember to rate my answer by clicking on the stars as that is how I am compensated for this work. Get back to me anytime if I can help. Dr Frank

Customer: replied 1 year ago.
Thank you for your time and input Dr Frank. One final question if I may.... should I see a geneticist to see if this is a genetic condition or some sort of chromosome disorder? I also have 4 kids so I'd like to know if this is a genetic thing that gets passed on. My daughter has chromosome 21 deletion syndrome, and epilepsy already. So is what what happened to me could be related to that?
Expert:  Dr. Frank replied 1 year ago.

Do you have a history of stroke in your immediate family members? This type of genetic stroke issue is usually pervasive, in CADASIL for example just about everyone has had a stroke, and many have died at an early age. Without that family history, you don't need genetic testing. I have had patients with lacunar strokes for no known reason. It just happens. That may be you as well. There have been cases of trauma (concussion) with a subsequent lacunar stroke years later with no other risk factors. So it may be difficult to give you a reason, but I would not worry about genetics unless it is obviously an issue. Dr Frank

Customer: replied 1 year ago.
Thank you again for your time and for your opinion. I understand it is very difficult to give proper advice when you have never examined me yourself. I just want my current neurologist to believe I'm not crazy, I'm not making this up, and the pain is VERY real. I needed something to go to him with to show or test for that what I've experienced is not some elaborate 8 month long hoax. You have given me that. Thank you so much Dr Frank. If I have questions in the future can I speak to you personally again?
Expert:  Dr. Frank replied 1 year ago.

I am here and would like to answer your questions anytime. Jusr get back to me. Dr frank