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Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1985
Experience:  Neurosurgeon - Brain, spine, and peripheral nerve surgery
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I have been trying to convince my doctor to refer me to a

Customer Question

I have been trying to convince my doctor to refer me to a cerebral vascular specialist because I have been experiencing neurological signs over the past few yearsseruiys ciybke vusuibm nyuumbness in my right foot elgl,
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: I have had foru MRI['s over the past three years, and they all showed a venous malformation on the left side of my brain. however, I have been unable to convince my doctor that I would appreciate further testing for a possible CCM.
JA: Do you keep personal medical records to help track this?
Customer: Yes, I do.
JA: Anything else in your medical history you think the doctor should know?
Customer: I know tht I havd a malfunctioning hiypothalamus, because I have beedealing with central Diabtes Insipidus for the past three or four year (no measufrable AVP in my blood serum), for one thing.) I also h ave dealth with ''''central hypoventilation disorder since my earliest memory (very shallow breathing and central sleep apnea which cannot be totally controlled in spite of my using a VPAP assisted ventilation device for a number of years. I also have low TSH and low T4 but am using Levothyroxin. So that does not really bother me. The other things are hard to deal with.
Submitted: 8 months ago.
Category: Neurology
Expert:  Dr. David replied 8 months ago.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 8 months ago.

I am sorry you are having these symptoms.

do you have your most recent brain MRI scan report?

Customer: replied 8 months ago.
This was done several years ago. Since then, when I went in because of foot drop in my right foot, a CT scan was done. This did show a hyperintense region in the left side of my brain. But I only know that because I asked for a copy of the report. I have been unable to get a local doctor interested in this condition.
Customer: replied 8 months ago.
I cannot make the phone call. Please answer here.
Expert:  Dr. David replied 8 months ago.

usually foot drop is due to a viral infection or temporary inflammation of the peroneal nerve next to the knee.

usually foot drop is not due to a lesion in the brain

has your foot drop gotten better?

Customer: replied 8 months ago.
The foot drop was a relatively minor concern. I only mentioned because it was on the opposite side of my body as the lesion in my brain. I am mainly interested in finding a health provider who would look further into the possibility of my having a CCM in the region of the venous malformation, since that is more likely to be causing the symptoms than the venous malformation itself. I would like to find a doctor who is willing to 'actively' search for the cause. One real possibility is that an accompanying CCM would show up by searching for it with an SWI. Even very small CCM's can ooze blood and cause neurological symptoms. Incidentally, foot drop can come about due to central causes, although it is less likely than the reason you suggested.
Expert:  Dr. David replied 8 months ago.

get a copy of your brain MRI scan

a brain MRI scan with contrast or a brain MRA Angiogram would show for sure if you have a Cerebral Cavernous Malformation or not.

Customer: replied 8 months ago.
After 4 MRI's that describe the location of the venous malformation, that has already been proved. All I am asking for is someone who is willing to go the extra mile and use the SWI which would show things that a routine MRI might not. It is the recommended procedure to use in a difficult-to-diagnose situation. A regular Angiogram would not show it up, as a CCM is a low-flow situation. I don't know about an MRA.
Expert:  Dr. David replied 8 months ago.

a radiologist is the doctor that interprets the Susceptibility-Weighted Images on a brain MRI scan and makes the conclusion on the MRI scan report.

a neurologist would not be able to interpret those images.

Customer: replied 8 months ago.
Actually, those with the problem I have tried to describe are advised to secure the care of a cerebral vascular specialist. But first it's necessary to convince a local physician that this is what I need.
Expert:  Dr. David replied 8 months ago.

I can not convince your local physicians either.

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