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Taking longer than hoped to get a neurologist to accept me…

Taking longer than hoped...

Taking longer than hoped to get a neurologist to accept me as a patient, not sure if I am at immediate risk. Severe headaches increasing in frequency led to checking BP, extremely high (200+ / 130+ with pulse 120+ at rest. CT at urgent care. 2.5 cm non-specific low attenuation lesion LF lobe. No acute intracranial abnormalities or hemorrhage. MRI W & w/o yesterday. Area in question shaped like a small egg, pretty much looks like a void to the untrained eye. BP and pulse now under control with meds.

Doctor's Assistant: Is the headache episodic or daily? And what about nausea?

Headache continuous for 6 weeks, mostly low level but frequently rising to sever with activity and sometime without. Got to the point of nausea which trigger urgent care trip.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

No. 59 years, exceptionally healthy barring silly injuries.

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Answered in 8 minutes by:
2/16/2018
Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 12,600
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
Verified

Hello-

I assume you haven't had the results of your MRI at this point?

When you don't have the headaches -- is your blood pressure normal?

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Customer reply replied 4 months ago
I do have the MRI results/images but they have not been evaluated. I can send a partial zipped set with viewer or screenshots, whatever. Monitoring BP it is definitely linked to severity of headaches, near normal = minimal (but not entirely gone). The higher the more severe.
Customer reply replied 4 months ago
screenshot

OK.

Well, I would want to have your MRI images evaluated by a neurosurgeon.

The non-specific low attenuation area on the CT could mean any number of things. Could it be a cyst? A tumor? An infection/abscess? Area of old stroke -- it is unclear just from a CT.

The MRI with contrast will help to see this area better, and the report will list a few of the possibilities, depending on it's appearance on the MRI.

Based on that information, the neurosurgeon will determine if 1) waiting and watching this area with a repeat MRI in 3-6 months is better, or 2) a biopsy of that area, if it looks concerning to them.

It's hard to say whether or not a small 2.5 cm area is the cause of severe headaches (usually it would have to be much larger in size to cause headaches).

That first picture shows a low attenuation area, without much swelling around it, but not specific enough to narrow down the possibilities (except stroke -- it does not look like an area of an old stroke).

Dr. Mark
Dr. Mark, Neurologist (MD)
Category: Neurology
Satisfied Customers: 12,600
Experience: Neurosurgeon - Brain, spine, and peripheral nerve surgery
Verified
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I sincerely ***** ***** I have helped you, and that I have earned my 5 star rating today! Please remember to rate my service by selecting the 5 stars at the top of the screen ( rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you!

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Customer reply replied 4 months ago
Working from my PC browser it indicated that adding the rating would not end the session, but then it clearly did anyway. Someone should look into that.I’m not sure how the ratings should work really or what exactly rates 5 stars in a case like this. Obviously you can’t give a perfect and detailed response remotely and based on so little data, but at the same time what constitutes excellent? I guess the only thing i’ve heard that wasn’t evident is yhat you think the lesion doen not look like an old stroke. What are the top 3 candidates? I’ve go lots of images, some are like “negatives” of the others, but none seem to have more detail of the area in question. Pretty much just looks like a void.
Customer reply replied 4 months ago
Sorry for typos, small phone, big hands.

I would want to have the MRI images further evaluated to see if they believe this is a :

low grade tumor

cyst

abscess

Unfortunately, it is difficult to narrow down based on the single image that I can see. I would ask to get the report of the MRI today (it should be done within 24 hours of the scan), as they will be able to look through the series of images (the T2, the T1 with contrast, the GRE, the FLAIR, the DWI images) to narrow down the possibilities further.

You are free to rate however you feel - based on your satisfaction with the answer.

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Customer reply replied 4 months ago
It seems tgat I had the scan done at a place that doesn’t then offer an evaluation. So I dropped it at the office of the neurologist referred by my primary but referral in hand the receptionist would not even accept me as a new patient until my case is reviewed. That was about noon yesterday. No call yet so I doubt I’ll hear before EOD at best. Hence this inquiry. Ah well, I wait.

A neurologist is probably not the specialist that you will want to see.

You will want to see a neurosurgeon, as we typically will evaluate lesions within the brain.

The exception to this is if the MRI report says this lesion looks characteristic of an acute MS lesion (which it doesn't seem to be), but MS would be in the domain of the neurologist.

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Customer reply replied 4 months ago
Ah, that makes sense. Even based on the CT perhaps my primary should have skipped ahead to that. I just don’t know the protocol for getting up the chain so to speak. If the neurologist step is unnecessary then I need to seek out a surgeon now. Thanks.

Yes, you're welcome.

Best of luck to you.

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Customer reply replied 4 months ago
They don’t make it obvious, at least on the mobile browser version, how to adjust a rating.

I believe one has to "ACCEPT" the answer first, prior to rating the answer.

Of course, I'm on the other side here, so I can't see what you are seeing.

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Customer reply replied 4 months ago
Poor design (I speak as a person who has designed stuff like this for almost 30 years). It seemingly forced me to rate you after about 3 exchanges then did not return to the chat thread. Now working from my phone via links sent via text my options are extremely limited. Yet above this is a box stating that “when finished you must rate at the top to credit the expert.” I’ll figure it out.
Customer reply replied 4 months ago
Weak, weak, weak. See scteenshot. Nothing in the ratings is active to allow me to change.Sorry, the hole in my brain has me edgy and impatient. :-)

I agree, that is weird. The screen that I see shows that you have not rated the question, nor accepted the question.

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Customer reply replied 4 months ago
Really. Very odd. The menu doesn’t get me anyoeitger. I guess I’ll try the full site when I get back to my PC.

Well, that's not a big deal to worry about -- good luck to you.

I'm sure the computer issue will just work itself out.

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