When knowledge, experience and technology
fall into place concurrently amazing things happen.
Sometimes this takes time.
The latest and greatest in new technology provides contemporary
ample fodder for advertisements and bragging rights. Lack of experience and knowledge with technological capabilities can produce some unforeseen problems; antibiotics cure infections, but microorganisms fight back, X-ray treatments of enlarged thymus glands in children gave rise to cancer later in life, and bone marrow transplants for metastatic breast cancer were a big disappointment.
This is my personal tale of an encounter with a brain MRI done back in the good old days of the 1980's when these gigantic imaging machines were called NMRI-the "N" was short for nuclear. The neuro radiologists of today were likely in Kindergarten and ordinary run-of-the-mill radiologists interpreted these vintage scans.
After a fusillade of neuro problems including confusion, right upper extremity weakness, and visual field distortions I had one of those new fangled NMRI imaging studies performed. While I was reclined in the tight confines of that sewer pipe of a machine, I was aware of a commotion commencing in the procedure room. Turns out mine was one of the very first NMRIs that showed significant pathology at this facility and an audience had gathered to witness the premier event. I walked into the NMRI room and left on a Gurney for an acute neuro ward-not a good sign. Here is the radiologist's interpretation.
The striking finding is an increase in T2 signal intensity in the right occipital area and to a somewhat lesser extent in the right frontal area. Differential might include CNS lymphoma, primary demyelinating process, encephlopathic or infectious etiology less likely. Correlation with clinical findings is suggested.
Now the real fun began. Neurosurgery was consulted and felt the scan was consistent with a glioma and a stereotactic biopsy would be necessary to determine the type. Alas, this was impossible because of the unavailability of a non-ferrous stereotactic head frame. Using the standard head frame would wind up with my head plastered to the magnet like a bug on a windshield. I remember thinking about calling Jack Kevorkian to see if he could squeeze me in as the prognosis seemed more grim as time passed, but there were many more consultants waiting in the wings so let's wait and see.
Next on the parade of consultants was a neurologist whose primary area of expertise was MS, of course he concluded that MS was the diagnosis and a spinal fluid study for monoclonal antibodies would be the confirmation. The studies later proved negative for monoclonal antibodies so the diagnosis was changed from MS to "demyelination syndrome," whatever that means.
Let's consult a clinical pharmacologist to get his opinion. I was taking Azulfidine for Crohns Disease and a review of the literature suggested an encephlopathic process could be a result of taking this drug. The final diagnosis: Azulfidine induced encephalopathy. Stopping the Azulfidine made no difference in my neuro status, but jump started the Crohns, not a pleasant situation.
I slowly recovered and started backing away from follow-up appointments, figuring that whatever it was would take its course. My neurosurgeon died about 5 years ago and I started to marvel at my survival skills having outlived him. He had given me a prognosis of 5-7 years.
So 28 years after the original excitement a
A genuine neuro radiologist interpreted this MRI and there was none of that old school beating around the bush. This lady knew what she was looking at, no bones about it. I certainly could have benefited from her expertise 28 years ago. Here is her impression.
abnormal foci of T2 hyperintensity within the subcortical and periventricular white matter are much greater in size and number in the right cerebral hemisphere compared to the left. There is a more confluent area of abnormal T2 hyperintensity posterior to the right lateral ventricle. The asymmetrical appearance of these lesions effectively rules out classic multiple sclerosis. This MRI is indicative of an acute disseminated encephalomyelitis.
It's nice to have a definitive diagnosis even though it required a 28 year wait. Some problems cure themselves if you can wait them out. Time is the most valuable commodity and the neuro Gods have cut me a break. I'm still vertical and my foolishness remains intact but sometimes I wonder about my cognitive abilities.