« Good news, bad news, and no news | Main | Feb 14 Email: First Visit with my Neurosurgeon »
June 9, 2013
The possible diagnoses
My neurologist and I discussed the results of all my tests, including the clinical, imaging, sanguineous, and CSF examinations, on January 30, 2013. She endorsed but could not confirm two possible theories. It could be a lesion caused by localized acute inflammation, or it could be a neoplasm (tumor). She suggested I make an appointment with a spinal neurosurgeon to review the tests and try to come to a diagnosis.
I saw my first expert spinal neurosurgeon on February 5, 2013. He was most interested in viewing the original cervical spine MRI imagery from January 4. He looked through the sequence of images and within about 60 seconds proclaimed that the enhancement was a neoplasm. He thought that it explained my symptoms fairly cleanly. Further, the edema (swelling) that would follow from a neoplasm would explain the signs of stenosis and appearance of bulging discs that were identified in the original MRI as well. He then explained that he had not treated this specific sort of condition in years and referred me to another expert spinal neurosurgeon. His staff coordinated a clinical appointment for me with the new doctor for February 13, 2013.
This was to be my fourth physician's opinion on the subject. We had been through 2 rounds of bloodwork, 3 MRIs, the lumbar puncture, and multiple clinical examinations. Despite all this, we still didn't have much of a diagnosis. We knew a few things that it was unlikely to be, but to actually treat the issue, we needed to know what it actually was.
The new expert spinal neurosurgeon did not immediately agree with the previous one's interpretation. His opinion was that it was spinal stenosis (narrowing), which causes pressure on the spinal cord. He did not think the enhancement necessarily represented a neoplasm or inflammation. After learning of my tendency to throw my body around recklessly, he was more convinced that it was stenosis caused by some sort of traumatic or gradual injury. He recommended that we wait until early March and take a follow-up MRI of the cervical spine, at which point we could compare results with the original MRI of January 4. The 2 months between imaging should be informative, he said, and would help us come to a better conclusion. As my symptoms had not changed dramatically over the last few months, it wouldn't be that risky to wait a few more weeks before making any decisions or formal diagnoses.
Amongst all the doctors, we had 3 reasonable possibilities. It could be inflammation, neoplasm, or stenosis. Only time, more tests, and more procedures could tel.
This brings us to the point in the narrative where I began to inform select close friends and relatives of my condition and attempts to diagnose and treat it. I sent detailed status emails on a semi-regular basis, which I will now repost with minimal editing. The prior blog entries were written with the events further in the past, but I did try to ensure accuracy by referring to all my test reports and notes for dates, terminology, and opinions, and analyses.
Posted by jon at June 9, 2013 11:08 PM