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MRI - Referral by GP?

Hi everyone

Can a GP send you for an MRI scan, or does it have to be a neurologist or consultant?

I am in limbo with a clinically isolated syndrome (optic neuritis), which I have had since March of this year. However, I have loads of MS symptoms, which seem to be getting worse, and for the past 4 weeks, I have been experiencing face pain, which is a new symptom, which I understood to be a relapse. However, when I saw the MS nurse last week, she said that she wasn’t sure whether it was a relapse and she would ask my neurologist at a meeting yesterday. All I have had back from the MS Nurse is an email saying the neuro is checking my blood tests, as I had asked whether I had been checked for Hughes Syndrome (my brother got Deep Vein Thrombosis a couple of years ago). My blood tests were done on 30th June and the neuro had written to my old GP back in July saying they were all clear. I only asked this as a “by the way”, as I have no idea what I have been tested for! :evil:

I am so frustrated (as I know many of you are), as my MRI showed “several focal areas of abnormal signal within subcortical white matter of the frontal and parietal lobes” and “Two white matter lesions within periventricular white matter adjacent to trigone and occipital horns with volume loss within the right parietal lesion”, there is also “a cystic area adjacent to the fourth ventricle within the left cerebellar hemisphere”, which they say has no significance. Anyone know what significance a cyst might have in this area of the brain?

There is obviously something going on and I asked whether I could have another MRI scan with contrast to see whether there is further inflammation, and to have a comparison. I have been told by the neuro that she doesn’t do MRI scans as a matter of course, but surely I would have thought if the face pain is a new symptom it would be beneficial to have another one done – what do you think? Am I just being unreasonable and being difficult? :mrgreen:

I have just registered with a new GP, who I am yet to see, and wondered whether it was something he could send me for. I also want a second opinion – can he refer me to an MS specialist too? My current Neuro is not an MS specialist.

Sorry - I have gone on a bit ! :shock:

Ness

Hi Ness.

Have I done an MRI interpretation for you before? It’s time consuming so I don’t want to repeat myself if I don’t have to!!! If I haven’t, please let me know and I’ll explain it.

In my unqualified opinion, I think you might benefit from a second opinion, ideally from an MS specialist (use the “Near me” function on this website to find a name in your area).

The reason I say this is that your “volume loss” in the parietal lobe suggests it’s an old area of demyelination - which means that there was stuff going on before you saw the neuro in March. Also, you have quite a lot of lesions for a CIS, which again suggests that there has been stuff going on for a while. It also suggests that you might already have met the dissemination in space criteria for a “probable/possible MS” diagnosis in March, in which case a new relapse would confirm MS. A completely new bout of trigeminal neuralgia is definitely a relapse. It is caused by a lesion on the trigeminal nerve. HOWEVER, whether or not a new lesion would be visible on MRI is a completely different thing - lesions on the trigeminal nerve are not normally terribly big, which means that it is unlikely to show on an NHS MRI scan :frowning:

I don’t think a GP can send you for brain MRI, however there is no reason why he/she couldn’t send you for a second opinion. You may have to argue your case though - you are legally entitled to ask for a second opinion, but a doctor does not have to agree to it unless he/she believes there are grounds.

Good luck!

Karen x

Thanks Karen. You are right, as you have done an MRI explanation for me previously. I guess I am just trying to confirm with all you lovely people that I’m not going completely bonkers, as I really do think the MRI suggests previous activity and all the symptoms I am experiencing and have experienced before ON are consistent with MS (I have been tested for everything else I believe).

Things have moved on slightly. My MS nurse rang to say she had sent me an incorrect email re the blood test results and that the Neuro was looking into giving me steroids, but she would ring her back to confirm. I thought this was a bit strange, as I have now had the facial pains for about 5 weeks now, and I thought you only had steroids at the very beginning of the relapse if it was going to do any good - but I thought I would go with the flow!!. Anyway, I got a call from the Nurse later that day saying that my neuro had reconsidered and wants to put me on pregabalin (SP?). I have now made an appointment with my new GP for Monday and will ask him to prescribe this for me. I had also sent an email to the MS nurse asking whether she could recommend an MS Specalist as I was thinking of getting a second opinion. Whether this had an impact in them trying to do something for me, I don’t know, but I am just glad that I am starting to get some help with the pain. When I see my GP, I will mention to him that I am not entirely happy with the Neuro’s interpretation of my MRI and see what he says. What dosage of Pregabalin will they put me on, do you think? The MS nurse didn’t say a dosage and I know very little about the drug, other than its for nerve pain and can cause some unpleasant side effects.

Thanks for your reply Karen.
Ness :smiley:

Hi,
My GP referred me for my brain scan and then for a full spine scan - this didn’t seem as if it was unusual. I wonder if it depends on where you live?
S x

@ Ness: Pregabalin dosage is usually quite low to begin with (e.g. 50mg), and then built up slowly to whatever the patient needs. The max dose is 600mg I think. We all react differently - some need more than others, even if their pain levels are similar - so it’s impossible to say what you might ultimately need. A lot of people get side effects in the beginning. Dizziness is really common. I felt pretty terrible on pregabalin for the first 3-4 weeks even though I increased it very slowly. My MS nurse persuaded me to continue with it when I nearly quit after 2 weeks, and I’m really glad I listened to her - it’s done wonders for my pain.

It’s entirely your decision about the steroids. Personally, I would give them a miss if I were you, if the pregabalin does the trick. Steroids are very strong drugs. Mind you, I’m completely biased - I hate them!

@Dogtanion - that’s really interesting. As you say, I bet it’s a postcode thing. Some PCTs probably allow it and some don’t. Thanks for letting us know.

Karen x