Forum

private neutologist , not sure of the outcome?

Hello everyone

Iv been having problems for a few months nowwhile? balance, constipation , neuralgia, pins and needles, twitching, lazy eye, andmany more symptoms, i had a day where i couldnt walk as legs were to heavy and painfull, my doctor put a referal to neurologist which is in february, she also requested a mri but it isnt With contrast, so i decided to pay to see a privatr neurologist through bupa, where i went today, he basically told me thaT normAilly when there are loads of symptoms it turns out to be nothing, he did a neuro examination, after he completed he said everything was Fine other than thr fact when he did flash test my eyes paused or was sensitive to light, something to do with pupils, canT quite remember, hetold me it may be nothing but has said i need a mri with contrast on spine head and kneck, manf didnt say much more, my specsavers appointment a monTh ago was fine, light test was fine, is this a sign or common, optic neurtis? or a normal change? Iv had pain behind the right eye for a while? Im rather concerned hes not taking it seriously

Hi,

It sounds fine to me, if he says you need an MRI. They can’t establish much just by examination and discussion alone.

MS is a comparatively rare disease, and there are at least 100 lookalikes, so he’s right when he says that most times, it doesn’t turn out to be anything sinister.

Contrast is only useful for showing whether the disease is active at the moment. If you have an MRI without contrast, it will still show MS lesions - if there are any. It just won’t show whether they are recent or historic. Although it is useful for deciding treatment to know how active the disease is, it is not that useful for diagnosis only - as the key finding is having lesions at all, whether new or old.

I think perhaps you were just expecting too many answers on a first appointment. Nobody gets answers on a first visit - the best that can be hoped for is a referral for further investigation, so I don’t think you should read into it that he is not taking you seriously. He seems to be trying to reassure you (“It’s normally nothing.”), whilst at the same time, not ruling out that it could be something - otherwise he wouldn’t have said you need an MRI. That seems a fair and reasonable path to me.

So what now? Are you going to pay for a private MRI (several hundred pounds), or is he referring you back to the NHS? You are allowed to mix and match like this. Tests and investigations are often prohibitively expensive for patients who don’t have private health insurance, so it’s not unusual for a private consultation to result in a referral back to the NHS for the tests themselves.

Is he going to do this, or are you sticking with the original scan your doctor called for? I’m not clear whether you’ve already had that, but I’m assuming not, or there would have been some discussion of findings.

Tina

Hi, Thankyou for your reply , I have a scan booked on the 9th a MRI without contrast but he recommends I have a MRI on head kneck and spine and had told me he would support me with nhs and he would try rush the referral , I just feel mixed emotions as he said its prob nothing but then he didn’t explain why my flash light test showed problems with light and said I was prob fine but yet wanted further tests, I was hoping it was just freak head aches , but feel completely clueless, I had it in my head that paying private would give me instant re assurance but it’s not is it in reality , I just wish I knew what was causing this. Are there other things that can cause abnormal reasons for failing a flash light test?

Unfortunately, I’m just a patient, not a neuro.

​As I’ve said, there are at least 100 conditions that can mimic MS, so my “commonsense” reaction is that yes, there could be many reasons for an abnormal flash test response, although I’m not knowledgeable enough to name any of them. If it was proof positive of MS (or of anything), he could have diagnosed you on the spot, and not bothered with MRIs etc, so that means it’s definitely not an open-and-shut case of anything.

Abnormal flash test response isn’t in the MS diagnostic criteria, so it’s definitely not something that points to MS, and only MS.

Sorry I can’t be more help, but this level of uncertainty is normal at this stage in the investigations, and indeed can go on for some time, as MS is one of the most difficult clinical diagnoses to make, there being no conclusive test, AND you have to rule out all alternatives first. Only a small number of people go all the way to an MS diagnosis, without some other explanation being found first. Of course, for some, it does turn out to be MS, and there’s no getting away from that, but it’s last conclusion, not first conclusion.

Tina