Are there gremlins in there?

February 4, 2009 12:06 PM

I want to get pictures of my brain. What kind of pictures and how? Or is this ridiculous?

My left side is kinda messed up. Eye doesn't work so great and I don't actually use it with any frequency. Much worse dexterity (beyond normal side-dominance). Apparently when I was a kid, they wanted to take a look, but insurance didn't cover it. Now I have insurance with a $50 specialist co-pay and no referral needed. I am both curious what's going on and wonder if maybe there isn't something to be found.

What kind of pics do I need? What kind of doctor would do them? A neurologist? Any neurologist? Is this a bad plan?

posted by dame to health & fitness (20 comments total)

If you have a GP, that's where I'd start. He/she could probably direct you to the kind of specialist who could take the most relevant pictures.
posted by restless_nomad at 12:09 PM on February 4

Go to a neurologist and explain the problems you've been having. You can say you'd like to get an MRI all you want, but unless they think you should have one, they're not going to give you one. If that's the case, find another neurologist in your network and try again. (For whatever reason, some doctors are really averse to scanning you. Others are happy to investigate as long as you're insured.)
posted by phunniemee at 12:21 PM on February 4

Yeah, start with a normal family doctor. They'll probably escalate you to a specialist pretty quickly, but you probably don't want to just walk into a specialist's office without a proper referral. Even if your insurance doesn't require it, you won't actually know who to talk to until someone has properly worked you up diagnostically.

Unfortunately, modern medicine still isn't all that good at treating serious neurological problems. So even if you can get a clear idea about what's wrong, you may or may not be able to do anything about it. Just sayin'.
posted by valkyryn at 12:28 PM on February 4

Nthing the a primary care physician - family medicine or general internal medicine. Some insurance companies won't cover a specialist visit without a generalist referral.

IANAD(yet)... A full neurological workup can take some time and in the end, the results may not end up being all that satisfying. A lot of neurological examination occurs without imaging. Often, the imaging will just confirm the diagnosis. But, if the neurologist requests pictures, they'll probably be either MRI (which is better at finding pathologic tissue), or CT. Even then, there may not be a whole lot to be done medically. Nonetheless, I wish you luck and hope for the best.
posted by honeybee413 at 12:49 PM on February 4

Thanks so far, all. Just to be clear, I am probably fine and the end result would be merely satisfaction of my curiosity. Or a discovery that miniature pirates can live inside someone's head. Whichever.
posted by dame at 12:53 PM on February 4

I can't quite tell from your question if this is "I have some weird medical problems and I think brain pictures would help me solve them" or "I just want a picture of my brain."

If it is the former, I agree with other posters: go to your GP and explain what is going on. S/he can get you in to see the right kind of specialist, or give you the *right* kinds of tests, which may be an MRI or another type of imaging test (or maybe no imaging at all).

If it is the latter, I hate to disappoint, but: a few years back I had an MRI for a suspected brain tumor (luckily, it wasn't). Insurance paid for a copy for my file, but I asked for a second copy and they cost about $500 per print. Before paying, I looked at the prints, and they were not really useful from an aesthetic standpoint: sure, you can tell it's a brain, but it's kind of all washed-out grays, and there's nothing to mark it as my brain.
posted by holyrood at 12:54 PM on February 4

I can't quite tell from your question if this is "I have some weird medical problems and I think brain pictures would help me solve them" or "I just want a picture of my brain."

More like: I have some weird quirks that don't adversely affect my life, but make me curious. And hey, maybe there *is* something there that could matter.
posted by dame at 12:58 PM on February 4

If you can't get a medical referral, maybe try participating in a brain research project? Several years ago I was a test subject for a friend's research (he is a neuroscientist) and he was happy to show me the various brain wave scans after they were done. It was pretty interesting.
posted by min at 1:32 PM on February 4

Just a cautionary note: The worst outcome is for them to conduct a brain scan and report back to you that they found nothing.
posted by found missing at 1:33 PM on February 4

This probably won't help in terms of diagnosis, but if you're just interested in pictures and your medical leads don't work out, your best bet is participating in imaging studies at a research university. They'll only be able to tell you if something is grossly off, or if your gremlins reside in the particular area/receptor population that they're looking at.

Here's a link to Columbia University's fMRI center - the page is set up for researchers, not subjects, but there's contact info there that you could follow up on and ask about becoming a subject.
posted by twoporedomain at 1:35 PM on February 4

(sorry about lack-of-preview)
posted by twoporedomain at 1:36 PM on February 4

If it is the latter, I hate to disappoint, but: a few years back I had an MRI for a suspected brain tumor (luckily, it wasn't). Insurance paid for a copy for my file, but I asked for a second copy and they cost about $500 per print. Before paying, I looked at the prints, and they were not really useful from an aesthetic standpoint: sure, you can tell it's a brain, but it's kind of all washed-out grays, and there's nothing to mark it as my brain.

In contrast, I had an MRI last summer and I got two free CDs of the images, which were super-clear and zoomable. However, I don't know how you're going to tell the difference between your brain and someone else's, unless there's something stunningly obvious or you've had medical training. The only way I knew it was me on that CD was that my neck vertebrae are fused. Otherwise it looks like every other brain picture I've ever seen (nothing was wrong with it btw). Medically speaking, anyway.
posted by desjardins at 1:43 PM on February 4

This guy does brain scans like it's his JOB. Wait, it is his job. He's a physician/psychiatrist/professor but apparently also one of the top guys in SPECT scanning (or claims to be). He wrote a book and talks about the kind of stuff he finds - links between physical brain issues and emotional stuff. But he also finds physical stuff. For example he might find aneurysms or masses or areas of especially high or deficient activity and then make connections between that and issues people are having and possibly prescribe some kind of treatment or procedure.
posted by Askr at 2:16 PM on February 4

You pointed out that the issues/quirks that you have aren't bothering you that much. If you do get a brain scan, the WORST thing that can happen is they actually find something that needs to be worked up and dealt with appropriately. Finding nothing on an MRI/CT is not the worst thing that can happen, contrary to found nothing's assertion. (ha!)

This workup can range from the trivial to more invasive tests. You should talk to your internist/family doc before you proceed and discuss the risk/benefit to what you're planning to do.
posted by scalespace at 5:43 PM on February 4

By the way, MRIs are not any fun at all, even if you're not claustrophobic. From my previous AskMe:

The MRIs were very difficult for me as well. I'm not claustrophobic but I do have panic disorder and they had to stop one test when I started aspirating on my own vomit. The next day they wanted to run the whole test straight through and it took three hours. I was nearly catatonic afterwards. I still have tinnitus from the noise of the machine and I wake up fearing I'm still inside it. I'm also afraid to go to sleep for fear I'll wake up paralyzed.

They're also hot as hell if you're in there more than an hour. You can't move, you're dripping with sweat, and there are constant machine-gun noises. Really not worth it just to sate your curiosity.
posted by desjardins at 6:48 PM on February 4

What you probably want is a PET scan, not an MRI.

Before you go there, I'd advise picking up a copy of Mind Hacks. It's basically a "reverse engineer your brain" in the privacy of your own home lab manual for an entry level psychology course. It's got to be cheaper than your co-pay, doesn't involve producing anti-matter inside your skull and may give you some insight, or at least clue you in to what your doctor is talking about.
posted by Kid Charlemagne at 7:31 PM on February 4

If you can't get a medical referral, maybe try participating in a brain research project? Several years ago I was a test subject for a friend's research (he is a neuroscientist) and he was happy to show me the various brain wave scans after they were done. It was pretty interesting.

These days, it's unlikely that researchers would share MRI or other imaging results with a subject. I ran an fMRI study at a major research university and was specifically instructed not to give subjects copies of their MRI scans; there are liability issues, so this is likely to be the policy at any university. Imaging for research studies is not diagnostic medical imaging, and in general the people conducting the imaging aren't neurologists or radiologists and aren't qualified to make medical judgments.

The story is probably different with clinical research projects associated with medical schools, but I imagine they have fairly stringent selection criteria.

If you want a medical diagnosis (even if just to satisfy your curiosity), ask your doctor.
posted by L0 at 7:33 PM on February 4

Yes, definitely coerce the system into paying $3500 so you can see what your brain looks like. But remember as well, that modern scanners will pick up incredibly minute details of the [normally aging] brain, and the radiologist that subsequently reads it will comment on said changes as "white matter changes" amongst which the differential is old strokes and multiple sclerosis. Mind you, we see this all the time, and it's not nearly as though these things actually happened, but they do go a long way toward scaring the crap out of the patient. So in general, getting an MRI (PET scan? good luck) without a clear neurologic rationale is asking for trouble.

I've had 2. They're loud as shit, but unless you're claustrophobic, they're hardly anything but tedious.
posted by docpops at 8:56 PM on February 4

Thanks again everyone. I think in this case the claustrophobia wins.

Except no thanks to the actual doctor who seems to be a pompous douchebag. I don't know what sort of weird brain problem impairs your reading comprehension, but you might want to get it checked. My brain is somewhat fucked, seeing as it seems to not do everything it ought to. I would be going to ask a neurologist, not holding them up at gunpoint. And I pay way more in premiums than I get in care, so why don't you go bitch at the pregnant ladies for all the money they are "coercing" out of the system.
posted by dame at 5:16 AM on February 5

Thanks so far, all. Just to be clear, I am probably fine and the end result would be merely satisfaction of my curiosity. Or a discovery that miniature pirates can live inside someone's head. Whichever.
posted by dame at 12:53 PM on February 4 [+] [!]


Sorry for the very obnoxious answer - some of it was directed at the replies. MRI's are really loaded tools. They are just so misleading so often as far as clarifiying diagnoses, and the amount of time we spend trying to counsel people on this is unreal. Not so much that they're expensive, and that people often find out that their copay for an MRI is more on the order of 20%, but that forever after they become convinced that they have dementia, or MS, or old strokes.

Look, if you think you have a neurologic issue, or just some congenital thing that has led to some odd symptoms or behavior with your body, get started by talking with a primary doc (FP or internist) and then if you or they aren't able to make peace with it then see a neurologist.

Good luck.
posted by docpops at 8:14 AM on February 5