Medical acronym bingo time ...
December 17, 2019 8:38 AM Subscribe
After almost exactly a year since his first bout of transient global amnesia, my husband finally saw a neurologist today. She is sending him for an MRI and an EEG on top of the two CTs he had previously. My question is - why?
As per two previous questions (linked here), Mr MMDP is once again waiting on the NHS to come up with some answers and in the meantime I thought I'd ask the MetaMind for its knowledge and experience.
So, he's had no discernible repeat of the two incidents in the previous questions. No other symptoms either mental or physical. No amnesia, unusual headaches, dizziness, weakness, collapses etc. The consultant examined him, asked about any symptoms and then said she was referring him for the two additional tests. If he's now essentially ok, with no obvious problems, why refer him?
Of course I'm freaking out, as I'd assumed not getting an appointment through ::For.A.Whole.Year:: meant that nothing urgent was going on. Now he's getting more tests within six weeks; Mr MMDP's view is that they're just doing the same follow-up as they would have done if the appointment had come through 12 months ago, but I don't see the NHS wasting money on unnecessary tests if it doesn't have to.
I know you are not a doctor / neurologist / medical professional (unless you are) but can anyone hazard a theory about why he would need these tests after all this time, and what is typically revealed by them? I really don't want to Google anything at the moment and Mr MMDP is not the sort to go back asking questions after the event.
As per two previous questions (linked here), Mr MMDP is once again waiting on the NHS to come up with some answers and in the meantime I thought I'd ask the MetaMind for its knowledge and experience.
So, he's had no discernible repeat of the two incidents in the previous questions. No other symptoms either mental or physical. No amnesia, unusual headaches, dizziness, weakness, collapses etc. The consultant examined him, asked about any symptoms and then said she was referring him for the two additional tests. If he's now essentially ok, with no obvious problems, why refer him?
Of course I'm freaking out, as I'd assumed not getting an appointment through ::For.A.Whole.Year:: meant that nothing urgent was going on. Now he's getting more tests within six weeks; Mr MMDP's view is that they're just doing the same follow-up as they would have done if the appointment had come through 12 months ago, but I don't see the NHS wasting money on unnecessary tests if it doesn't have to.
I know you are not a doctor / neurologist / medical professional (unless you are) but can anyone hazard a theory about why he would need these tests after all this time, and what is typically revealed by them? I really don't want to Google anything at the moment and Mr MMDP is not the sort to go back asking questions after the event.
(I am not a doctor and don’t play one on TV)
It seems possible that the new set of eyes arrived at one of two conclusions:
1) The original handlers of the case may have overlooked an important possibility that these tests would have revealed or
2) There is a possibility that the condition may repeat, and having a baseline to compare to would be valuable.
As for the seeming rush, I suspect that since the condition may repeat they would like to stay ahead of it. Neither of these possibilities imply that there is an immediate problem, just that a few steps now could make life much easier for everyone if it does.
These are of course Wild Ass Guesses. YMMV considerably.
posted by Tell Me No Lies at 9:09 AM on December 17, 2019
It seems possible that the new set of eyes arrived at one of two conclusions:
1) The original handlers of the case may have overlooked an important possibility that these tests would have revealed or
2) There is a possibility that the condition may repeat, and having a baseline to compare to would be valuable.
As for the seeming rush, I suspect that since the condition may repeat they would like to stay ahead of it. Neither of these possibilities imply that there is an immediate problem, just that a few steps now could make life much easier for everyone if it does.
These are of course Wild Ass Guesses. YMMV considerably.
posted by Tell Me No Lies at 9:09 AM on December 17, 2019
Best answer: Hi, I'm a neurologist! (Not your husband's neurologist, and I don't practice in the UK.)
Transient global amnesia is a weird, weird thing. We don't have a great handle on what causes it, 95% of the time. The other 5%, it can be an unusual manifestation of epilepsy. It's not clear to me from your prior questions whether what your husband had was truly TGA -- I'll leave that to the people who actually examined him -- but people who have recurrent episodes of TGA are more likely to be in the 5% maybe-epilepsy camp than people who have it as a one-off. Hence the EEG and MRI; standard procedure as part of a possible seizure workup. The CTs your husband got earlier are fine in the acute setting because they are fast, but CTs are not nearly detailed enough to get a good picture at actual brain tissue, particularly the hippocampus, the tiny part of the brain that (we think) is involved in TGA.
The other nice thing about an MRI is that it can show you areas of prior damage, which can be much harder to pick out on a CT. Think of it like a timelapse photo -- you can see what has happened over a lifetime but not necessarily when. The EEG, by contrast, tells you what is actively happening right at that moment; even if he doesn't have an event while hooked up (and he's unlikely to) it gives us a lot of information about whether particular brain regions are more "irritable" and thus more likely to seize when given the opportunity. They complement each other well.
I wouldn't put much stock in the fact that the neurologist wants to get an MRI/EEG now; they wouldn't be a good neurologist if they didn't use appropriately use the tools at their disposal. I know the NHS is a little more resource-aware than US-style defensive medicine, but I can't imagine anyone would look askance at getting those studies done within a few weeks after seeing a specialist.
posted by basalganglia at 9:19 AM on December 17, 2019 [22 favorites]
Transient global amnesia is a weird, weird thing. We don't have a great handle on what causes it, 95% of the time. The other 5%, it can be an unusual manifestation of epilepsy. It's not clear to me from your prior questions whether what your husband had was truly TGA -- I'll leave that to the people who actually examined him -- but people who have recurrent episodes of TGA are more likely to be in the 5% maybe-epilepsy camp than people who have it as a one-off. Hence the EEG and MRI; standard procedure as part of a possible seizure workup. The CTs your husband got earlier are fine in the acute setting because they are fast, but CTs are not nearly detailed enough to get a good picture at actual brain tissue, particularly the hippocampus, the tiny part of the brain that (we think) is involved in TGA.
The other nice thing about an MRI is that it can show you areas of prior damage, which can be much harder to pick out on a CT. Think of it like a timelapse photo -- you can see what has happened over a lifetime but not necessarily when. The EEG, by contrast, tells you what is actively happening right at that moment; even if he doesn't have an event while hooked up (and he's unlikely to) it gives us a lot of information about whether particular brain regions are more "irritable" and thus more likely to seize when given the opportunity. They complement each other well.
I wouldn't put much stock in the fact that the neurologist wants to get an MRI/EEG now; they wouldn't be a good neurologist if they didn't use appropriately use the tools at their disposal. I know the NHS is a little more resource-aware than US-style defensive medicine, but I can't imagine anyone would look askance at getting those studies done within a few weeks after seeing a specialist.
posted by basalganglia at 9:19 AM on December 17, 2019 [22 favorites]
This thread is closed to new comments.
posted by Jane the Brown at 8:56 AM on December 17, 2019 [3 favorites]