Any neuro radiologists in the house?

Any neuro radiologists in the house?

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jontysafe

Original Poster:

2,361 posts

185 months

Sunday 12th June 2022
quotequote all
Hi, currently living in Dubai and my wife has been suffering from debilitating headaches which was initially diagnosed as migraines. The last one has been 14 days now. She’s had an MRI and the doctor has seen an enlarged pituitary gland but no tumour.

It’s now affecting her vision and she’s in agony. Getting any decent pain management as an outpatient here is very difficult and she feels her head would get worse if in patient.

Is there any advice of what she can do? We have the mri images without contrast and with contrast if someone with the right credentials could have a look?

Dealing with the health insurance company has been a nightmare.

redhotsheep

19 posts

34 months

Sunday 12th June 2022
quotequote all
Not a neuro-radiologist I'm afraid but I am a neuro-ophthalmology registrar.

How long has she been having headaches? How is it affecting her vision? Who has reported her scan? What kind of doctor has seen her? Has she seen an endocrinologist or had any pituitary related blood tests? Has she had a formal visual assessment including acuity, colour vision testing and visual fields? If being an inpatient would mean these things would happen quicker I'd suggest that.

If there is chiasmal compression you don't want to hang about. This can affect the outer (temporal) visual fields of both eyes. You'd hope that if a radiologist had reported her scan they would make sure to assess the chiasm for compression but there is always room for error and in the NHS, neuro-radiologists are far more au fait with neuro-imaging than non neuro radiologists. Rarely they (pituitary growths not radiologists) can raise the intracranial pressure which could give headaches more associated with nausea, coughing, change of position and intermittent visual loss.

jontysafe

Original Poster:

2,361 posts

185 months

Sunday 12th June 2022
quotequote all
redhotsheep said:
Not a neuro-radiologist I'm afraid but I am a neuro-ophthalmology registrar.

How long has she been having headaches? How is it affecting her vision? Who has reported her scan? What kind of doctor has seen her? Has she seen an endocrinologist or had any pituitary related blood tests? Has she had a formal visual assessment including acuity, colour vision testing and visual fields? If being an inpatient would mean these things would happen quicker I'd suggest that.

If there is chiasmal compression you don't want to hang about. This can affect the outer (temporal) visual fields of both eyes. You'd hope that if a radiologist had reported her scan they would make sure to assess the chiasm for compression but there is always room for error and in the NHS, neuro-radiologists are far more au fait with neuro-imaging than non neuro radiologists. Rarely they (pituitary growths not radiologists) can raise the intracranial pressure which could give headaches more associated with nausea, coughing, change of position and intermittent visual loss.
On and off for 6 months. It's affecting her margins. It's like she's seeing movement that isn't there and fogging. She's seen an endocrinologist and is borderline hyper thyroid, has pcos that she's never suffered from, her periods have changed and sexual desire has diminished. She also seems to be getting very fine hairs on her face.

She had an appointment with neurologist after scan who confirms the pituitary is "considerably" enlarged. Like nearly twice the size.

She hasn't had the visual tests you mention.
She's currently alone in Dubai with kids and I'm back on 18th so if she needs to go in then we can arrange then.

Her neurologist doesn't fill me with confidence. He's prescribed codeine and another mri in 2 months. In the meantime she's in agony and she has a very high pain threshold. Like no meds silent birthing hard.

Pain is worse when laying down.

She has asked for a better treatment plan but he hasn't been forthcoming.

K50 DEL

9,355 posts

235 months

Monday 13th June 2022
quotequote all
Which insurer and which hospital has she been using so far?
In Dubai all are very definitely not created equal and you should not be afraid of moving hospitals (as long as your insurer will cover the new one you're moving to)
I went through similar with a friend and moving from one hospital group to another made all the difference to the care and treatment received.

redhotsheep

19 posts

34 months

Tuesday 14th June 2022
quotequote all
jontysafe said:
On and off for 6 months. It's affecting her margins. It's like she's seeing movement that isn't there and fogging. She's seen an endocrinologist and is borderline hyper thyroid, has pcos that she's never suffered from, her periods have changed and sexual desire has diminished. She also seems to be getting very fine hairs on her face.

She had an appointment with neurologist after scan who confirms the pituitary is "considerably" enlarged. Like nearly twice the size.

She hasn't had the visual tests you mention.
She's currently alone in Dubai with kids and I'm back on 18th so if she needs to go in then we can arrange then.

Her neurologist doesn't fill me with confidence. He's prescribed codeine and another mri in 2 months. In the meantime she's in agony and she has a very high pain threshold. Like no meds silent birthing hard.

Pain is worse when laying down.

She has asked for a better treatment plan but he hasn't been forthcoming.
Ok - personally I'd be keen to try and get her eyes looked at. Here opticians can assess the optic nerve and do visual field tests. If that is possible there I'd do that as soon as possible. Awful headaches with visual changes and pain worse lying means high intracranial pressure needs considering and a quick visit to an optician should allow the nerves to be checked.

jontysafe

Original Poster:

2,361 posts

185 months

Tuesday 14th June 2022
quotequote all
redhotsheep said:
jontysafe said:
On and off for 6 months. It's affecting her margins. It's like she's seeing movement that isn't there and fogging. She's seen an endocrinologist and is borderline hyper thyroid, has pcos that she's never suffered from, her periods have changed and sexual desire has diminished. She also seems to be getting very fine hairs on her face.

She had an appointment with neurologist after scan who confirms the pituitary is "considerably" enlarged. Like nearly twice the size.

She hasn't had the visual tests you mention.
She's currently alone in Dubai with kids and I'm back on 18th so if she needs to go in then we can arrange then.

Her neurologist doesn't fill me with confidence. He's prescribed codeine and another mri in 2 months. In the meantime she's in agony and she has a very high pain threshold. Like no meds silent birthing hard.

Pain is worse when laying down.

She has asked for a better treatment plan but he hasn't been forthcoming.
Ok - personally I'd be keen to try and get her eyes looked at. Here opticians can assess the optic nerve and do visual field tests. If that is possible there I'd do that as soon as possible. Awful headaches with visual changes and pain worse lying means high intracranial pressure needs considering and a quick visit to an optician should allow the nerves to be checked.
She’s made the appointment and is going tomorrow. Thankyou for your very much appreciated help.

jontysafe

Original Poster:

2,361 posts

185 months

Tuesday 14th June 2022
quotequote all
K50 DEL said:
Which insurer and which hospital has she been using so far?
In Dubai all are very definitely not created equal and you should not be afraid of moving hospitals (as long as your insurer will cover the new one you're moving to)
I went through similar with a friend and moving from one hospital group to another made all the difference to the care and treatment received.
Takaful Emarat Nextcare RN.

It seems the direct billing options aren’t the best so have switched now to pay and claim and very much better.
They have agreed to cover MRI.

K50 DEL

9,355 posts

235 months

Wednesday 15th June 2022
quotequote all
jontysafe said:
K50 DEL said:
Which insurer and which hospital has she been using so far?
In Dubai all are very definitely not created equal and you should not be afraid of moving hospitals (as long as your insurer will cover the new one you're moving to)
I went through similar with a friend and moving from one hospital group to another made all the difference to the care and treatment received.
Takaful Emarat Nextcare RN.

It seems the direct billing options aren’t the best so have switched now to pay and claim and very much better.
They have agreed to cover MRI.
Looks like that insurance company will let you use the Iranian Hospital on Al Wasl
For various reasons I've experience of a fair number of hospitals in DXB and both I and the patient would put the Iranian at the top of all our lists, it might not look glitzy and glamorous from the outside, but the quality of the medical staff and treatment there was light years ahead of some of the ultra-posh Medcare etc places.

jontysafe

Original Poster:

2,361 posts

185 months

Wednesday 15th June 2022
quotequote all
K50 DEL said:
jontysafe said:
K50 DEL said:
Which insurer and which hospital has she been using so far?
In Dubai all are very definitely not created equal and you should not be afraid of moving hospitals (as long as your insurer will cover the new one you're moving to)
I went through similar with a friend and moving from one hospital group to another made all the difference to the care and treatment received.
Takaful Emarat Nextcare RN.

It seems the direct billing options aren’t the best so have switched now to pay and claim and very much better.
They have agreed to cover MRI.
Looks like that insurance company will let you use the Iranian Hospital on Al Wasl
For various reasons I've experience of a fair number of hospitals in DXB and both I and the patient would put the Iranian at the top of all our lists, it might not look glitzy and glamorous from the outside, but the quality of the medical staff and treatment there was light years ahead of some of the ultra-posh Medcare etc places.
Thank you for the advice.