Medical Records???

[curranmom]

I went out and got copies of most of my medical records yesterday and I am about halfway through and I came across this anyone have a clue what this means? I have read it over 100 time and have no clue :confused:

On FLAIR sequence, there is suboptimal nulling of cerebrospinal fluid in convexity cortical sulci.

Thanks as always! Kim

[Baffled]

Hi Kim,

This is what I was able to find for you. (Please understand, I am only a fellow leaker, not a medical person.) I dissected the phrase you were trying to understand in hopes that by understanding the sum of the parts, we would begin to understand the whole sentence.

First, to understand “On FLAIR sequence,” my understanding (which is probably an over simplification) is that it is a type of MRI of the brain. The focus in your case seems to be on the csf fluid in your brain. It stands for “Fast fluid-attenuated inversion recovery” (FLAIR). It seems safe to say that “sequence” means over time.

(Suboptimal to me means below a desired level, but I do not know if that holds true in the medical context of things.)

I looked into the “nulling of cerebrospinal fluid.” The best I could identify is that it is a reduced csf production and/or csf pressure.

To determine ”convexity cortical sulci” meaning:

"Convexity" means- A measure of the rate of change in duration; measured in time. The greater the rate of change, the more the duration changes as yield changes.

“Cortical Sulci” lie on the valleys of cortical folds. If you visualize a brain, it is lumpy, bumpy in appearance. I believe this means the crevaces or valleys of the brain are the parts that they are looking at specifically,…if that makes any sense.

I found an abstract that may be of interest to you. “Automatic recognition of cortical sulci of the human brain using a congregation of neural networks”

The address/link is below:
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W6Y-45FYX2J-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=aa81fb606032bdf07968fe52ae435d44

The information above is merely my best guess at this moment, for you.

Best Wishes!

Baffled

[curranmom]

Hi Baffled - I really appreciate you taking the time to dig through that, it was very nice of yo honestly!

So I would think that sounds bad and gives me a little ammunition to prove something maybe?!?!?

Thank again I really appreciated your help - Kim

[suebear6]

Dear Kim:

I have no help or knowledge to offer (my brain is shot after fighting this for 15 months), but just wanted to let you know I'm hoping and praying for you. You're situation hits home. At least youR docs have tried to aggressively treat this. I hate to think that another Mom with a beautiful new baby is going to suffer and miss out on a large period of time in their kids lives. I think Laura is right--get all your records and send them to Schievink--ASAP. This is a rare condition. Get to THE MAN. I am 15 months into this. I was sent to a neurosurgeon at the hospital where this all started on Friday. He got pissed and said where is your recent Lumbar MRI? You brought me a brain MRI. If your symptoms started with a lumbar puncture you need to bring me a lumbar MRI. Who is the neurologist who sent you? He has wasted my time and yours. I said they have done brain MRI, MRV, MRA and just repeated the MRI again this past week. So this is the wrong test? Yes. At least he gave me back my copay. I am so frustrated. Keep fighting it's all you can do, and get your records to Schievink as fast as you can. I was so excited when she posted that DH was seeping (and would never have shown on imaging). She's wonderful. Good luck Kim!!!!!!!
Sue

[sadlisa]

Yes, we must all keep fighting. I am to see someone else in my HMO for this tomorrow. I have asked to see an outside opinion. Last Nov. I asked to see outside help or someone in the system who knew more about this. They sent me to neurology. Now they say this guy is the expert in the system. Why didn't I get to see him last Nov? We will see if he is just out to tame this bull or if he will move things forward. Keep fighting Kim. We are all here for you. Thia

[CSFChallenged]

Kim,
MR Flair sequencing is a type of MRI imaging that is used to specifically get a better look at your brain tissue while minimizing the effects of your pulsatile CSF flow. It is considered a better method than T2 weighting for looking specifically at your brain tissue to rule out underlying disease. http://www.ajnr.org/cgi/content/abstract/13/6/1555
Since the CSF flows in a pulsatile manner (in relation to your heartbeat), this can cause interference or an artifact on your MRI which muddies the picture. This is called a dirty CSF sign or CSF artifact. It prevents the radiologist from properly examining the brain for signs of stroke, recent stroke, emboli, cystic diseases, tumor or other disease.

So, MR Flair sequencing was developed to specifically remove or nullify the CSF signs on the films, or in other words get rid of the artifact or interference that is produced by the CSF flow so that the brain tissue is more clearly visible to the radiologist ( http://www.ajronline.org/cgi/content/full/179/1/237 )

So, the quote "On FLAIR sequence, there is suboptimal nulling of cerebrospinal fluid in convexity cortical sulci." simply means that the nulling or removal of csf flow interferance on your films was suboptimal or not the best. Therefore, the test was not optimal regarding this specific need or did not provide them with the best pictures of your cortical sulci because the CSF flow was clearly still visible over the convexities of the cortical sulci (aka, the convex or outward curvings of the large folds of the cortex of your brain) and not nullified as completely as it should have been.

Unfortunately this will not provide you with any obvious ammo for your leak, it just means that the pictures on MR Flair Sequencing were not the best that could have ben done. Sorry to be the bearer of bad news...I know we all need ammo to prove or find our leaks. But......

After writing this, I did begin to wonder if suboptimal nullification could mean that your CSF flow was somehow abnormal ie. either too high at time of testing due to increased cerebrospinal pressure or if the flow was too low but due to the brain's need to keep it flowing there are areas of increased intensity at narrow points of the CSF pathway(foramen of monroe, Magendii etc). Hmmm??????

Or, does it simply mean they did a bad job on your films, or the machine was old, or tech was careless or clueless. So, I would want to find out from a doc specializing in CSF dynamics (neuroradiologist of Schievink, or Dr. Dillon,) if could this result has any bearing on your CSF pressure, or chronic state. Is this a "soft" sign of CSF problems or leaks.

Hope this helped, sorry so long and not exactly the answer you probably wanted.
CSFChallenged

[CSFChallenged]

Me again...Hey, let's just do this and all charter one of those big comfy buses and go to see Schievink together...and quit wasting our time with anyone else. I am so sick of inferior care, horror stories of procedures gone wrong, and rude, insensitive, uncaring providers. Let's just cut to the chase and get a package deal in LA. Nobody's perfect, but come on, they could try to be decent to their patients

Sue, your doc is/was so completely rude and innappropriate, please don't hesitate to file a complaint with the state medical board. That is your right, and you can also file one on rate your doc or MD websites. If he does not have a profile yet, create it! http://www.ratemds.com/social/ What a jerk!

Have a good day! It has to be better than the day you saw him...Grrrrr! Can you tell, I'm annoyed...I'm usually very patient, kinda have to be after 6 years on bedrest...I like to joke that I am truly the stay at home Mom.

CSFChallenged

P.S. For the record, my providers locally are awesome, and regularly go above and beyond for me. Several of my consults however have not.
P.S.S. Really not trying to hijack your post Kim!

[curranmom]

Challenged - Thanks so much for all the info. If I ever get to actually talk to my NS I will ask him about it but I never get to talk to him only his mean nurse. I have an appointment on July2nd so I am sure that is only when I will be able to talk to him next. It must be so hard for a NS to pick a phone and talk to their patients or something..

Thanks again - Kim

[wobbles]

Challenged:
As long as you are highjacking the thread.....you guys get the bus...I'll meet you in LA!
Also, thanks for the great explanation about Kim's MRI results......really informative...you explain things so well!
Kim: I agree that NS seem to NEVER return calls...are you sure that your's gets the message? When I asked my NS if he was just to busy to return my 3 urgent calls..he told me that he NEVER got a message and that if he had gotten them he WOULD have called! You said that his nurse is mean...maybe she screens his calls inappropriatly...it would not be the first time.......ask your NS when you see him. Mine said to bypass the front desk from now on and insist on talking to HIM! Told me to be a pest if I didn't hear back in a timely manner and assume that he had NOT gotten the message!!!!!!

So, back to the suggestion that we "do" a group trip to Cedars for great care...I say...
Book the Bus, Make the appointments...I'll bring my motor home down to LA so we can stay cheaper than in hotels....even with $4.75 gas and 10 mpg it would still be cheaper than hotels in the area!!!! What do you think?

stay strong everyone-

wobbles

[dkdreamer1]

Count me in!!!!

DK

[sadlisa]

I have been told again my symptoms don't add up to a CSF leak. He said this was most likely permanent after effects of my meningitis. My request for outside help goes to the board on Friday.

Can I come to? Thia

[Concerned Gal]

Can we paint on the side of the motor home "Leaking our way to Cedars Sinai" (or similar). :D

[curranmom]

Leaking our way to Cedars..Here we come Schievink!

PS - I did send out all my records and films to him yesterday so we will see if he has any insight, I hope!

[LauraL840]

Not to keep singing the man's praises

*hobbesnobbin
but Dr. Schievink always called us HIMSELF. Whether we called or not with questions. He'd call to check in on DH AND, AND, AND .... he gave me his cell phone number and said to call him anytime we needed him. The only time we wouldn't be able to reach him would be if he was in surgery and then we'd most likely get a surgical nurse.

Challenged:
As long as you are highjacking the thread.....you guys get the bus...I'll meet you in LA!
Also, thanks for the great explanation about Kim's MRI results......really informative...you explain things so well!
Kim: I agree that NS seem to NEVER return calls...are you sure that your's gets the message? When I asked my NS if he was just to busy to return my 3 urgent calls..he told me that he NEVER got a message and that if he had gotten them he WOULD have called! You said that his nurse is mean...maybe she screens his calls inappropriatly...it would not be the first time.......ask your NS when you see him. Mine said to bypass the front desk from now on and insist on talking to HIM! Told me to be a pest if I didn't hear back in a timely manner and assume that he had NOT gotten the message!!!!!!

So, back to the suggestion that we "do" a group trip to Cedars for great care...I say...
Book the Bus, Make the appointments...I'll bring my motor home down to LA so we can stay cheaper than in hotels....even with $4.75 gas and 10 mpg it would still be cheaper than hotels in the area!!!! What do you think?

stay strong everyone-

wobbles