Testing for Neuropathy

Never had an MRI for anything related to my PN. Nerve conduction tests were what verified my PN.
Tests done through a neurologist.

I was told the opposite. My last 3 MRIs I had to do the blood work before the MRI, which the last one was earlier this week.

I never had an MRI either although a podiatrist mentioned getting one. My neurologist confirmed SFPN, and he and my internist ordered blood work which confirmed there was no underlying disease, and suggest mine is idiopathic. No one ordered an MRI. Sorry you are having such a run around.

Hi @klro0001, I had an MRI before I was able to meet my neurologist at the Mayo Clinic where I was diagnosed with idiopathic small fiber PN. The MRI is not a test for peripheral neuropathy, but is performed to exclude other disorders that produce similar symptoms.

Peripheral neuropathy - Diagnosis & Treatment
-- https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/diagnosis-treatment/drc-20352067

This short video by Matthew B Jensen Assistant Professor of Neurology, University of Wisconsin that gives a good explanation of how the different neuropathies are diagnosed.

I understand the purpose of the MRI and the need to exclude other conditions. However, I can’t understand why a simple blood test and biopsy can’t happen first. In fact, I didn’t even meet the neurologist. My appointment was with his physician’s assistant. I just don’t want to pay the astronomical insurance deductible if it’s not absolutely necessary.

I had a blood test prior to the MRI and meeting with the neurologist. I'm guessing a biopsy is not really as simple as a blood test but I have no medical background or training so don't really know the reasons. Can you seek a second opinion or help from another doctor or neurologist?

@johnbishop

Interestingly, this neurologist was supposed to be my second opinion. Lol. But, I have to advocate for myself so I am down for trying for a third. Thanks for your help and your advice.

Kia

kiro0001 Hi Kia, Never heard of MRI's first, but I could see it if docs really do suspect something besides the neuropathy. I don't think this has to be the order in which to do these tests in, though. I hope you are OK? Lori Renee

@lorirenee1

Thanks so much for inquiring, Lori. I hope you are still doing better. I’m fine, physically. I’m just extremely discouraged and annoyed. Before this, I never had bad experiences with finding doctors that listened to me, stayed in my corner. And came up with a game plan that we both could agreed with. The PA said that their clinic’s first step is always to rule out MS so the 3 MRIs are “medically necessary.” The scans would take more than two hours so I would need to book them over two appointments (and the two appointments are over a 4 week period). Also, When asked what the next step would be if my MRIs were clean, I was told, “Let’s just cross that bridge when we get to it.” Something about this didn’t sit well with me. And this clinic has their own MRI machines so a small part of me thinks they may be more motivated by money than patient care. And I don’t want to be just a number to someone treating me. Sorry for the rant. I will put my big girl pants on and keep searching.

Kia

Interesting that they say they rule out MS first. Because MS is usually diagnosed by ruling everything else out first. I had an MRI first, and it even showed lesions, but further testing hasn’t shown a for sure diagnosis of MS or anything else for that matter. I have ruled out a whole bunch of things, through bloodwork, 3 EMGs, spinal tap, skin biopsy, etc so those tests are valid for finding a source of neuropathy and at least some of them are cheaper than MRIs (I don’t remember all of the costs). I hope you can get a good second opinion. There are so many things that can cause neuropathy - some are pretty easy to find and don’t need a MRI. Good luck!