I was Diagnosed with Chronic Microvascular Ischemic Disease

Overall I would view this as good news. No acute infarct means no evidence of a stroke, and no new changes in the SVD means that it isn't progressing significantly. I also have chronic micro vascular disease and can empathize with you.

I think that the normal for reflexes is +2, and a negative Hoffman sign is also good.

An MRI is a painless way to see if you have any nerve compression that could cause your paresthesia.. It could be something as simple as a pinched nerve or slipped disc. I have had both cervical and lumbar fusions (and a lumbar discectomy) due to injuries. The cervical surgery was not that bad and if necessary don't worry about it. I have had 2 EMG's due to ulnar nerve damage and they are not fun.

Just follow your doctor's recommendations. If your symptoms are an issue you can choose to have further testing to see if there is a course of action that you may benefit from.

Good luck!

I understand JanaShay 13 as I have cardiac microvascular disease. Very common in women. I have been dealing with this for 10 years now since age 58. I take medication for chronic angina. Unfortunately my cardiologist informed me this condition is "systemic"...I wouldn't be surprised if I too had it in my brain. I had a concussion in 2019 and still feeling the effects - one of which is forgetfulness, migraines or saying the wrong word (as soon as I say it, I do know it). However MRIs of my brain showed a "normal" brain in 2020 (last one). Try not to despair and, hopefully, there are medications targeted for the brain. Be sure to see an excellent neurologist.
Johns Hopkins in Baltimore, MD is number 1 in the country for neurology. Perhaps a trip there would be beneficial for another opinion. Check out 2023 US News and World Report for their hospital rankings according to specialties there may be a closer location for you. In the meantime I hope you are doing everything you can to lower your stress level...yoga, meditation, walking, music, gratitude journal, spirituality as you define it, healthy eating, aromatherapy, spa treatments...find whatever works for you, these are only examples.
The very best of luck to you!

Dr. Scott Speelziek, M.D. ( The good Dr. is a very pleasant person) No evidence of acute infarct or new significant changes in small-vessel disease. Not sure if this is good or bad news?

"He does have hyperreflexia most notable at the bilateral patella where there are crossed adductor signs and +2 reflexes bilaterally. In the upper extremities, I would grade his reflexes at +2 on the left and +1 on the right negative Hoffmann sign"

The exam is suggestive of perhaps a spinal cord pathology in the low cervical or upper thoracic spinal cord.
My hyperreflexia as well as evolving paresthesias or numbness and balance issues would raise a suspicion for pathology there either in terms of intrinsic cord inflammation, which is relative
An MRI of the cervical spine. to evaluate for any potential pathology involving the cervical spine. additional testing including potentially EMG could be pursued.
As far as the Mayo Clinic Tapestry Study people are randomly offered to ask to participate. The good Dr. said felt like it was more of a business decision with help from Helix genomics company to compete with 23andMe and other DNA test kit companies.

Thank you, I let you what was said tomorrow

Good luck with the appointment tomorrow. Frankly, I think you outlined some pretty darn good questions in your previous post:
- "What does 'Subcortical and periventricular white matter T2/FLAIR signal abnormality in keeping with sequela of chronic ischemic microvascular change' mean in plain English?
- At what stage of the disease am I?
- Where is it located?
- What else do I need to know?

To that list you might also want to ask
- What tests do I need?
- What treatments are available and which do you recommend for me?
- I have other health conditions. How can I best manage them together?
- What are the next steps?

And you might also want more info about the Tapestry study
- Why was I chosen to participate in Mayo Clinic's Tapestry Study?
- What are the benefits to me and to science if I choose to participate?
- Are there any risks or burdens on me to participating?

I look forward to hearing what you learn.

I have an appointment tomorrow for a Neurology consultation with Scott Speelziek, M.D . At Mayo about my CMVD. What question should I ask?

Hello, I can sympathize with you. I also have cvsd. Had 8 at least ischemic strokes when I was diagnosed jan. 2020.. I have numbness in both hands now. Dizzy spells off balance, walk to the left always droppin g things , memory lapses. I find it hard to answer direc question s.. I was put on a station , blood thinner, blood pressure pills and now a beta blocker as it's effecting my heart. Yes , I am frightened too. Everyday.

Yes, the Result from my last MRI. I live alone, family is spread out across the county. It sucks, haven't told nobody.

@cutlermax, it sounds like you have received some test results before having a chance to review them with a physician. That can be nerve wracking.

You mention the Tapestry Study. A few other members are talking about taking part in it here:

- Anyone participating in the Tapestry DNA Sequencing Research?
https://connect.mayoclinic.org/discussion/anyone-participating-in-the-tapestry-dna-test/
.
- Tapestry Results are In, What is your story?
https://connect.mayoclinic.org/discussion/tapestry-results-are-in-what-is-your-story/

Hopefully you'll get more information regarding your specific situation at your consultation. While it is a progressive disease everyone is different. Mine presents with aphasia, ataxia, slurred speech at times, TIA's, balance issues, and sometimes memory. It can be quite stable for a while and then I might have a period with increased symptoms (sometimes I think it could be stress related). I'm 67 and my biggest fear is cognitive decline. I also find myself more easily irritable. Everyone's symptoms and progression are different based on the areas of the brain that are impacted.

Unfortunately, as my neurologist said, you can't rotoroot your brain. The best thing is to try to have a positive attitude, work on that bucket list, eat well, and exercise. I also have ASCVD, so the same things I do for that apply to CMVD (including my daily aspirin). Since the root cause of CMVD is the same as ASCVD and carotid blockage be aware of your health in those areas as well. The good news is that if these are an issue for you is that they are treatable.

Feel free to reach out.