Getting an MRI with Cerebral Palsy

In my last post, I wrote about my first ever neurologist appointment. Dr. X wanted me to have an MRI of my c-spine, and if that came back normal, of my brain. All because of some suspiciously robust reflexes (hyperreflexia) in my upper body that may signal a herniated disc or spinal compression in my neck. 

I was dreading another head-first-into-the-machine MRI. This would be my second head-first, and my fifth overall. I tried to get medication a couple weeks beforehand. But using the messaging system in the patient portal takes a long time. I asked the neurologist for something to help me get through it, and let her know I was currently taking tizanidine. This is a new pain medication I was trying, a muscle relaxant that was having no effect whatsoever. She wrote back that I should just take that and it should help. I wrote back that in fact I had just spoken to pain management and they told me to stop taking it since it wasn’t helping. She wrote back and said that she couldn’t prescribe medication to me and that I should ask my primary care doctor for one dose of ativan. I did. All of this took days, the back and forth. Because of course it’s not actually the doctor reading or writing the messages, but a nurse or some other go-between. By the time I wrote to my primary care doctor, I think it was the Thursday before my Tuesday MRI, and I had little hope of getting the medication. Yes, I probably could have called the office and sped things up. I did not.

My MRI was at 6:45pm. I liked that the hospital was nearly empty. I did not like that I had to get undressed and put on two gowns and put my shoes back on. (By now I know not to wear anything with metal.) I had decided to leave my walking poles in the waiting room with my husband. 

My MRI tech, Jeff, was nice. I told him that I have cerebral palsy, and have very strong reflexes in response to loud noises. My MRIs tend to be “motion degraded.” I asked for help with the earplugs, because I can never get them to stay very well. Jeff obliged and really shoved them in there. I also asked for some extra weight on my legs, and he put a significant amount of weight on my lower legs (folded blankets, I think). I would have about fifteen minutes in the machine, then out for the contrast injection, and then back in again. He told me that it was okay if I needed to move during the quiet parts, and that it was only when the machine was making noises that it was taking a picture. Swallowing was okay, and there was no need to hold my breath. (Depending on the MRI, sometimes this is necessary. Yikes.)

I find that it’s less uncomfortable if I keep my eyes open. When I close my eyes, then my brain really starts revving up. There were two scratches on the smooth white surface above my face, and focusing on them helped me, rather than looking at a plain white expanse. I think doing the Gupta Program helped me stay calmer than my first experience. I breathed and I told myself, “I am absolutely safe. It’s okay to feel anxious.” I was reminding myself that everything was under control and that there really was no danger, while also accepting my feelings. Repeating this steadily to myself helped more than singing a song in my head or doing grounding exercises (focusing on what I could see or feel).

That’s not to say that it was an easy experience. My legs absolutely tensed up with the loud, unpredictable noises. And once they were tense, even with the weight, they didn’t want to relax. I sometimes felt a near panic that I needed to move and couldn’t hold still against the barrage of sound any longer. When I swallowed, sometimes they were giant, anxious swallows. 

Jeff kept me updated: “The next one will be three minutes.” Then, “This one’s longer. About four minutes.” Then, “This is the last one, but it’s a long one. Five minutes.” Have you ever tried to hold absolutely still for five minutes? While horrendously loud, electronic, machine-gunnish sounds assault you? In a small space?

When I was let out for the contrast injection, I still had to hold my head absolutely still. No moving. Then back in. At the end he said, “It was nothing you did, but I’m not satisfied with that last one. If you can tolerate it, I’m going to recalibrate the machine and do that one again.” Okay. The back of my head was hurting, stinging from lying on the same surface for so long.

When it was finally over, Jeff told me to sit up and stay there a moment to get my bearings. I told him that if this MRI came back normal I would have to get a brain one next. I asked if I could see the thing that goes over your face. I thought that if I saw it in person, rather than on an informational video, it wouldn’t seem so horrible. I was wrong. It does seem really, really horrible. I crossed my fingers for this MRI to show something.

It did not. Well, it showed some things, but nothing to explain the symptoms that prompted the neurologist to order it (forearm pain and hyperreflexia). The skeletal system peaks at thirty, so everyone over thirty is going to have something show up in their spine.

Here are my “findings”:

Slightly motion degraded study. [Only “slightly” motion degraded this time. Yay me!]

Alignment: There is normal alignment of the spine.

Vertebral body heights and marrow: Normal.

Spinal Cord:The craniocervical junction is unremarkable. The questionable areas of signal alterations versus artifact scattered through cervical spinal cord probably artifactual. There is no abnormal enhancement within the limits of motion degradation.

Soft tissues: Normal. 

At C2-3: Unremarkable.

At C3-4:Unremarkable.

At C4-5:Mild disc bulge. Uncovertebral joint hypertrophy and facet arthropathy with left mild to moderate foraminal narrowing.

At C5-6:Mild disc bulge. Mild left foraminal narrowing.

At C6-7:Mild disc bulge and thickening of ligamenta flava.

At C7-T1:Unremarkable.

IMPRESSION:

1. Mild degenerative changes of cervical spine with no significant spinal canal or foraminal stenosis.

2. No obvious cord signal abnormality or abnormal enhancement within the limits of motion degraded study.

Look at all the normal, unremarkable stuff going on in my neck. And sure, for a neurologist “mild disc bulge” is no big deal. For me, it confirms a lot. My neck has hurt intermittently since 2008 and every moment of every day since June 2016. I infer that these mild degenerative changes aren’t supposed to be enough to cause the kind of pain and issues I’m having, and that my brain is just being hypersensitive about it all. I’m glad I don’t have a herniated disc or a compressed spinal cord. That’s great.

But it does mean that I’m having a brain MRI with and without contrast next month. No use worrying about it, but that won’t stop me. Time to meditate.