MRI positive MRA negative?

General
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To be clear, I have only talked to my family nurse practitioner so far. I went to a previously scheduled appointment for a hypothyroidism bloodwork (as well as some other bloodwork for EXTREMELY low estradiol, anemia, low FSH). This was 9/21/23. The significance was that for 2-3 days prior to the appointment I just so happened to have the worst “migraine” of my life. Migraine lasted 9/18-9/21.

I am an active person, a special Ed teacher, volunteer a lot, mom of two, 35 years old… but I got knocked out by this headache. I was extremely sensitive to light. I felt weak and tired at the start of it and when I laid down to sleep I woke up the next morning still in a lot of pain. I called in and my kids got themselves ready for school for the first time ever. I went back to sleep and woke up THE NEXT DAY! I haven’t taken a daytime nap in over ten years, despite increasingly frequent headaches that I assumed were migraines bc light sensitivity and my family history of them. Basically, I’m not someone who rests, ever.

I didn’t even plan to discuss it at my appointment but the office lights were killing me and I kept covering my eyes like a visor to block the light wheel we were talking. She asked, so I explained why. She seemed really nervous about my story and asked if I would do an MRI. I thought that seemed extreme, because I have hormone issues and I thought the headaches must be from that.

I did the MRI at the first available appointment (11/27), and got results same day.(I have no idea why it took so long but the nurse practitioner wasn’t happy it would be so long. She warned me if I had any new symptoms to go straight to the ER.)

The report said that I had a flattened pituitary gland and possible hypertension. This made sense to me. The second finding was a 4mm aneurysm on the communicating segment of the carotid artery. They suggested further imaging (MRA or CTA specifically).

I saw my nurse practitioner to discuss on 12/1. She told me she wishes she understood more to help me understand. She explained in detail to me that I’d get imaging done where they inject dye and see all my veins and be able to get a better look. I already knew what the MRA was and I understood the difference in contrast or no contrast from previous health issues, but I listened. Then she ordered an MRA WITHOUT CONTRAST and referral for a neurologist. When I called the neurologist number they said that’s not who I need to see, it’s probably the neurosurgeon, and they would talk to the drs and get back to me that day. They did not.

Idk when or if I will see either one now because I got the MRA on 12/2 and got results the same day- NO SIGNIFICANT FINDING. NO ANEURYSM.

I want to be thrilled about this, but I feel more scared and confused than before. Was the MRI a false positive? Was the MRA a false negative? Why no contrast? I just wish this weekend was over so I could schedule an appointment to talk to someone who can actually explain things to me. I’m really hoping you guys can give me some insight. Anyone ever have a false positive? Idk what to expect tomorrow when offices are open. I’ve just been sick to my stomach scared for a week.

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Gosh Almighty you’ve been told a lot Kayla! I have a pituitary adenoma, they found it when I was laying around in NSICU not doing much. Since then I get a special MRI/A that is specific for the pituitary every five years now. My Neurosurgeon says it can’t really be seen on the generic one that looks at my arteries.

Check with your NP about the contrast not being used. Contrast and I don’t get along well at all but in the beginning I always had my images with and without contrast. Check with her on if that’s what she really wrote and they forgot to do it. I once had to remind the Radiology Tech I was supposed to get an MRA with my MRI. He went and looked at the order and sure enough that’s what it said.

As for a difference in the findings, that’s not unusual I’ve found. One time I had my results prior to seeing Dr. Quintero-Wolfe, my Neurosurgeon. I was confused about the findings and asked her about it. She said I didn’t have what the Radiologist said and she read the findings. She jumped up faster than I can type, got on the phone and before she came the few steps back into the exam room, it was changed. Fast forward to 2020 and the Neurologist I had then didn’t like my symptoms, ordered the MRI/A without contrast. He really wanted me to have it at Atrium and not Baptist where my Neurosurgeon is and where I’ve had all of my MRIs. I relented and had the next day. Then we waited and waited for the Radiologist to write the final findings.

My Neurologist didn’t know what was taking so long and I wondered why the nitwit left out my aneurysm. It’s got lots and lots of coils in it, kinda hard to miss. Seems he couldn’t make his final decision without seeing any other MRIs. I went to the hospital where I was taken to when I ruptured and requested all my images. Drove to the Neurologist who was in a different county and hand delivered them. I had also called Baptist and requested all my images be sent to my Neurologist. Found out they had merged with Atrium and he should be able to see them. I still asked them to be sent. When I met with the Neurologist I learned they had put all my mammograms in with the images as well as an angiogram for my heart and a few images for spine and other bits and pieces of my body. My Neurologist was surprised and said he really didn’t need those mammograms :rofl:

Neither specialist knew that Atrium had merged with Baptist. My Neurologist didn’t know how to send the images at Atrium to Baptist as he doesn’t get the images only the findings. So I called Baptist and sure enough they could see them. So while in his office, I asked them to send them up to Dr. Q-W to read. I was done with this nonsense after a couple of months. I think my Neurologist was as well. He was also very concerned as my symptoms kept getting worse. Dr.Q-W read my images and had a FaceTime or Zoom meeting with me as it was during COVID. She didn’t need to put me through an angiogram, the images told her all she needed to know and I had my stent installed the next month when she could get a bed. Around the same time as the Zoom meeting, the Radiologist finally did his final readings.

Long story short, have your NP refer you to a Neurosurgeon and let them look at both sets of images. Heed your NP on going to the hospital. Since you’re well aware of migraines, it will be the worse one you’ve ever felt which is why they call it the “thunderclap”. Do not go to bed with it, go straight to the ER, preferably by ambulance. Also, please practice relaxation breathing all the time, it can and will help more than I can say, I give you my word on that.

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I have been told newer MRAs can show full details of arteries without the need for contrast. So if yours was done on new tech, it should be great for identifying aneurysms and arterial issues. However, I am not a health care professional, I’m just relaying what my former GP told me. I know MRIs are definitely NOT reliable for fully and properly identifying aneurysms. So hopefully the MRA with its more detailed depiction of your arteries ruled out what they thought they saw on the MRI.

However, i wouldn’t hesitate to push for confirmation from someone highly qualified such as a neurosurgeon (they can read both studies and determine if further study is needed). If that proves to be a problem, attempt to have your current practitioner order a CTA (CT with contrast, which for that equipment contrast is an absolute must) to confirm the MRAs negative findings. Not sure about getting it through insurance after a negative MRA, but without a neurosugeon’s input, that what I’d shoot for so you can feel at ease.

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Oh thank you both so much for your input! I did get to talk to my NP today and she said let’s go ahead and make the appointment with a neurosurgeon (and I did). I will go Thursday this week. It’s very helpful to hear what everyone else has used for imaging and what the results were, because I am very much a newb to this.

I was honestly super disappointed when I had the second scan done at a different place and the machine looked like it was built before the hospital. The first place everything was all new and shiny and the staff was knowledgeable and comforting. The second one looked like I was in the beginning of a horror film. Think yellowing plastic, tech had to slam the headgear closed more than once to get it to stay closed, and even had to bring me back out and put me back in once because something “didn’t work right”… so I was hesitant to get excited about the MRA for so many reasons. I’m glad I’ll be seeing a neurosurgeon. Hopefully it’s nothing and I’ll just be dealing with my good ole’ pituitary problems that I’m already familiar with! I appreciate you guys so much for your support. I feel like such a drama queen when everyone here has been through so much trauma and you’re all so strong. Being able to talk to you and read everyone’s stories is making me feel so much more stable. Bless all of you! :heart:

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You are definitely not a drama queen! The new MRI machines are a thing of wonder, just like @Judi mentions. My last MRI/A took a total of about 15 minutes and done! No contrast needed at all. It is simply amazing and I couldn’t tell the techs how wonderful the difference is between old and new. I was once sent to another outpost for imaging and the machine felt like it was coming apart at the seams it shook so much, it’s a wonder they were able to get any images.

Please let us know what the Neurosurgeon says…

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I saw a neurosurgeon and he said he disagrees with the “no aneurysm” call on the MRA. In fact, he pulled it up and showed me that it is exactly where they said it was on the first MRI (and the size was accurate too). He also showed me I have a second small aneurysm on the left carotid artery according to that same MRA. He said he will do an angiogram but with my good health and low risk factors he believes we will be able to do stents. It’s not the best thing ever to hear but I was so happy and relieved to have clarity! Also I’m relieved that he believes my risk is low and is taking action to give me the best possible outcome. Thank you all for supporting me while I waited to get an answer!

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Kayla, so sorry to hear you are officially part of our crazy aneurysm club, but so glad it was found before a rupture. It may not feel like it now but this is a huge advantage. Keep us all posted and we’ll help in any and every way possible as you navigate through this.

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Thanks so much @Judi. It’s odd but truly feel lighter knowing there is certainty and a plan. And thank you all for this “little group”…. You guys are keeping my sanity intact!

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Thank you so much for letting us know what the Neurosurgeon said! I can imagine it’s a little of both being apprehensive and relieved. At least you have confirmation and the best news is you didn’t have to rupture to get it! I always go with the positives. When has he scheduled your angiogram or are you waiting for his scheduler to call?

After I popped my pipe (ruptured) I had that coiling and then because of my oddly shaped aneurysm, the coils compacted (my theory which Dr. Quintero-Wolfe let me share with her Residents) and then I had a Neuroform Atlas stent put in Dec 2020. The stent improved my ability to process tenfold. I just had to wait for medical science to catch up with me🤣

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@Moltroub I am definitely feeling relief and apprehension. I’m waiting for the scheduler to call. (Technically they did call when I was driving home and I missed them… I called back but I was just a few minutes too late to catch anyone.) He told me we’ll try to get it done before Christmas, and I’m glad it’ll be done so I can have more information. I’m very much data driven so more answers equals more sleep for me! :sweat_smile:

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I had my stent installed before Christmas during COVID. It may have been during Chanukah, it was a wonderful gift either way! My Neurosurgeon usually would do an angiogram then a week or two later so the coiling but with the stent, she didn’t need to do the pre-angiogram, just the fix and six months later the follow up angiogram. Make sure you’re hydrated before you go in, it helps the RNs stick you.

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Oh yeah, I’ve already been in trouble for lack of hydrating! :sweat_smile: I admitted I don’t drink enough water and he’s like “Well buy yourself a sweet water bottle because it’s your new best friend!” And what a wonderful gift you received, @Moltroub!

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I use a big Tervis cup. Usually in the summer I add some flavored vinegars, not much, coconut and pineapple are a great mix, think pina coloda without the rum. Sometimes I add some powdered lemon. We gifted a friend with one of those water bottles that you can put fresh fruit in several years ago and they loved it. Fortunately we have been on a well in this house and the previous house. My SIL and her family are on city water down in Alabama and we got a Brita pitcher because their water is slap nasty with all the lime that’s in their area. I have to have my hot tea first thing in the morning and BH needs coffee so we use the pitcher for those. There are all kinds of ways to make water taste different when you get tired of plain water and it’s fun to experiment! I also still need to watch electrolytes so I drink a sports drink or three depending on how much I’m working outside.

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I got my fancy new cup today! Woo hoo! Here’s to a healthier me. Gulps from a giant water bottle maniacally. :joy::+1:t2:

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Woo hoo!