Seeking Insight on Abnormal Neuroimaging Results
A 42-year-old female, standing 6 feet tall and weighing 194 pounds, has been grappling with cognitive challenges for over three years. She has a clinical history that includes a diagnosis of Bipolar II disorder coupled with generalized anxiety, which she manages effectively through a regimen of an antidepressant, a mood stabilizer, and medications for anxiety. Currently, she is under the care of her fifth neurologist in the Boston region. An FDG-PET scan revealed a significant decline in metabolic functions, showing a 30-40% reduction within the left parietal lobe and a 20% decrease in both mesial temporal lobes. As part of her evaluation, a lumbar puncture was performed to assess amyloid and tau protein levels, with results coming back negative. Although a radiologist recommended pursuing an amyloid PET scan to gain further insights, her neurologist has declined this option. Despite the neurologist's suggestion that her indications might fit into the Functional Neurological Disorder (FND) category, she remains unconvinced and believes there must be an identifiable underlying cause for her symptoms and the irregularities observed in her scans. She is seeking advice on the next steps to take in pursuing a clearer diagnosis or understanding of her condition.
Answers (1)
2/7/2026, 3:40:28 AM
OpenHealth AI
It’s understandable that you seek clarity regarding your neuroimaging results and ongoing cognitive challenges. Based on the provided background, you’re navigating a complex situation that requires careful consideration and follow-up. Here are the key points and what steps you can take moving forward.
Summary of Key Points:
- Cognitive Challenges & Neuroimaging Findings: You have experienced cognitive issues for over three years, and recent scans show reduced metabolic function in specific brain areas.
- Negative Amyloid and Tau Results: The lumbar puncture results were negative for amyloid and tau proteins, which are associated with certain neurodegenerative diseases.
- Differing Opinions: You are dealing with differing expert opinions, including potential Functional Neurological Disorder (FND).
Explanation:
Cognitive decline can arise from various underlying conditions, and the findings from your FDG-PET scan suggest significant changes in brain metabolism that warrant further investigation. The negative results for amyloid and tau proteins are reassuring in some contexts, as they might rule out diseases like Alzheimer’s. However, the suggestion of FND indicates that your symptoms could be related to how your brain is functioning rather than identifiable structural changes.
Next Steps:
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Seek a Comprehensive Second Opinion: Consider consulting another neurologist specializing in cognitive disorders or a neuropsychiatrist who can review your case, symptoms, and imaging results holistically. A fresh perspective might illuminate other possible conditions.
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Request a Detailed Discussion with Your Current Neurologist: Schedule a dedicated appointment to discuss your concerns about FND and ask for clarification on your diagnosis. Inquire about the rationale for not pursuing the amyloid PET scan and express your desire for more comprehensive testing.
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Explore Multidisciplinary Evaluation: Look into evaluations that might include neuropsychological testing, which can provide insights into your cognitive function and distinguish between possible psychological and neurological components.
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Keep a Symptom Diary: Track your cognitive symptoms, their frequency, and duration. Note any triggers or patterns. This can provide valuable insights and is useful information to share with any healthcare provider.
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Consider Support Resources: Engage with support groups for individuals facing similar symptoms and mental health challenges, as shared experiences can be invaluable for emotional support and potentially discovering helpful resources.
Conclusion:
Your search for answers and clarity is crucial, and it’s important to advocate for yourself in this process. Each of these steps can help you build a clearer understanding of your condition and ensure you receive the best possible care. Please don’t hesitate to follow up if you need further guidance or assistance.
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