The neurologist today gave me new prescriptions for cymbalta and percocet (in addition to the nortriptyline and oxcarbazapine) and said he wants a 3rd MRI at the end of Feb.
At first he said I have TN, then now he says I have atypical cranial facial pain rather than TN...I don't really see a difference. He said if we can't get rid of it with meds that a surgeon could "go in and look". He mentioned sending me to a pain specialist if the cymbalta and percocet don't help enough.
Anyone had a surgeon "go in and look" without having a MVD? For those who've had an MVD, did the rubbing vessels show up on an MRI?
If my memory serves me correctly, a "thin slice" MRI (one that takes images that are packed allot closer together than a standard MRI, and can sometimes be assembled into a 3D image) will have a much better chance of picking up whether you have an impinging vessel than a standard MRI - they often will do the images once without, then once with contrast. My standard MRI, ordered by the neurologist, did not show a vessel, but my neurosurgeon found one "hiding between the slices" when he did the thin slice, and so proceeded to do the MVD.
Hope this helps, however I don't know exactly why they would offer to "go in and look", other than that they have a really strong feeling that there is one there, but they are not 100% certain. I would think that this does happen, though, because the imaging technology that is out there is not 100% perfect, so they have to play it by ear, and you just need to explore how much you trust that neurosurgeon's instincts in deciding whether you want to move forward.
I have had two MRIs now. I have bilateral TN. On my first MRI an artery was on the nerve on the left side, and on the right side he saw a narrowing of the nerve, which he thought would be the compression point on the right. I was sent to another doctor and he had me get an MRI on a 3T scanner and he said he should be able to get a better look. We are looking to do MVD on my right side, but he said he wouldn't do the surgery unless he saw the compression point. So now I am just PRAYING to God he sees what he needs to see!!!!! I am on Tegretol (1200mg a day) both doctors I have seen didn't think adding any other medications would help me...so right now I am deal with pain on a daily basis because the Tegretol only dulls the pain.
I have only had 1 so far without contrast and it showed nothing. I go to an actual neurosurgeon on the 16th though and I kind of hope he gets me one WITH contrast so that maybe it will show up. But it doesn't always show up. There are several people on here that have had MVD and the MRI didn't show, but when the Dr. got in there, they saw the compressions and fixed them. Hope this helps!
I had many MRIs, MRAs and MRVs, a few with contrast, done and no compressions were ever seen. When I say many I mean more than 5 in the past 5 years. The NS decided to go in anyway based on my symptoms and found an arterial compression of the TN as well as 2 other compressions of 2 other cranial nerves.