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EEG and Carotid Doppler-- What for now???

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#1 Didi


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Posted 28 March 2014 - 02:38 PM

You have all been so supportive and helpful, I hope I am not taking advantage, but my husband and I have another question. We have only had one appointment with a neurologist. Although he told us at that first visit he thought my husband had PD, gave us books and info on PD, and a prescription for Azilect, still he ran a whole bunch of tests, I guess to make sure he wasn't missing something. Bloodwork for everything from HIV to lupus, RA, Hepatitis, Lymes and Wilson's disease, also and MRI and MRA,  the Dat Scan.

He also ordered a Carotid Doppler and an EEG. We have done all the testing except the EEG and Carotid Doppler which is scheduled for April 22. But now since the Dat Scan came out abnormal,we are wondering why he still has him scheduled for an EEG and Carotid Doppler. They are done at his office and I don't want to even think he ordered these because of the money he makes. I want to think he is just being thorough--or maybe he hasn't had the time to look over my husband's file and realize what's going on. Our follow up with him is not until the end of May. But we are thinking about calling his office to find out if these tests are still necessary. I do know that my husband's MRI came back showing some scattered nonspecific subcortical hyperintense foci that the radiologist wrote under impressions could be: small vessel ischemic change (or demyelination, vasculitis or gliosis). But when I questioned the Dr. on the MRI he said that the spots on the MRI meant nothing (if I understood him right) In my researching that made sense because it seems very common to have some of these UBO's (unidentified bright objects-- I saw some Radiologists refer to them as such) in healthy people with no symptoms. So I don't think he would need the doppler becaues of those results, but of course I'm not the Doc.


And so, I just wanted to ask you all -- is there any reason at all to do an EEG or a Carotid Doppler, when we now have the abnormal results from the Dat Scan? Is PD still a diagnosis of exclusion? Did any of you have those tests during the diagnostic process. I think I have read that an EEG can show changes related to dementia or cognitive problems. Do any of your Neuros do EEG's on you looking for cognitive issues?


Just want to understand before I call the office and question the reasoning behind these two more tests since we now have the Dat Scan results.

Thank you for your help

#2 RNwithPD


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Posted 29 March 2014 - 03:10 PM

A carotid doppler is used to check for narrowing or blockage of the carotid arteries. This is typically performed when a patient presents with stroke-like symptoms, especially dizziness or passing out. It's also used prior to cardiac surgery. It's not a typical test in a PD work-up. Likewise, the EEG is performed for mental status changes, etc., but not a typical PD workup. Unless your husband is having symptoms to account for these tests, it sounds unnecessary.


#3 Didi


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Posted 29 March 2014 - 03:39 PM

Thanks, that's exactly what I thought. But I didn't want to mistrust the doc, or think he likes the income for these tests done in his office.


But... Now that I'm thinking about it, when taking my husband's  history my husband told him about a mild concussion he had had about 1 year ago and some dizziness he experienced for months afterward. It was not severe dizziness -- my husband would mention it occasionally. I would ask him what he meant by dizziness because he never looked or acted like he felt dizzy --- so whatever the sensations were they were very mild. However, he did mention it to the neurologist. I think my husband really wanted to believe that all his symptoms were from that concussion. So.. maybe my husband mentioning the dizziness is where the Doc justifies the doppler, not sure where he got the idea for the EEG-- can't think of what was said in our visit to warrant an EEG.


I am thinking about calling the office and asking why these tests are necessary -- but there are very few neuros in our area, and fewer yet who will take our insurance, so I hate to tick him off. We already are worried about how he will react to the fact that my husband hasn't taken the Azilect he has prescribed as of yet. Only having seen him once, we have not much idea what his manner is. I have a rheumatologist who tells me I am the boss -- he recommends tests or treatments but wants me to decide on the path we take. I have a GI doc who wants to run the show and gets annoyed when  I question a med she prescribes or even more upset if I ask not to take it. Docs can be so different in their style. EEG and Doppler are not invasive tests(I've had both myself), But it will be copays we don't really want to pay if we don't have to. And why be so wasteful with unnecessary tests. But again, hate to bite the hand that feeds you--- since as a PD patient, it will be a long term relationship with a neurologist.

#4 Beau's Mom

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Posted 29 March 2014 - 11:45 PM

Funny, in January of 2009 I went to my PCP and said my smile was lopsided. I had already complained about tremor, but he said I was taking too much thyroid medicine. So he ordered the carotid doppler and did nothing else. it was 23 months before my daughter suggested PD and I was diagnosed by a regular neurologist.  It makes no sense that PCP's don't refer if they can't find an answer.



I am not a human being trying to have a spiritual experience; I am a spiritual being having a (sometimes difficult) human experience.


First symptoms: right-hand tremor, constipation and restless arms 1978 (age 25). Depression and anxiety (non-motor symptoms) began in 1989 and worsened through the years. Last inpatient episode June 2013.


Diagnosed December 2010 by a regular neurologist (age 57). After negative reactions to Requip, Mirapex and selegiline began Sinemet 25/100 3x/day. First MDS visit in Houston in February of 2011 was inconclusive. Second MDS visit at Baylor Fort Worth in May/June 2011 diagnosis changed to Parkinsonism, Sinemet stopped. Third MDS visit in August 2011 in WA State: received a confirmed diagnosis of idiopathic PD which had started on the right side and had now crossed to the left side as well. Restarted on Sinemet 25/100 4x/day. A short trial of Amantadine caused audio hallucinations in September 2011.


Current medications at age 63: Duopa gel via PEG-J tube, 6ml loading dose; continuous dose 2 ml.  Trazodone 150 mg at bedtime, Fluvoxamine 300 mg at bedtime. Clonazepam 0.5 mg morning and afternoon, 1 mg at bedtime. Vit D3 2x/day, Calcium Carbonate Susp. 5 cc daily, Baclofen 10 mg 3x/day, Flonase two sprays 2x/day, Calcitonin-Salmon nasal spray once daily (for osteoporosis). Gel eye drops as needed throughout the day, Restasis Eye drops 2x/day, Nighttime eye ointment at bedtime. 02 2L per nasal cannula while asleep. Walker, electric wheelchair, moist and soft or pureed foods and 135 caregiver hours per month keep me moving.


Edited 2/5/2016

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