Neurologist recommendation at Sirrirat Hospital

[MattATX]

Hello, I had a visit with Neurologist at Bumrungrad hospital and would like a second opinion regarding my MRI and test results. Can anyone recommend a Neurologist at Sirrirat Hospital please as I have visited that hospital before and liked the service and attention as well as the price better than Bumrungrad. Thank you

Edited January 5 by MattATX
misspell

[Sheryl]

Please indicate the type of problem, as neurologists have sub-specialties.

[MattATX]

10 hours ago, Sheryl said:

Please indicate the type of problem, as neurologists have sub-specialties.

Thank you for your reply  Sheryl. My visit was for slight random right hand tremor as well as feeling lightheaded while getting off elevator at high floors. Sensory tests and brain MRI were conducted.  I was told the results looked normal during my visit. However, in a report that was sent later, he highlighted the MRI showed 2 of brain cavities showed fluid increases to the limit acceptable for my age.  I don't have the report at hand to use the right terminology. The discrepancy between what I was told during the visit and what he wrote in his report later is the reason I don't care to go back to the same doctor although I did follow up with him to clarify the discrepancy.  He however couldn't explain except for mumbling and basically asking me to return for another MRI within a year to compare.  I don't want to name the doctor but he is the doctor you once recommended on this forum and he seems to have excellent credentials including US board etc.  

Edited January 5 by MattATX

[MattATX]

I believe this is what the report was referring to: 

Hydrocephalus is the buildup of fluid in cavities called ventricles deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain.

Cerebrospinal fluid usually flows through the ventricles and bathes the brain and spinal column. But the pressure of too much cerebrospinal fluid can damage brain tissues and cause a range of symptoms related to brain function.

 

Hydrocephalus can happen at any age, but it occurs more often among infants and among adults 60 and older. Surgery can restore and maintain healthy cerebrospinal fluid levels in the brain. Therapies can manage symptoms resulting from hydrocephalus.

[Sheryl]

I see. Normal pressure hydrocehalus (NPH) is a very common funding in  people over age 60 and can sometimes cause tremor and other Parkinson-like symptoms, However  "fluid increases to the limit acceptable for my age" suggests you do nto, at this point, meet the definition of hydrocephalus (which would be fluid amount over the normal limit for your age) hence the advice to just repeat the MRI in a year.  I don't think any one is going to perform surgery for hydrocephalus with your current findings and symptoms.

 

However, the MRI finding does not seem to explain your tremor (assuming the radiologist's report is accurate - should certainly have the actual scan re-read by a skilled specialist)

 

A  neurologist with expertise in hydrocephalus (even though you seem to fall short of that diagnosis) at Siriraj is   Prof. Sarun Nunta-aree

https://www.siphhospital.com/en/medical-services/find-doctor?doctor_id=239&medical_id=59&day=&startTime=&endTime=

 

He can also be seen at Bangkok Hospital  https://www.bangkokhospital.com/en/doctor/dr-sarun-nunta-aree-2

You will nto get a different result at a different hospital seeing the same doctor. But SIPH maybe be a bit less costly than Bangkok Hospital.

 

Be sure to bring the actual DVD of the MRI with you, not just the report.

 

If the result of this consultation is that your MRI findings do not explain your symptoms (quite possible), you could  then consult specialists  in MS and Parkisnon's, as tremor can be early sign of both. There are many MS specialists at Siriraj, ask Prof. Sarun to suggest one. For Parkisons's  that seems to be more a Chukalonhgkorn specialty  while Siriraj's neuro department ism ore focused on autoimmune neuro problems like MS.  If you want to see a neurologist at Chula let me know.

 

Wherever you go, you should have some basic tests to rule out non-neurological causes of tremor such as:

- B12 level

- serum sodium, calcium, magnesium

- HB1Ac (for diabetes/hypoglycemia)

- thyroid panel

 

The light-headness after getting off elevator at a high floor is actually more suggestive of an inner ear issue than anything else. Do you have vertigo at any other times, like when rapidly getting out of bed or otherwise changing position?

 

Lastly:

- how much do you drink? (alcohol)

- What if any medications are you on?

 

 

[thesetat]

23 hours ago, MattATX said:

Hello, I had a visit with Neurologist at Bumrungrad hospital and would like a second opinion regarding my MRI and test results. Can anyone recommend a Neurologist at Sirrirat Hospital please as I have visited that hospital before and liked the service and attention as well as the price better than Bumrungrad. Thank you

If you have good insurance. go to the pain management center there. Or go to the private one there at Sirirat.. My last back surgery they imported a surgeon from Australia to sever some nerves in my spine using lasers. 

[Sheryl]

12 minutes ago, thesetat said:

If you have good insurance. go to the pain management center there. Or go to the private one there at Sirirat.. My last back surgery they imported a surgeon from Australia to sever some nerves in my spine using lasers. 

OP does not mention suffering from pain. His issues are a slight occasional hand tremor and vertigo after taking an elevator to a high floor.

 

Pain management center would not be appropriate for that. (But good to know you had a good experience with it!)

[MattATX]

Thank you for the replies and information. 

[Dirk Z]

Please allow me to clarify some issues about hydrocephalus. In the brain there are four spaces filled with cerebral spinal fluid, the brainwater. We call these the ventricles. In the course of life we all lose brain matter. In some this is more than in others. The space lost by the brain tissue is filled with the cerebral spinal fluid. So the ventricles become larger. They can also become larger when the outflow of the cerebral spinal fluid is obstructed. If this is complete, for instance by a tumour, it leads to serious symptoms that need emergency treatment. If it proceeds slowly then the symptoms will be more gradual. This can be the case in the so-called non-resorptive hydrocephalus where there circulation of the cerebral spinal fluid is disturbed because the fluid is not taken back by the circulation system. This causes the syndrome of normal pressure hydrocephalus (NPH). Unlike Sheryl says in her comment this is not a common condition. I have a record of only 121 patients treated for hydrocephalus over a period of 30 years and this includes all forms. Only a part of these were probably normal pressure hydrocephalus. The diagnosis is not always easy to make. There are symptoms that point in the direction like cognitive deterioration, problems when walking or incontinence with an enlarged ventricle system on the MRI. But even that is no proof and does not guarantee a good result of a treatment which consists of a diversion of the cerebral spinal fluid to the heart or the abdominal cavity. There are some additional tests but none of them is 100% conclusive. The MRI can show some typical signs but even then no guarantee for correct diagnosis.

[Dirk Z]

On 1/6/2024 at 1:18 PM, Sheryl said:

I see. Normal pressure hydrocehalus (NPH) is a very common funding in  people over age 60 and can sometimes cause tremor and other Parkinson-like symptoms, However  "fluid increases to the limit acceptable for my age" suggests you do nto, at this point, meet the definition of hydrocephalus (which would be fluid amount over the normal limit for your age) hence the advice to just repeat the MRI in a year.  I don't think any one is going to perform surgery for hydrocephalus with your current findings and symptoms.

 

However, the MRI finding does not seem to explain your tremor (assuming the radiologist's report is accurate - should certainly have the actual scan re-read by a skilled specialist)

 

A  neurologist with expertise in hydrocephalus (even though you seem to fall short of that diagnosis) at Siriraj is   Prof. Sarun Nunta-aree

https://www.siphhospital.com/en/medical-services/find-doctor?doctor_id=239&medical_id=59&day=&startTime=&endTime=

 

He can also be seen at Bangkok Hospital  https://www.bangkokhospital.com/en/doctor/dr-sarun-nunta-aree-2

You will nto get a different result at a different hospital seeing the same doctor. But SIPH maybe be a bit less costly than Bangkok Hospital.

 

Be sure to bring the actual DVD of the MRI with you, not just the report.

 

If the result of this consultation is that your MRI findings do not explain your symptoms (quite possible), you could  then consult specialists  in MS and Parkisnon's, as tremor can be early sign of both. There are many MS specialists at Siriraj, ask Prof. Sarun to suggest one. For Parkisons's  that seems to be more a Chukalonhgkorn specialty  while Siriraj's neuro department ism ore focused on autoimmune neuro problems like MS.  If you want to see a neurologist at Chula let me know.

 

Wherever you go, you should have some basic tests to rule out non-neurological causes of tremor such as:

- B12 level

- serum sodium, calcium, magnesium

- HB1Ac (for diabetes/hypoglycemia)

- thyroid panel

 

The light-headness after getting off elevator at a high floor is actually more suggestive of an inner ear issue than anything else. Do you have vertigo at any other times, like when rapidly getting out of bed or otherwise changing position?

 

Lastly:

- how much do you drink? (alcohol)

- What if any medications are you on?

 

 

Sorry to have to correct you. NPH is not common at all, ventriculomegaly is, but it is not the same and not treatable as opposed to NPH that can have good results after shunting. The triad of symptoms for NPH are cognitive deterioration, gait disturbance and incontinence. On the MRI large ventricles with hyperdense lining. Tremor and Parkinson symptoms are not part of the NPH complex.

[Dirk Z]

In a previous post I said: "I have a record of only 121 patients treated for hydrocephalus over a period of 30 years and this includes all forms." I omitted : patients over 65 years of age. The many other CSF operations are children or younger patients where it is unlikely that they had NPH. Even those over 65 are not allNPH patients, but my database records treatment and not diagnosis.

[thesetat]

On 1/6/2024 at 2:00 PM, Sheryl said:

OP does not mention suffering from pain. His issues are a slight occasional hand tremor and vertigo after taking an elevator to a high floor.

 

Pain management center would not be appropriate for that. (But good to know you had a good experience with it!)

The pain management center there has a neurologist there and the doctor in that pain center also has after hours offices in the newer hospital building. I know because I go to both.