I wasn't even close. It came back, not just abnormal, but weird. All kinds of odd changes. Nothing easy to point a finger at, like a stroke or brain tumor. But definitely not normal.
Like I always do in these cases, I called the neuroradiologist who read it, and discussed the case. He was pretty certain of the strange findings. We reviewed all the different causes, and none of them fit with his history.
Because of the unusual nature of the findings, I got a copy of the MRI and took it to another neuroradiologist for a 2nd opinion. She absolutely agreed with the first guy.
So, I was stuck with something weird, not easily explainable for his case. After hospital rounds the next night I went to the hospital library, and spent some time looking up the findings, what can cause them, how you work them up, etc. I had Mary bring him in, working him in over lunch to give me extra time to discuss the news with him and answer his questions.
He came in, and I took some time. I explained the findings, and what they might mean. I went over the steps to work them up further, including a spinal tap and labs. He and his wife sat in silence as I went over everything. Finally, I opened up the floor for questions.
Mr. Sternberg: "These abnormal findings, could they be caused by lymphoma?"
Dr. Grumpy: "You have lymphoma?"
Mr. Sternberg: "Had. About 10 years ago."
Dr. Grumpy: "How did they treat it?"
Mr. Sternberg: "I had chemotherapy, and they did radiation treatment on my whole body and head."
(Pause. I pick up the phone and call the neuroradiologist, who says that, yes, absolutely, the changes are typical for someone who's had radiation).
Dr. Grumpy: "Yes, they're likely from radiation. Why didn't you tell me you had lymphoma?"
Mr. Sternberg: "I didn't think it was important. By the way, my headaches are gone."
Today's lesson people: When the neurologist asks about your past medical history, lymphoma and brain radiation are things you want to mention.