MRI for Hand Tremor

[JordanKX]

Have any of you dealt with hand tremors and/or had an MRI?

I posted a few weeks ago about my 3yo DS being "twitchy" in the mornings. His SLP requested from our pediatrician that he have a neuro-consult. Yesterday when I went to the ped, he witnessed what he calls his "tremor" and ordered an MRI, with the idea that we'll have a neuro consult AFTER. 

Which seems a bit backwards to me, and as much as I don't want to admit it, is Freaking me out.

No one else in our families have tremors.

And when I mentioned something dietary like hypo-glycemia or low blood sugar, he basically washed over that and said he's not concerned about those types of things in a 3yo.

So I've gone from your basic "my son sometimes twitches" to "Hand tremor", and hand tremor seems to have a lot less reasonings behind it... a lot benign, but most of those tend to be hereditary.

Enyhoo... just curious if anyone else has gone this route or has any words of wisdom. I could use a few doses of ... MRI's are helpful just to Rule Out, which is why the ped ordered one first. 

[mopdop2000]

When we were on the disgnosis road with ds2 we were referred to a pedi-nuerologist and told to get a brain MRI done before the appointment. We live in a small town in south west CO, and have specialists from Denver come to do clinics a few times a year. We were told that if we didn't have teh MRI done first, the pedi-neuro would just tell us to get one, then we'd have to wait until the next clinc to get any answers!

Ds was 1 1/2 at the time and had to be sedated ... and that was probably our best expereince with sedation he's had! The other times were for tubes, sedated hearing tests etc andhe was SOOOO angery and disorientated coming out of sedation. We just rocked him to sleep and then when he woke up the second time, life was good!

So, I understand why they would want the MRI first: the pedi-neuro needs something to look at as well as doing a physical exam. And our MRI experience was extremely positive :)

[melissa17s]

Ds has had sedated MRI, too, but he was 9.  Could not stay still for the duration, so sedation was required.  It was terrible for ds because he was very nauseous afterward.  His MRI was to rule out causes for seizures, such as tumor or lesion.  I would assume that the dr. is looking for a focal that would be causing the hand tremor.  MRI is a very safe form of neuro imaging compared to CTscan, which may also be required because it looks at different characteristics of the brain.  Both are diagnostic tools for the neurologist along with information/history that you tell them during the exam or blood work up.  

[JordanKX]

Thanks for your words. I'm really trying to keep my rational brain alive, that they are ruling out bad stuff, just in case. There are a lot of reasons for a hand tremor, I keep reminding myself.

Good to know about side-effects. He just turned 3, will Definitely have to be sedated. oh I can't even imagine otherwise.  I didn't realize "sedation" meant fully out, but I would think he would Have to be. So I'm betting they give you time afterwards to come out of it and get his bearings back.... and a nice lazy afternoon afterwards sounds like a good plan.

I was told the whole process takes about 45 minutes?

[blessedwithboys]

My son had an MRI on the day he turned 5yo.  They said Benadryl would knock him and I warned them that it wouldn't but no one would listen to me.  So they added cloryl hydrate.  It made him extremely irritable and he fought going out like he was in flight or fight mode.  Then in the machine he had very bad desats and they were minutes away from calling 911 (I was at a free-standing imaging center rather than a hospital) when he went back up to 99.  When he was coming out of the sedation, he was almost violently angry and lost bladder control.  He was basically acting like a very mean drunk.  I'm not telling you this to scare you but just to suggest you ask LOTS of questions ahead of time.  I thought I had done so, but I guess I didn't ask the right ones.  The rest of our day after the scan was anything but relaxing, and the next day was no picnic either, since he was still feeling the effects and couldn't go to school.  I'm still not sure if this is a normal reaction to cloryl hydrate or the combo of that plus Benadryl, if my son had a particularly strong over reaction which most people don't have, or if it had nothing to do with the drugs and he was just having a really bad day with his mood disorder.

[blissful_maia]

My ds just had a sedated MRI today! He is 3y3m. It went so, so smoothly. He had similar sedation for a dental procedure (called "conscious sedation", they seem fully out but not as risky as a GA) at age 16-17 mos and it was much rougher for him to wake up from. So needless to say, I was very nervous leading up to today, as he is much stronger physically and more aware of his body/boundaries. But as he woke up, he was babbling quietly to himself and as soon as he realized I was there he reached to be picked up and snuggled with me as he woke up fully. He didn't seem to have any nausea or pain, and promptly drank two apple juice boxes which he kept down easily. We went home about 45 mins after he woke up. Ours was *hopefully* a rule-out MRI as you say, ds has regressive autism and so they want to look at structure, blood flow and enzyme activity in his brain to make sure all is well. 

Hope this helps!

[JordanKX]

Thank you for your stories. Blissful... makes me realize that I've yet to take DS to a dentist, hmmm, really should get on that :)

I think I'm prepped for the MRI. I hope. We're awaiting OHP approval (Oregon's version of Medicaid), which shouldn't balk, and shouldn't take any time. They say once they get approval, should be the next day. So we're hoping for next week.

The bummer about "ruling out" and argh on my brain, of course, is....just that unknown. Of course we're ruling out. Of course there's no fear of a brain tumor. According to his SLP, he has a classic Articulation Disorder. It is Significant, he doesn't just substitute a few consonants... he substitutes almost all, yet at the same time CAN pronounce all when forced to. Which makes more question of WHY is he substituting? She's not discouraged about his speech... she's confident that will work itself out in time, albeit might be up to HIM to make a decision to speak differently now that we've realized he can say all the consonants he substitutes. 

But everything else...  he is not on the ASD spectrum, he seems to have no sensory issues, he seems to have no glaring gross motor issues except... he can't walk straight. He can jump and run and do everything on the test, but he walks sideways and falls All The Time, which they don't test for length of time, just the ability to perform a certain function.

His SLP has this is her notes because she's watched him walk from her waiting room down to her office... he'll literally bounce off walls, or fall for absolutely no reason... as though his legs just forget to work.

Yet he passes all gross motor tests, and fine motor he passes with glaring results because he's Way Smart. If you catch him when he's not shaky, he can do anything. If it's first thing in the morning though, he'll pass still, but he'll have his "tremor" (do not like this new word)

Of course I'm thinking of the parents who were ruling out, and found...

Because there wouldn't be a reason to Rule Out, if the bad stuff didn't exist.

but at least hearing 4-5 stories of MRI's that didn't result in "brain tumor"... that's good for today :) That's enough for me to exaggerate in to the hundreds of thousands of kiddos that get MRI's that Do Not end up being "brain tumor". I hate google... researching can be evil.

Thanks again.

[melissa17s]

I was really thankful my ds's mri was good and his seizures are deemed idiopathic.  I do not know why he has them other than genetics playing a role, but it also means that because the brain is very plastic that he may out grow this because there is no irregularity or injury. JordanKX, I hope your ds has a good MRI, too.  

Blessedwithboys, I did not know benadryl was used to sedate for MRIs.  My ds had general at a hospital.  We had trouble with the anesthesiologist because first he told ds he was going into surgery.  I informed that both myself and dh had problems with general and nausea.  It took over 7 hours after the MRI for ds to be able to hold down food following the MRI and they would not prescribe antinausea meds nor check us out of the hospital.  Ds was unable to move when he came out of recovery and was very weepy for quite a while because he was disoriented.  At least, we had this knowledge this summer when ds had emergency surgery for a ruptured appendix- much better anesthesiologist the second time around.    

[NiteNicole]

My daughter actually had something similar - fine tremor in her hands and a lot of falling down.  As time progressed, we could see it was one leg in particular that was giving her trouble.  She had an MRI with sedation, and just prepare yourself for that because they will NOT warn you but you can get anything from hysterical giggles to screaming panic.  My daughter lost bladder control and screamed till her lips cracked at the corners and bled.  I don't tell you this to frighten you but because if another mom hadn't warned me, I wouldn't have known that such extreme reactions were possible.  Once she finally came around, she forgot all about it and was fine.  Take a snack, they can't eat before and he'll be hungry when he wakes up.

We are about three years on with no real diagnosis other than sort of dystonia...that's as a description but not really a particular diagnosis.  Sometimes the muscles in her right leg act in unexpected ways.  We have no idea what causes the hand tremor but as with her leg, sometimes everything is fine (she can not run and has not been able to since she was almost four) and sometimes it's pretty bad.

Hang in there, ask lots of questions. 
 

[purplepaisleymama]

My now 2yo had an MRI at 14 months...it was done with anesthesia...IV sedation at the local children's hospital and they gave her nasal sedative(a spray that they refer to as loopy juice) and after that took effect which was about 5 minutes they put in the IV and we were good to go. They monitored the whole time she was under and my DH and I stayed in the room...we brought scrabble and a pen to keep score....played through the whole 3 hour MRI( they were ruling out all sorts of major brain issues).  Her recovery was ok, she was not happy afterwards but was only sick once and that is actually typical of her feeds at time (she is breastfed and has swallowing and tongue issues)...she was in recovery for about 20 minutes and we asked to leave as we had a drive to get our older kids. The whole procedure was pretty low key....we were prepared for it and had been through surgery with two of our older children so we are not unfamiliar with hospital procedure etc...if you ask for childlife (or whatever they call it) they usually have someone who will come and bring toys and other distractions for the child and our daughter ended up with a few toys to take home and some stuff for her siblings....if she were older than she was at the time I think it would have been even more of a hit for her. 

[Virginia Mom]

So, am I reading this right? The pediatrician did NOT order any sort of blood work? That's kind of interesting. When my ds had numerous brain scans done (up to an including an angiogram) it seemed like he always had blood work done....sugar work up, white blood count, clotting factor, etc. Keep us posted.

[JordanKX]

So the MRI was yesterday. And was as great as could possibly be. DS was a trooper about meeting the new doctor who was going to let him play with a mask. And the nursing staff was very supportive of me who was trying not to lose it. He went fully under - they offered for him to sit on my lap, but honestly DS was doing so great, I laid him on the table. And he didn't seem scared at all of all the strangers looking down on him. Coming out took some time; about 30min before we could be discharged, but they let him go while he was still quite out of it, although had finally stopped fighting and squirming. 2hrs of Vomit at home. They told me to offer him something to drink, and I gave him 3oz of water. two major vomits from that (3oz turns in to a LOT of vomit!). An hour later he had a cracker which came right back up too. So.... nixed everything after that.

Long 2hr nap. And he woke up saying "me hungry". Gave him a light sandwich. And then he wanted to ride his bike. He'd forgotten all about it.

So, a very successful trip.

Wait is 3-5business days on results, which for a Thursday means potentially until next Wednesday. Sheesh.

THEN a neuro-consult which I discovered today, is not already scheduled. So that could be some wait. Once we have the MRI he'll have a full neuro visit, but NO VirginiaMom, no blood work already done and none ordered, that I'm aware of.

Some other oddities going on with him, I'm considering starting an Elimination Diet. I'd considered waiting until after the neuro visit, but seeing as how that might be a significant wait, I might just tackle an ED diet for the weeks in the interim, see if foods have any indications at all (he has no physical reactions to foods, but he can be hyper and more stumbly, tremor seems to be at completely random times.... not just when he's focusing on a fine-motor task, but just random times of the day). Couldn't hurt, I guess.

Enyhoo.... there's the update. Minus a lot of vomiting coming out of anesthesia, not too terrible. I think the incredible staff & anesthetist had a lot to do with that. We were the first appointment of the day and they really treated us like we were the first people to ever come in to their office. I felt very safe, that my son was in good hands. And Trust Me, I needed that :)

[studentDr]

hi

it is understandable that you are concerned

what are the other things that you have noticed ?

we're there any complications I his birth, has he developed normally ?

is there any family history or epilepsy, any metabolic conditions ?

has he had any accidents recently ?

I worked in paediatric anaesthetics and there was an awesome anaesthetist who got the kids to help him with magic. of course the kids don't remember anything as we give them medications for that.

[melissa17s]

Glad the mri went smooth, minus the vomiting.  Everything is better when you get staff that cares about the whole family and not just the procedure.

Sometimes it can be a slow process to see the neurologist, but hopefully you have a followup with your ped that ordered the mri?  It would be a good time to follow up about blood test or find out if they need any further tests before your neuro appointment (maybe a ct or eeg).   

Hope it keeps going well, and that his tremor and all resolve.

[JordanKX]

MRI results were CLEAN! Oh happy joy-joy dance! :)

I wanted to make sure I posted that, because when I was researching, I found all the posts, but no one ever finished the sentence, you know?

And I'll come back an answer after the Neuro-consult too, but that will be (major sigh) until April. Apparently all of Oregon, outside of Portland, has only one neurologist. Aside from my frustration, honestly... imagine that doctor's life - only neurologist in a 300mile radius? Bummer.

Originally Posted by studentDr 

hi
it is understandable that you are concerned
what are the other things that you have noticed ?
we're there any complications I his birth, has he developed normally ?
is there any family history or epilepsy, any metabolic conditions ?
has he had any accidents recently ?
I worked in paediatric anaesthetics and there was an awesome anaesthetist who got the kids to help him with magic. of course the kids don't remember anything as we give them medications for that.

 

THANK YOU StudentDR for asking.

And I might likely post a new thread for new things about tremors, and history. Because now that I have four months to compile a history, I need to know everything to look at.

I say there were no complications at birth. But my best friend makes me point out that in the last 10 minutes (in my head, who knows... could've been an hour.. I was, obviously not aware of the clock), we lost his heart-beat and things got heated; I remember my doula grabbing my face and explaining that they wanted to do a cranial monitor (and I was coherent enough to flash back to my pre-labor hospital visit where they showed the monitor that they drill in to the skull), explaining  it all to me and asking me if it was okay...  which I OK'd, of course, through my doula because I wasn't really speaking... and soon after, there were the threats of C-section. Which is when D-Ex really kicked in and started, not yelling, but he started to try to push for me. I could tell the pressure was on to Get This Baby Out.  I remember having a moment of thinking that I'd be willing to die, you know, just push so hard that you might die, just so he doesn't. And then he was there.

So, my hindsight thinks 10 minutes, but could've been an hour.

Is that complications? 30hrs leading up to it, and then the last few moments... somewhat of panic?

My best friend brings it up because her son was Apraxic and she holds direct correlation between her delivery and the resulting processing disorders with her son.

I've never really thought his delivery was That traumatic. But by her pressing, I at least give the details.

----

no no and no to everything else. I had a grand maul seizure at 2yo but I was sick for 2weeks prior and had a crazy building fever. I was given anti-seizure meds for  6mo and never had another episode.

So... beyond that, no familial history of epilepsy; no thyroid; no allergies. And no one has tremors, that we're aware of.

I really want the neuro consult. 

I've never asked a WHY about his speech. I'm resigned that it will take time; I'm lucky to have a bestfriend who's kiddo was apraxic and now at 13, after many years, you wouldn't know it. So, I get that work is involved and time. Lots of time.

But hand tremors..... if it is something, I want to know if it's connected.

And it makes me ask the Why about his speech so much more... because He Is Not classic apraxia. While diagnosed Articulation Disorder, he is not that either. He CAN articulate. He CAN say every sound. He just... doesn't. It's a processing... something is getting disrupted. who knows... maybe the two aren't connected.

enyhoo.... I'm rambling. Keep you posted.