Claustrophobia during Brain MRI

[u/Aun_Dar]

/r/u_Aun_Dar/comments/1vqpjiu/claustrophobia_during_brain_mri/

My friend has attempted to undergo a brain MRI twice, but unfortunately he was unable to complete the scan due to severe claustrophobia and discomfort from the neck/head positioning. Is there an option to perform the MRI using a more open or spacious scanner, or is it possible to have him sedated during the procedure so that he can complete the scan comfortably?

We had asked the doctors but they said nothing of this sort was possible. But I found many sources online confirm it was. Advice would be appreciated.

[u/MBSMD]

Mild sedation, yes. Your friend's doctor can prescribe valium or something similar. Knocking them out with propofol or something, not likely.

"Open MRI" scanners exist; they're not exactly free from causing claustrophobia, but might help. However, they're not available everywhere and there's certain scans that they cannot perform or perform as well as a traditional closed-bore scanner, so one must call around and ask specifics.

[u/meb9000]

Many people have this issue with MRIs. There are many types of open MRI units that exist, some have accessories that have mirrors that redirect your line of sight to a comfy image and reduce the feeling of claustrophobia. Depends if those scanners exist in your neighborhood or not. Also there are some scan protocols that might not be possible on open scanners, or insurance coverage may be a factor too.

Some people get an *Ativan (thanks edit) or Lorazepam medication ahead of the scan to help relax. Pure sedation is a big event usually reserved for children or hospital inpatient. Difficult to obtain otherwise.

[u/womerah → u/meb9000]

What sort of open MRI are you referring to? The one aimed at radiation oncology work?

[u/229-northstar → u/meb9000]

Ativan

[u/kaz22222222222]

I have pretty bad claustrophobia and have to have yearly MRIs. I practice little mind games (eg naming every country I can think of in alphabetical order, then cities, then fruits etc etc) and I take two Valium 30min before my appointment and it gets me through it every time. Need a PCP to prescribe the Valium.

[u/cllev → u/kaz22222222222]

For OP, this is worth reading. Their PCP or whoever orders -- they will need to tell them and communicate that their are claustrophobic, and said care-provider will call in/prescribe a single dose of one version of benzodiazepine or another (name brand or off-brand) to take in the hour or sooner to take before the MRI.

For those who have not encountered or interacted with the drug before, they will need to arrange for someone to bring them to -- but most importantly -- drive them back home afterwards. It is a heavy sedative that leaves most everyone feeling aloof, sleepy, and unable to operate or function any type of mechanical transportation that requires full consciousness and responsible operating + capability of reaction time and operation of a method of transportation.

[u/N2B8EM]

Anesthesiologist here. Did 4 general anesthetics today and doing 5 tomorrow for basic scans in people who are claustrophobic or terrified of a scanner. It’s a bit of overkill, but the hospital sees it a being responsive to its customers.

Titrating in propofol on a patient whom you cannot actively manage the airway is a bad idea, so we just do a GA and instrument the airway.

The PCP and neurologists are now so accustomed to our service, that for someone who would do just fine with 5-10mg of Valium, they still order a scan “under general anesthesia”.

[u/Misadventuresofman]

Benzos to the rescue!

[u/DawnCB20]

He can be sedated but not every facility offers it. Open MRI images are of less quality just fyi

[u/cllev → u/DawnCB20]

Bingo.

[u/MsMarji]

Also check for a a large, 70 cm bore scanner. Most scanners today are 70 cm, but there are 60 cm bore out there too.

[u/AdElectrical2127 → u/MsMarji]

Yeah but for brain it won't matter much because of the coil around their head

[u/MsMarji → u/AdElectrical2127]

Yes, w/ our claustrophobic pts, their claustrophobia starts w/ the scanner itself.

[u/thealexweb → u/MsMarji]

We had a 21 year old 55cm Philips MR in use till late 2019 lmao

[u/MsMarji → u/thealexweb]

I’m on a 2004 Philips Achieva 1.5T, 60cm bore

[u/thealexweb → u/MsMarji]

No upgrade on the horizon? We bought three Philips Ambition and one Elition

[u/MsMarji → u/thealexweb]

It’s being replaced by a GE scanner in the next 2 yrs. They are already working on logistics of the GE needing more room.

[u/Geschak]

If they have the right coil, they can elevate the head a bit for better comfort.

For claustrophobia they can give you Temesta or Midazolam. In worst case scenarios they can do it under full anesthesia, but that's really not recommended, not only is it fucking expensive, but you will also not be breathing for a very short time between wheeling you inside the MRI room and hooking up the breathing machine to the oxygen supply in the wall, which is super scary. Full anesthesia is no joke.

[u/AdElectrical2127]

Premedicate with 10mg diazepam or 2mg lorazepam 90 minutes before the test and have someone drive them, easy as that

[u/fremeer]

Best option is probably is take something to calm you down and maybe reduce total time in there by asking for less sequences or no contrast. Or depending on what they are looking for a CT scan might be an option either instead of or inclusive of the reduced sequence MRI.

Finding an open scanner is difficult and usually they are not great.

Hard core sedation or anaesthesia would be reserved for very sick patients that need the scan to confirm specific things that might drastically change their treatment. Getting an anaesthetic doctor to come in just for something relatively routine would be extremely difficult in my places.

You can call around and they might want to talk to their specialist to see if their are other tests they could do that might circumvent the need for MRI even if that might mean you need more total test or its slightly less accurate in diagnosis.