I live in Maryland too, and some recent changes on my MRI as well as severe arm fatigue have my neuro sending me to Johns Hopkins for further evaluation....he had mentioned a possible spinal tap but then backed off and said lets see what they say...I think I have exhausted his testing ....he did emgs and ncs and dopplers on my arteries, I see him also for migraines..just wondering if your doc did more tests, or did he send you to Hopkins for more tests and what your sx were? I have already been seen there once for a different issue that they couldn't figure out and am being put with same doc....right now looking at PN testing, I think.....I just don't want to be blown off....how do you make them give you the right tests? My recent MRI after 5 months did have some focal changes ....more lesions....neuro still not sure on the the MS at all....