Question Title: CSF, MRI RESULTS PLUS MEDICAL HISTORY. WHAT IS YOU OPINION

History:
I am 36 years old and about 7 years ago, I had dizziness for 3 days (not anymore) and since then I had minor neurological problems such as minor feciculations, tingling in my left thumb. MRI IN 1993, 1995, AND 1996 showed 1-4 white lesions. Doctor told me that I have MS even though my LP was normal.

In June of 1998, I found out that I have pernicious anemia and since then I have been on B12 injection (2000 mcg/month). In fact, my B12 level was low even in 1993, my doctor missed reading my test result. I also have minor thalasimia with HGB of 11.5 compared to normal 13.

MOST RECENT NEUROLOGICAL COMPLAIN: Complaining of electric shock in my left leg. No change when I move my head or when I bend by neck. I asked for another LP, MRI of lower back and brain.

MOST RECENT NEUROLOGICAL EXAMINTAION: NORMAL

SPINAL TAP RESULTS: normal for IGG (synthesis rate and index), AND OLIGOCLONAL BANDS WERE NOT DETECTABLE, but protein level was 63 compared to normal level of 50. However, protein distribution was normal.

LOWER BACK RESULT: showed minor tear (slight bulging) at L4 and L5. I will be doing MRI this Friday.

MRI RESULT: Previous MRI scans used standard protocal and most recent one used standard protocal with the addition of Sagittal T2, axial FLAIR and double dose of Godolinium.

Finding: The previous described scarttered foci of T2 prolongation are all identified. These are mostly scattered within the deep white matter and periventricular regions. Most of the lesions are in nonspecific locations however the presence of a pericallosal, corpus callosum and modulla olongata lesions are suggestive of MS. There is no change in the pericallosal lesion as well as the lesion in the posterior body of the corpus callosum. There is however a new foci in the anterior body that appears to be subtly enhance. There are two additional foci not identified on prior exam. One of these lies in the deep white matter of the left frontal and appears to spare the subcortical “U” fibers. the other new lesion is identified in the right posterior parietal lobe. There are no other areas of abnormal enhancement.

Please note that the most recent MRI in 1998 was compared with MRI in 1996, one year before I start B-12 treatment.

: In summary:

: All neurological exams negative since 1992.
: MRI positive in 1993, 1995,and 1996 and 1998
: Evoked potential negative in 1992.
: LP negative in 1993 and 1998.
: History of low B12 since 1993.

The question of MS vs vitamin B12 deficiency has been debated for a long time. Vitamin B12 deficiency can mimick the symptoms of MS, and MRI lesions have been described in people with vitamin B12 deficiency. However, as mentioned in your MRI report, some lesions are very suggestive of MS (e.g. lesions in the corpus callosum). Lumbar punctures can be negative in MS. You can have both MS and a vitamin B12 deficiency. If you keep having new symptoms, and new enhancing lesions on repeat MRIs, despite being treated for vitamin B12 deficiency, MS becomes much more likely. And in this case, although your symptoms are mild and you are apparently not disabled, the question whether you should be started on initiating a disease-modifying treatment (with the so-called "ABC drugs") should be discussed, because these treatments are meant to prevent problems from occuring, not to reverse existing problems. I encourage you to discuss these issues with your neurologist. If your diagnosis remains unclear, you might want to get a second opinion, for example in a MS center if there is one in your neighborhood.

I hope my answer helped. I wish you a Happy Thanksgiving.