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Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: MS or Vitamin B12 Deficiency? Believe it or not, I've had MS symptoms for 16 years without a definite diagnosis. I was told I was "probable" after a positive EP on the legs in 1984, but a brain MRI in l988 was negative. Symptoms from 1982 to 1988 were numbness and tingling in hands and feet, L'Hermitte's, sensations of heat or water on leg,and occasional blurry eyes, all of which were made worse by the heat, or a fever. I took a 10 year break from doctors, until my symptoms started up again, about 18 months ago, this time with right leg weakness, tripping, bladder problems, balance problems, depression and severe fatique, still some numbness in hands and feet, the L'Hermitte's, and all symptoms still made worse by heat or fever. I recently saw a new doctor who started over with all new tests. Everythings is negative: visual & hearing EP's, brain & spinal MRI. I refuse to have a Spinal Tap. My blood test showed low Vitamin B12 (207), so now he is telling me I do not have MS, and never did, and all my symptoms are from the Vitamin deficiency and should go away in 3 to 6 months. He has given me sub-lingual Vitamin B12 supplements, and sent me on my way. I am having a hard time believing that I could have had a simple vitamin deficiency for all this time and never known it. Wouldn't other doctors have tested for it? If the symptoms are so similiar to MS wouldn't there be many cases of mis-diagnosis? Is my current doctor right? My own web-search came up with Subacute Combined Spinal Degeneration, which seems to me to match my symptoms exactly, but my doctor seems to think that I would be severely disabled and paralyzed with that diagnosis. So I guess my question is: What do you think? Can I completely rule out MS? Do you think my symptoms will all go away after this length of time? Does this sound like a reasonable diagnosis? I'd really like to avoid the dreaded Spinal Tap, and without it being 100% definitive, I see no reason to have it. Any advice is appreciated. Thanks!! Dear Wendy, thank you for the question. Well, I can not tell you without examining you, but B12 deficiency can certainly cause neurologic symptoms, such as what you have described. The term subacute combined degeneration refers to two tracts in the spinal cord that is affected from the B12 def. Your level is a bit low (low end nl) The other findings with B12 def is gastric anchlorhydria (reducec acid secrietion), macrocytic anemia (low red blood cells, and they look bigger than normal). A diagnosis of Subacute combined degeneration demands immediate treatment of B12.which is NOT sublingual B12 but INJECTION of B12 for life. A level of less than 100 is usually associated with neurologic symptoms, whereas level less than 200 pg/mL needs further investigation. More sensitive test such as methylmalonic acid and homocysteine is helpful in these borderline cases. There is also Shilling test for B12 def, but it is difficult and cumbersome to perform. The most important factor influencing the response to treatment is the duration of symptoms before treatment is begun. I hope the above information is helpful. GOod luck to you. | |
