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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Previous Post of 8/2Forum: Neurology Forum
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Hello again, I posted a question to your forum on 8/2 and received a couple of follow-up from other users of your forum, but none yet by the physicians. I understand how busy everyone is and that this is an entirely volunteer system. And I appreciate all of your time you have committed to this program. It is truely a great forum, I've learned alot. My hope is that you will have the time to answer my questions to my original post, I am scheduled to go to UCSF Medical Center on the 31st and would like any advise you can give me. Thanks so much for your time. = Your symptoms do sound like they could be from MS, though as you have discovered, MS is sometimes a very hard diagnosis to make. There is no definitive test which proves or disproves it. But my clinical suspicion is raised that everything could fit with demyelinating disease in the CNS. Bear in mind that many patients with symptoms worrisome for MS turn out not to have it. As your other doctors have told you, time will tell. You are wise not to neglect other possibilities. There are other causes of neurogenic bladder. We typically divide them into "upper motor neuron" and "lower motor neuron" disorders. In motor control of anything, there is a cell in the brain (upper motor neuron) which is connected to a cell in the spinal cord (lower motor neuron). The cell in the spinal cord sends out axon fibers which are bundled to make up nerves. So MS, being strictly a central nervous system disease, would be in the class of upper motor neuron diseases. Other causes of damage to the upper motor neuron: usually some sort of mechanical damage to the spinal cord (trauma, tumor, vascular malformation, etc). You have had MRI of cervical spine, which is reassuringly normal (trauma, tumor, etc, would show up). I don't think I saw any thoracic cord MRI. Lumbosacral cord MRI might be helpful too. Lower motor neuron neurogenic bladder is usually from some sort of neuropathy. The classic example is diabetes, though there are other causes of neuropathy. A variety of disorders of the autonomic nervous system can also lead to neurogenic bladder. Evaluation of neurogenic bladder should be systematic, to localize the problem (upper vs lower) and to always reconsider the possibility that the problem is not neurogenic (local mechanical problem within the bladder itself, etc). I hope this helps. CCF MD mdf.
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