Re: misdiagnosis of MS as staph infection?
Re: misdiagnosis of MS as staph infection?
Posted by CCF Neuro MD on June 28, 1997 at 01:56:44:
In Reply to: misdiagnosis of MS as staph infection? posted by Julie E on June 17, 1997 at 11:40:34:
:
On March 11, I went to the emergency room at the local hospital because I was concerned about my speech, which was coming out much slower than I wanted it to. (I'm 32 years old, and stroke seemed unlikely given my healthy lifestyle.) The hospital did a CAT scan, then an MRI, which indicated multiple lesions in the brain -- one about the size of a quarter, and about 15 smaller ones (about the size of eraserheads). The hospital admitted me, then performed a biopsy. From the result of my pathology reports, they concluded that I had a staph infection that was causing the speech problems. My speech returned to normal within a week, and I went on Bactrim for 6 weeks, administered by IV. After I stopped taking the Bactrim intravenously, (but still taking it orally), I developed new symptoms: about 10-25 times a day, my speech slows down so that I sound drunk, my motor skills get jerky and I get a dizzy/warm sensation that works its way through my body and leaves through my feet. I have been having these symptoms for about 2 months now. I asked to have my pathology samples sent to an outside lab for a second opinion. This time, a lab concluded that they were "80 percent sure" that I had demyelination -- that in fact, I probably developed the staph infection in the hospital and that staph was not the source of my problems. I found a neurologist who studied my MRI report, my spinal tap report (negative for MS) and my many blood tests. He concluded that it could be MS or ADEM; that the only way to know if I had MS was to have another major symptom. And that, he said, could be next week, next year or 15 years from now. As for my speech problems and motor problems, he told me I'd just have to get used to them. My questions to you are: Why is it so difficult to diagnose whether or not I have MS? Is there anything my doctors could be overlooking? And do I really have to learn to live with the symptoms? -- my professional life requires much time on the phone and at the computer. Losing my speech abilities and typing abilities at critical moments has been disastrous. Thanks for your help.
Dear Julie:Your questions are highly pertinent and appropriate. I would tend to agree with your current neurologist's opinion. I do not know about staphylococcal infection of the brain causing a problem similar to yours. It might have been a contaminant of your biopsy specimen. It is unlikely that you actually developed staph infection.
The diagnosis of MS still remains essentially clinical. There is no blood or CSF test, MRI finding, or brain pathology finding that is, in itself, completely diagnostic of MS. The diagnosis, in principle, requires the demonstration of at least two typical lesions disseminated in space (meaning at least two different sites in the brain/spinal cord) and disseminated in time (there have to be two more different events or exacerbations). Other conditions which can mimic MS have to be excluded.
If these criteria are unequivocally met, the patient is classified as having clinically definite MS. If not, less definitive labels such as laboratory-supported definite MS, probable MS, and possible MS are used. Although a fair number of these patients eventually (due to the natural course of the disease) graduate to clinically definite MS, some do not.
ADEM is a demyelinating illness which is not disseminated in time. It is a "one time hit". You might now understand why your neurologist is reluctant to label you as MS.
With regard to the question of your doctors missing something, I could enumerate a long list of possible disorders that could mimic MS clinically/radiologically. Most experienced neurologists are aware of these conditions.
If you still have concerns and uncertainties, and want another opinion, I suggest that you visit an MS/neuroimmunology clinic affiliated to an academic institution near where you live. If you live near Cleveland, we would be glad to see you at the Mellen Center affiliated to the Cleveland Clinic, which is involved in all aspects of diagnosis, care, and research related to MS. You could call (800)223-2273 for an appointment. This information is provided for general medical educational purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.
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