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Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Neurogenic Bladder/MS Test Results...Need your help, please First of all I wanted to say thanks to all the doctors on here that take their time answering our questions. I have learned so much through this forum, and really appreciate all you do. I'm a 32 white female born and raised in Arizona. I was diagnosed with Neurogenic Bladder about 3 moonths ago. I had a bladder infection that turned into a kidney infection that lasted almost 10 weeks. Seven antibiotics, IV'S and injections didnt clear it up. Primary sent me to Urologist who diagnosed urine retention. Started self cath 3 times per day and have progressed to about 7 times per day to reach goal of no more thatn 500 CC retention. I can still urinate on own and can feel need to go at times, but this is happening less frequently. I also have high amount of blood in urine. The hematuria was found 3 years ago at which time negative results on IVP and cystoscopy (SP). Symptoms have gotten progressively worse in last 2-3 months. They include: severe fatigue, headaches, migraines, flank pain, back pain, burning shooting pains from back of neck up back of skull, bottom of left foot burning, fingers and toes burn and tingle, left leg falls asleep frequently, in last week weakness in left arm, I'm unsteady on feet and have fallen seven times in last 2 weeks, I have pain in right eye when I look to one side this causes dizziness. I also feel dizzy at times and start to see black spots in my vision. I know this sounds like a lot, but believe me, this is what is going on. Tests include: Negative IVP except shows non-functioning bladder..Negative Cat Scan, Negative Lumbar MRI except show multiple levels of disk degeneration, Negative Diabetes. I had a brain MRI with and without contrast 2 days ago and results will be in on Tuesday. I have not been seen by a Neurologist, and Urologist has no need to see me. My Primary and I are very close and I think he is wonderful but this has gone on too long. My docor, my father and myself have decided that if brain MRI shows MS, iI will stay in Tucson and go to the University Medical Center which is a research hospital that has 2 MS Specialists. If negative MRI, we are thinking about going to The Barrows Institute of Neurology in Phoenix for a week for tests and to get a diagnosis and plan of treatment. This has all taken a toll on my lifestyle obviously. I havent worked much because of feeling terrible, and I'm a single mom and dont have the energy for my 5 year old. My questions are: 1. Do you think my plan is a good one as far as who I will see after MRI result? 2. If this isnt MS, what else could it possibly be? If not MS, would it even help to go to Barrows? It seems like we've exhausted all other diseases. What are the chances of MRI showing MS if I do have it, and if negative, what other tests can be done? 3. What questions should I ask my doctor if negative. 4. Is there any hope in getting to the bottom of this if Negative MRI? Thank you very much for your time and consideration. Your clinic is wonderful, I wish I lived closer to Cleveland. Any thoughts or suggestions will be greatly appreciated.
= Dear DeeDee, Thank you for your questions. Your constellation of symptoms are not uncommon in MS. Especially interesting is your eye pain when looking to one side, do you get double vision too ? How about color vision, is it ok ? Optic neuritis can herald MS. Neurogenic bladder can occasionally be the presenting symptoms of MS. It is no question that you have neurogenic bladder and now the question is that whether or not your bladder problem is due to demyelination (the primary problem in MS). You will need MRI of the whole spine, not just the lumbar area as MS plaque (the abnormal area of demyelination may be in the thoracic or even the neck region). You also mention weakness in your arm, again more reason to get a complete spine MRI. The brain MRI will be very improtant and helpful if it shows plaques, in making the diganosis of MS. If the MRI is negative, there are other tests your doctor may order, such as lumbar puncture (spinal tap) to evaluate the spinal fluid for MS (the MS panel may be ordered), and a visual evoked potential test to evaluate the integrity of the visual pathway. The sooner the diagnosis is made the better, as now we have treatments Good luck, and I hope this helps.
= Dear DeeDee, MRI is sensitive is detecting MS in about 85% of cases, this is higher than the other tests I mentioned above. Nevetheless it is not perfect. More than 90% of clinically definite MS patients will have abnormalities on the MRI. There are specific criteria in diagnosing MS. Based on history, examination and laboratory findings, patients are categorized as having clinically definite MS, laboratory supprted MS, probable and possible MS, in decreasing order.
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