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Neurology (Expert Forum)
Do I now or will I get MS?
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Do I now or will I get MS?
by teri, Mar 16, 2000 12:00AM
I have had a history of migranes for the past 2-3 years and I am being treated by a Neurologist for the headaches. I also have a history of right leg weakness from a presumed back injury several years ago. My neurologist had a Mri of the brain ordered on me to make sure there was nothing else causing the leg weakness. He also felt that my reflexes were hyperflexia and I hand some tingling on the right side of my face that were not associated with my migranes. The Mri showed that I had multiple foci of scattered abnormality throughout the cerebral white matter, as well as one vague focus within the left upper pons.A few of the white matter had a periventricular location.The corpus collosum had no definite lesions but the undersurface of the corpus collosum was irregular to the right and left of the midline. My neurologist looked at the films because he felt that the lesions could be due to migranes, but once he saw them he felt that they were too big for to be caused by migranes. I had a spinal tap, and the spinal fluid results were negative for protein,glucose,and oligoclonal bands.The csf electrophoresis pattern was normal. The Igg was 936 and the Igg synthesis was 3.80.I now have"pins and needles"feeling in my extremities.
Doctor's Answer
by CCF Neuro[P] MD, RPS, Mar 16, 2000 12:00AM
Dear Terri:
I am sorry to hear about your problems. When they did the MRI scan, on the FLAIR or T2 images, where there areas of different ages? I don't hear the symptoms waxing and waning. But high on the list of possible etiologies would be MS. I can tell you for sure without doing the exam myself and seeing the films, but MS is a very likely diagnosis. Was the IgG synthesis in the CSF high on the labs reference standards? I would think that you likely have MS but the diagnosis should come from your neurologist.
Sincerely,
CCF Neuro MD
I am sorry to hear about your problems. When they did the MRI scan, on the FLAIR or T2 images, where there areas of different ages? I don't hear the symptoms waxing and waning. But high on the list of possible etiologies would be MS. I can tell you for sure without doing the exam myself and seeing the films, but MS is a very likely diagnosis. Was the IgG synthesis in the CSF high on the labs reference standards? I would think that you likely have MS but the diagnosis should come from your neurologist.
Sincerely,
CCF Neuro MD
Thanks,
I really do appreciate it.
Say one has had ms type symptoms on and off for a few years, would am MRI by now show abnormalities? Typically how long does an attack last and does it reach a peak then dwindle off, I've been feeling things for the past 3 months, not getting better. Im guessing Ms would start to clear up now with remission. Also with muscle twitches, is this part of ms and is it typical all around or isolated with one section of the body. I hate to bombard you with so many questions. What tests could give me a better knowledge of the disease and if all neg does that dramatically reduce chance of ms? Again I appologize for the amount of questions and understand if you wish to skip this, I cannot post when I hit post, only under this message. Thanks so much for your time
The MRI of the brain and/or spinal cord would be abnormal and would remain abnormal. The clinical symptoms would wax and wane with periods of recovery between episodes. The duration of episodes would be individual and vary from episode to episode and person to person. Usually, during an excerbation the CSF would be abnormal and produce oligoclonal banding and increases in Myelin basic protein levels. Usually the oligoclonal banding will remain between episodes. If all the tests, neurological exam are normal, then you do not have MS. If only the clinical evaluation is abnormal and suggests MS, you likely have MS. The diagnosis of MS is clinical and can be made in the face of normal MRI and CSF studies, but only an experienced MS physician would likely make that diagnosis.
CCF Neuro MD
Im trying to understand all this, im sorry, im far from medically inclined. Ok wax and wane, you mean durring an episode (attack) like you feel better and worse throughout the attack, or do you mean throughout the course of the disease? Like with an attack I was under the assumption that you feel real crappy and slowly get better. Not a few good days and a few bad in between. (I picture a raw nerve within the body and see it causing problems untill it scars over) In your profession do you commonly see individuals who's flare ups last for several months?
The clinical diagnosis is also one that puzzles me. It sounds as if you present all the symptoms, an MD can diagnose you withouth testing, yet it also sounds like if you have passed all the testing normally you do not have it. So why would a Dr diagnose clinically if he/she can just run a battery of tests. I understand this disease is a very complex one, and I admire your ability and knowlege to understand it. I sure dont! Thanks so much, awaiting your input.
The symptoms of MS come and go. They may last for a variable length of time but will remit. The remission may also be variable from never occurring again to occurring within months. This is why the name is "multiple" sclerosis. There are usually multiple events that occur periodically. During the attack or exacerbation, the loss of function will be present and may or may not return to normal. Usually, there is a slight loss of function with each event, but not always. There is no single diagnostic test that tells you the you have MS. Several tests, such as MRI and CSF analysis can help in the diagnosis but they in and of themselves do not give the diagnosis. The diagnosis is done by clinical exam by the physician.
CCF Neuro MD
Thank you
A high normal IgG index is likely normal. There are many things that can induce the CNS to produce antibodies. Unless the clinical examination is abnormal, and the MRI is also abnormal, I would not consider a high normal to be indicative of MS.
CCF Neuro MD
Thank you for any imput you might give me.
Good luck to all of you who are suffering!
Mary