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Neurology (Expert Forum)
Why no definite MS diagnosis?
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Why no definite MS diagnosis?
by Morningstar208, Mar 19, 2006 12:00AM
I am a 60 year old woman who presented with left sided numbness,
balance instability, clumsiness,foot drop. Neuro did MS workup, first in March 2005 (MRI positive) and second one in December 2005. Radiologist read positive for MS (based on diagnostic criteria) plus one small stroke both MRI's. March 2005 lumbar puncture negative and EVP negative. No change in MRI from March 05 to Dec. 05. No black holes. Differential diagnosis both times from neuro small vessel ischemia. Both MRI's positive for optic neuritis on right side. Leg weakness(sometimes severe) since October 2005.Rapid decline in ability to walk except for short distances. Minimal blurred vision. Neuro is hesitant to diagnose MS because of age. Said if 25, definite MS diagnosis. Have ruled out DDD as culprit (neurosurgical consult) Ruled out neuropathy and ALS.
Have appointment at major university with specialist in April.
Should I push for a definite diagnosis to receive treatment before this progresses? Understand reluctance to diagnose this disease in older person. If it walks like a duck...Advice please!. My stress level is off the charts. Thanks!
balance instability, clumsiness,foot drop. Neuro did MS workup, first in March 2005 (MRI positive) and second one in December 2005. Radiologist read positive for MS (based on diagnostic criteria) plus one small stroke both MRI's. March 2005 lumbar puncture negative and EVP negative. No change in MRI from March 05 to Dec. 05. No black holes. Differential diagnosis both times from neuro small vessel ischemia. Both MRI's positive for optic neuritis on right side. Leg weakness(sometimes severe) since October 2005.Rapid decline in ability to walk except for short distances. Minimal blurred vision. Neuro is hesitant to diagnose MS because of age. Said if 25, definite MS diagnosis. Have ruled out DDD as culprit (neurosurgical consult) Ruled out neuropathy and ALS.
Have appointment at major university with specialist in April.
Should I push for a definite diagnosis to receive treatment before this progresses? Understand reluctance to diagnose this disease in older person. If it walks like a duck...Advice please!. My stress level is off the charts. Thanks!
Doctor's Answer
by CCF-Neuro-M.D.-PW, Mar 23, 2006 12:00AM
Unfortunately I cannot make a clinical diagnosis over the internet. You are correct though in pursing an accurate diagnosis at a major center - one must be confident of the diagnosis before initiating treatment (in most circumstances) as the treatment is expensive and has side effects which could be deleterious to your health. If the diagnosis is MS, then treatment may reduce or slow the course of the disease.
There are several mimics of MS which are sometimes hard to seperate out. MS may still be possible in an older person (rarely we see an MRI scan in an older person that suggests MS, when they have had no symptoms reported in their whole life, MS can be clinically silent for long periods of time, and the severity of the disease varies widely). But especially in an older person, the mimics of MS such as vascular disease, vasculitis, Lyme, sarcoid among others should be looked into before a diagnosis is made.
Good luck
There are several mimics of MS which are sometimes hard to seperate out. MS may still be possible in an older person (rarely we see an MRI scan in an older person that suggests MS, when they have had no symptoms reported in their whole life, MS can be clinically silent for long periods of time, and the severity of the disease varies widely). But especially in an older person, the mimics of MS such as vascular disease, vasculitis, Lyme, sarcoid among others should be looked into before a diagnosis is made.
Good luck
PS- Sorry if I sound nasty. I'm just bitter about the treatment I've gotten. I really hope things work out for you.