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Neurology (Expert Forum)
Worsening of Symptoms Due to Steroids?
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Worsening of Symptoms Due to Steroids?
by Mezazinine, Sep 16, 2006 12:00AM
My problems first began when I was waking up first thing in the morning with intense migraine headaches that would go away on their own after being up for a while. I've had migraines in the past but it was different from this.
The symptoms that prompted me to see a neurologist occurred when I had strep pharyngitis. As my fever and sore throat were developing, I developed a numbness that was on the right side of my body and very painful tendonititis that developed along with the strep symptoms. I stopped developing neurological symptoms shortly after beginning antibiotics. I was sent to a neurologist because the numbness persisted after the fever was gone.
It was 2 weeks before I saw a neurologist and got a MRI. There was a lesion at C3-C4 and a couple of "punctate" brain lesions. He diagnosed MS and insisted I get IV solumedrol even though the symptoms were leaving. On 3rd of day steroids, I developed new symptoms such as vitreous floaters, tingling in my feet that was worse on the left side, and Lhemmitte's sign. Neurologist called this a "medication side effect". I have proof that I worsened because 2nd MRI had 3 lesions on the c-spine instead of just one. Other MRI findings were cerebellar tonsillar ectopia; mastoiditis. I had a LP that showed no oligoclonal band; IgG index of 0.64. I also had several mouth ulcers and red eyes from posterior blepharitis for several weeks.
Is it normal to get worse b/c of steroids? Could this have been one long episode? How can you tell ADEM from MS on a MRI? Were my strange headache, blepharitis, and ulcers related?
The symptoms that prompted me to see a neurologist occurred when I had strep pharyngitis. As my fever and sore throat were developing, I developed a numbness that was on the right side of my body and very painful tendonititis that developed along with the strep symptoms. I stopped developing neurological symptoms shortly after beginning antibiotics. I was sent to a neurologist because the numbness persisted after the fever was gone.
It was 2 weeks before I saw a neurologist and got a MRI. There was a lesion at C3-C4 and a couple of "punctate" brain lesions. He diagnosed MS and insisted I get IV solumedrol even though the symptoms were leaving. On 3rd of day steroids, I developed new symptoms such as vitreous floaters, tingling in my feet that was worse on the left side, and Lhemmitte's sign. Neurologist called this a "medication side effect". I have proof that I worsened because 2nd MRI had 3 lesions on the c-spine instead of just one. Other MRI findings were cerebellar tonsillar ectopia; mastoiditis. I had a LP that showed no oligoclonal band; IgG index of 0.64. I also had several mouth ulcers and red eyes from posterior blepharitis for several weeks.
Is it normal to get worse b/c of steroids? Could this have been one long episode? How can you tell ADEM from MS on a MRI? Were my strange headache, blepharitis, and ulcers related?
Doctor's Answer
by CCF-Neuro-M.D.-SH, Sep 18, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and history you describe are most consistent with MS (multiple sclerosis), but other etiologies such as ADEM (acute disseminated encephalo-myelitis) are possible. MS exacerbations or "attacks" often occur when the body is stressed with an infection such as a UTI or respiratory illness. I doubt that you got worse due to the steroids, but you likely were getting worse due to your MS(as demonstrated by the new lesions on the MRI) and your new symptoms were attributed to steroid affect (causes mania, insomnia, energy, psychiatric problems in some). Steroids do not stop or reverse the demyelination, but do reduce some of the inflammation and decrease the time of some exacerbations. Your IgG index is on the upper side of normal, I would also suggest that you have a visual evoked potential and a somatosensory evoked potential. I think ADEM is less likely, because it is generally much more severe than what you described. I suspect the headache, blepharitis and ulcers were due to the underlying, viral/bacterial process that caused your upper respiratory infection (problably viral first, then followed by bacterial).
I would recomend that you are followed by serial MRI imaging, and see a neurologist that specailizes in MS. You will likley benefit from disease modifying therapy from the symptoms you have described.
I hope this has been helpful.
The symptoms and history you describe are most consistent with MS (multiple sclerosis), but other etiologies such as ADEM (acute disseminated encephalo-myelitis) are possible. MS exacerbations or "attacks" often occur when the body is stressed with an infection such as a UTI or respiratory illness. I doubt that you got worse due to the steroids, but you likely were getting worse due to your MS(as demonstrated by the new lesions on the MRI) and your new symptoms were attributed to steroid affect (causes mania, insomnia, energy, psychiatric problems in some). Steroids do not stop or reverse the demyelination, but do reduce some of the inflammation and decrease the time of some exacerbations. Your IgG index is on the upper side of normal, I would also suggest that you have a visual evoked potential and a somatosensory evoked potential. I think ADEM is less likely, because it is generally much more severe than what you described. I suspect the headache, blepharitis and ulcers were due to the underlying, viral/bacterial process that caused your upper respiratory infection (problably viral first, then followed by bacterial).
I would recomend that you are followed by serial MRI imaging, and see a neurologist that specailizes in MS. You will likley benefit from disease modifying therapy from the symptoms you have described.
I hope this has been helpful.
It's unclear why your symptoms got worse on steroids -- it could either be a coincidence or, perhaps, your original symptoms were infectious to begin with and steroids may have made them worse. LP findings should've picked it up, so most likely, the symptoms just got worse for other reasons.