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Is it MS; if not, what could it be?
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MedHelp Member's Question

Is it MS; if not, what could it be?

by dizzytinglyface, Sep 29, 2006 12:00AM
I'm a 54 yr. old man with a history of urinary urgency (thought to be prostate related), GERD, including swallowing difficulties; arthritis in the hip and back, and degenerative disc disease in my back and neck.  Three weeks ago I developed tingling in my face, mouth and tongue, and some dizziness.  Brain MRI, nuclear stress test, corotid artery test, and echo cardiogram were all negative.  Doctors thought symptoms might be related to a night mouthguard I had been wearing for about 6 weeks for nightime teeth grinding and referred me back to my dentist to check the fit.  Dentist said very unlikely that guard was causing the problem, and noticed some irregularities on my tongue that could be associated with auto-immune conditions, and referred me to an oral surgeon.  Oral surgeon took an MRI of my jaw, upper neck and sinus cavities, and results were all normal.  He said that if I were a younger female, MS would be the most logical diagnosis and didn't rule it out.  He did not rule out anxiety driven problem, since I am an anxious person under pressure now, but thought my symptoms were too specific to the facial nerves to be only psychological.  He referred me back to the neurologist.  During this entire time, the symptoms come and go, though they have been more frequent the last few days.  I have an appointment with my rheumotologist and neurologist late next week.  I have also noticed that my neck has been hurting me more lately, and I am encourged that all my imaging has been negative. Wondering though whether bladder and swallowing were early signs of MS.
Doctor's Answer

by CCF-Neuro-M.D.-SH, Oct 08, 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 you describe are non-specific and could be related to several different causes.  First, it is unlikely to be MS (multiple sclerosis), given that your MRI was normal and the description of the symptoms is atypical for MS.  However, I would recommend that you complete your MS workup, to be sure.  I would make sure your MRI included GAD contrast and a saggital flair (specific MRI sequence, your neurologist would know).  I would also recommend a Cervical spine MRI with GAD to look for additional possible lesions.  I would also suggest a lumbar puncture (spinal tap) to look for inflammation in your spinal fluid (Tourtelotte, IgG index, oligoclonal bands).  Your spinal fluid should also be sent off to screen for a variety of less likely possibilites such as lyme titers, cytology (for cancer/lymphoma), paraneoplastic panel and EBV/CMV titiers.  A visual evoked potential can look for past evidence of optic neuritis. Bladder dysfunction and swallowing difficulities can be associated with MS, but very late in the course.  These are not typical early or even mid-course symtptoms and are unlikely to be realted.  

Anxiety is another possibility for your symptoms.  This is often related to hyperventilation (unknown to the patient).  This causes tingling around the mouth area and often in the finger tips on both sides.  These symptoms can often be reproduced by asking the patient to hyperventilate (deep, rapid breaths for 1-5 minutes).  You should also have your calcium checked with ionized fraction, since some electrolyte disruptions can also cause similar symptoms.

The final possibility is posterior circulation TIA (transient ischemic attacks/small strokes) to work you up for this I would suggest an MRA (MR angiogram), and make sure your MRI was done with diffusion weighted imaging.  A Trancranial doppler study of the posterior circulation may also help with this concern.

I hope this has been helpful.
Member Comments (15)

by johnflox, Sep 29, 2006 12:00AM
To: dizzytinglyface
What medicines have you taken for your urinary problems and/or infections? Have you taken cipro or levaquin?

What other drugs have you taken for your other health issues?

Are you exposed to toxics at work or enjoying your hobbies?



Some drugs for rheumatic diseases, many antibiotics (cipro, levaquin, nitrofurantoin-macrobid), antimalarials (lariam) and other drugs cause all your symptoms and more, so it is always recommended to rule out that causes.

by dizzytinglyface, Sep 30, 2006 12:00AM
To: johnflox
johnflox - good questions.  I did have a bad reaction to cipro several years ago, so my doctors have stayed away from it and levaquin since then.  In the past few years, I have only taken bactrim.  So far, my internist, cardiologist, neurologist and oral surgeon have considered whether any of my meds, or combination of my meds could be causing my symptoms and all have concluded that it is not drug related.

by dizzytinglyface, Oct 04, 2006 12:00AM
To: Jenny Wren
Thanks for your comments, Jenny.  I haven't had leg problems, other than those associated with my arthritic hips and sciatic nerve problems.  So, your info is somewhat comforting on the MS front.  I too have disk problems, so maybe it's all tied up in that, though both my oral surgeon and one neurologist told me that they doubt the face tingling is associated with a disk because those nerves originate in the brain and not anywhere in the spinal column.

by missmellie, Oct 04, 2006 12:00AM
a test that you need to have is for the HLA 27B. systemic disease called ankylosing spondylitis, some of the symptoms you describe sound like AS. generally overlooked disease in women, usually gone to far before it is diagnosed in women, causes tingling numbness pain in hips, throughout joints in body tendons and ligaments, a chronic form of arthritis, 3 times more likely in men than women.

i have had it since i was 17 at 36 was recently diagnosed after pure agony. i have facial tingling numbness, you see it affects joints throughout body.

if you don't have insurance the test runs about $150 dollars.

with the hip involvement it is worth testing for, generally though it should have been detected before the age of 40. although in some cases i believe that people are misdiagnosed.

good luck i hope this gives you another insight as to what it could be!