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Can it be MS? Or b12...
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Can it be MS? Or b12...

I am new to MedHelp forum. I have been having tingling sensation in my hands and feet (mainly left hand) for the past 2 months. I was diagnosed with vitamin b12 deficiency and have been taking supplements. The tingling is much better since then but has not completely resolved (its been 2 months), so my PCP asked me to get an MRI done. This is what the report says. "There are scattered T2/FLAIR hyperintense foci in the periventrical and subcortical white matter of both cerebral hemispheres which are non specific possibly related to chronic microvascular ischemia". Is this serious? Can it be MS or can b12 deficiency cause this?
Tags: MS B12 MRI, tingling
21 Comments Post a Comment
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1831849_tn?1383231992
Hi APS - sorry to hear you're having troubles.

Ischemia relates to blood flow. Blood flow is not related to MS. The key word to look out for, relative to MS, in a radiology report is demyelination (demyelinating). Demyelination is the damage to the coating of nerves in our central nervous system.

MRI is only part of the MS diagnostic journey. The most important part o the process is being evaluated by a neurologist, preferably one who specializes in MS. Is you PCP going to refer you to a neurologist?

Kyle
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Avatar_f_tn
Calling hyperintense foci on FLAIR/T2 images microvascular ischaemia seems to be the standard description when clinical indications of MS haven't been put on the MRI request form.  According to the local neurologist, if you aren't grossly overweight, have high blood pressure, high cholesterol or are a heavy smoker, these spots can be demyelination.  

In addition to what Kyle suggests, my suggestion is keep a diary and track what happens with your symptoms, in particular whether you have the appearance of new symptoms or a significant worsening of a current symptom.  

Best of luck

Poppy

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Avatar_m_tn
Yes, I have a neurologist appointment scheduled for Monday. I have been so worried after hearing about my MRI report. I am not overweight or have blood pressure/cholesterol issues...my PCP was puzzled after reading the report. I am worried the spots are demyelination - but can this also happen because of b12 deficiency?
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Avatar_f_tn
Yes, B12 deficiency can cause brain lesions. I think they heal after several months on supplements, but this is something to discuss with your doctor.

One thing to note is that if there is a relapsing/remitting pattern to symptoms, they are not likely to be caused by untreated vitamin deficiency.

There have been a lot of discussions on this here on the forum. To see them, use the Search this Community box on the forum's main page. You will find quite a few comments by Quixotic1, informally called Quix, who was a pediatrician before MS, and whose information can be relied on.

Good luck with this.

ess

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Avatar_m_tn
Thank you so much for your response. I will check posts from Quix. Is he still an active member on this forum? Are MS symptoms more serious than tingling sensation or can it start out with just this one symptom? I guess what you are saying is once you start taking b12 supplements, the symptoms should steadily improve and not cause them to return (unless you stop the supplements). Is this correct? In case of MS, if the symptoms do return are they more severe than the first time? Does it help to get an early diagnosis of MS - in terms of no new symptoms appearing once medication is started?
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Avatar_f_tn
ah but we wish...........
Quix is no longer active on the forum, she has retired to taking care of herself at home and we so miss her and her wonderful knowledge.

If you have had a B12 deficit, documented by your doctor, he or she will probably advise you how they want you to keep these # in place.    You would be asking them about symptoms coming/going due to B12; we are primarily concerned and have a wee bit of knowledge when it comes to MS.

MS..........do they return and how?  it depends on each of us.  MS is different for each and every one of us, there is no predicting.  Some have symptoms that never return, some get them all the time, some have them come back worse......its an open book and  MS writes the plot line.

Does it help to get an early DX?  probably so, but most of us are denied that possibiity.  It depends on how aggressive your neuro is, how intense the symptoms he is chasing, what they find, etc.  I would have loved to gotten a Dx just 6 yrs earlier, it "might" have prevented my foot drop which is there to stay.........or would it have?  we will never know...........sometimes medications help, sometimes symptoms continue once started.  I've had 3 relapses since starting Tysabri 14 months ago, it depends on YOUR MS and how MS wants to act.  

Thats what makes it so hard to Dx, there is no "hard and fast" rules to go by, either to Dx or to treat.  

I jumped the gun and replied to your post to ess only because I happened to see it just after you posted.  Am sure she will follow with her own answers to you.  I meant no harm, just happened to be "around". (grin) and am soon headed into the kitchen to cook while I am still coherent (my cog fog comes and goes when it wants).

We sincerely hope your problem is B12 deficiency, but do keep a list of your questions for the doctor and if you feel free to share the answers with us, we all learn by sharing!
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Avatar_f_tn
Gosh, there are a lot of complicated issues here.

First off, Quix is a woman, who for several years was extremely active on the forum and helped me and countless others immensely. She hasn't posted in a long time now, having moved into another phase of her life, but she certainly would be welcomed with open arms by many of us oldtimers.

MS can start with just tingling, which is a common early symptom. More to the point is where the tingling is felt. If it's in a few specific areas, that could be MS, but anything close to 'all over' will almost never be MS, because of the disease mechanism.

Most often MS appears in the relapsing/remitting pattern, meaning times of symptom flares followed by let-ups when things either return to normal or get significantly better. There's no predicting what will happen the next time. There are medications shown to reduce flares and disease progression, but nothing remotely assuring no new symptoms. An early diagnosis is better since it allows access to these meds sooner.

When it comes to B12, a lot depends on why one is deficient. If it's because of inadequate diet, then the diet can be rectified and supplements taken until things are normal. Some, though, are lacking what's known as intrinsic factor, a chemical needed to metabolize B12, so no matter how much B12 is consumed via diet, it won't help matters. These people need regular injections of B12, not just pills. My grandmother had this condition (Pernicious Anemia), which is autoimmune, and now my niece has it too. Many autoimmune conditions are hereditary to a large extent

I understand that you are concerned, as anyone would be, but you might be jumping the gun quite a bit. First you need to have it determined whether B12 could be at the root of your issues, and if it is, whether it is being rectified. Let's hope that's what's wrong, because these days it's quite easy to fix.

If you need to investigate MS, I suggest you go to the Nat'l MS Society web site, where you'll find accurate info on all the fundamentals. Additionally, this forum's Health Pages (see far right column) address pretty much all the nitty gritty. Quix wrote a great many of these herself.

Good luck with this, but don't start worrying. If there's anything to worry about, that can happen well down the road, and even then, MS is far from a death sentence. But first things first.

ess
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Avatar_m_tn
Thank you so much for your response. My symptoms started suddenly in the beginning of Jan and they have me constantly worried.  I was really praying for a clean MRI report, but that did not happen. Hopefully, I will get some answers when I see the neuro on Monday. I will share what I learn on this forum. Thank you all.
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Avatar_m_tn
Thank you so much ess. I will try not to worry and wait for what neurologist has to say. He will probably do a bunch of tests. I hope b12 is at the root of my problems, but the PCP did run intrinsic factor test and that was fine. My MRI report is very scary and that is making me jump the gun...but you are right, first things first. :)
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749148_tn?1302864559
I for one miss Quix's post and think about her every time I sign on... She's so full of knowledge and what she didn't know she would research!  Hi to Quix's if you ever pop in just to read :)
Debbie
~Live as if all your dreams came true~
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1831849_tn?1383231992
As has been pointed out here, MS is different for each one of us. While there is significant overlap of symptoms, we all have our own symptom package.

My first symptom was having both feet go numb. This in itself was other than standard, as MS symptoms usually show up on one side or the other, not both.

Yes, earlier diagnosis and treatment is good. But MS, if that's what it is, is not a disease in a hurry. A few weeks, a month doesn't really matter. My feet went numb 20 years ago and I was diagnosed only 18 months ago.And I'm fine :-)

Between now and your neurologist appointment, as Poppy said, write things down. Try and focus on you top 3 symptoms. See if you can reconstruct a history. When did you first notice them? What were the conditions (hot out, humid, daytime, night time) Are there things that you know trigger them? Also note any new symptoms.

If you try and present a 15 item list of symptoms you risk the doctor's eyes glazing over. Once you have address the Big 3, you will have ample time to address the rest of your list.

If you haven't already done so, get copies of all of your test results and radiology reports (including MRI studies on CD) from any and all doctors. Make copies for each new doc you see. They may or may not read it, but it helped me feel more in control of what I was going through :-)

You diagnostic journey may be short and sweet, mine took about 6 weeks, or it may be long and frustrating. Some have been looking for answers for years. But you are wise to star!

Kyle

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1831849_tn?1383231992
"Wise to start!"
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Avatar_m_tn
Thanks Kyle. Hope my diagnostic journey is short and praying the dx is something that is curable. I should get some answers when I see the neurologist for the first time tomorrow. I have copies of my entire file from PCP and the MRI CD with me. And I did start keeping a medical diary. Thanks for all the support.
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3054080_tn?1358726456
Hi, it sounds like you are well prepared for your visit!

The medical diary is a great idea. I keep one, too, and it has helped me discover some trends in the presentation and duration of symptoms.

You may want to peruse my Symptom Timeline thread. While having detailed information is good for your personal reference and may be even added into your records, for the visit itself, short and sweet one-line lists are best. Gives the doctor a very easy reference tool, and you can refer to your more detailed list if needed.

A lot of the pros offered great advice so it might be worth it for you to check it out.

All the best and good luck!

Minnie
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Avatar_m_tn
Wanted to post an update. Saw neurologist today. He told me not to worry about the MRI - he said there are 4-5 "wrinkles" (that's the term he used) in the white matter after looking at the CD. He said out of 100 people, 50 people would have this in the MRI findings and that radiologist report scares everyone. Acc. to him MRI findings are non specific (could be related to headaches etc) He does not think the pattern/distribution is MS like. He has ordered some blood tests - ANA, Lyme, Vit b6 (I am already b12 deficient) and couple others. Now I have to wait till results are back and he has also ordered an EEG after couple weeks. Not sure if I should go for a second opinion? Maybe he wants to wait and see if additional symptoms develop.
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1831849_tn?1383231992
It's good that he keeps looking for answers. In a world full of dismissive neurologists it's great to find one that pays attention :-)

Kyle
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Avatar_m_tn
Sorry - want to correct the test he has ordered. It is EMG.
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Avatar_f_tn
I'd ask for a personal copy of the MRI, you can view them on your laptop/computers now.  Have never heard of "wrinkles", hmm, interesting.
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Avatar_f_tn
Am confused because brain wrinkles are something that everyone has.  They are developed by 40 weeks in the womb.  4-5 wrinkles?  NO NO NO, the brain is COVERED with them, they look like a roadmap if you could look inside your head!  

Yes, they say migraines have lesions now but........wrinkles?  Am just not buying that one!

I'd find an MS specialist and have them read the MRI.......does he read his own?  Just throwing out thoughts for you!
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3054080_tn?1358726456
As usual, Sarah is spot-on.
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Avatar_m_tn
I guess what he was saying was that the radiologist calling them as "hyperintense foci" on the MRI report is scary. They are more like small spots or freckles (sorry...not wrinkle). According to him, they don't cause any harm (of course, it would depend on the size and the amount etc.). But headaches can cause them too.
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