Can you still be Dx'd with a normal neuro exam???

[shawnie31]

Oh hi it's me again. Sorry for so many questions lately. I just checked our health pages cause I thought I read something on this before.

Does anyone know if your neuro exam needs to be positive somehow for neuro's to believe it's really MS??

Thanks

[shawnie31]

Thanks for explaining this in greater detail. That's exactly what I was inquiring about. I'm hoping to get a copy of my first neuro exam before I see the third one.

Take care

[shoshin]

I realized I left off the main point I wanted to make. I swear sometimes my brain is just AWOL.

What I meant to say is that neuro #1 (the hypersensitive nerves guy) said that my exam was in the "normal range." Six weeks later when I saw neuro #3 (the one who dx'd me), I hadn't changed noticeably, but he did more tests and concluded I had MS.

Neuro #3 approached the situation with a more open mind (despite the fact that I arrived with an abnormal EMG/NCV report showing mild sensory peripheral neuropathy, when he sent me for a repeat he said he thought it would be normal; it was and I've always regretted not asking him how he knew that). He also took what I said more seriously. For example, even though I apparently didn't have significant problems with the balance part of the exam, neuro #3 asked follow-up questions about the type of balance problems I was having--I think in order to try to narrow down the source of the problem.

So far as I can tell, the results of the exams were basically the same.

Neuro #1: bilateral Hoffman's (which according to Wikipedia at http://en.wikipedia.org/wiki/Hoffmann%27s_sign is a central nervous system problem and which I have apparently had, at least on the left, since my first neuro appointment), patient had a "tendency of swaying back and forth without falling" during the Romberg (which sounds like I was doing in on purpose, but I don't remember swaying) and decreased  vibratory sensation in the ankles.

Impression: Sensory neuropathy; *normal* neurological examination

Neuro #3: Hoffman's sign on the left, nothing about the Romberg, diminished temperature sensation up to mid shins and wrists, pinprick sensation decreased in a nonspecific pattern, vibratory sensation absent and proprioception impaired at the toes.

Impression: suggestive of mild sensory neuropathy or pathology of the dorsal column of the spinal cord

Two very similar exams; two very different outcomes. So it really can depend on the neuro.

Well, that's probably more than you want to know, but it can pay to get a copy of your records (I didn't get the records from neuro #1 until much later, which in retrospect was a mistake) and a second opinion.

sho

[shawnie31]

I don't mind at all sharing with you my list of symptoms. The most frequent ones lately are:

fatigue, muscle spasms, numbing to lips and nose, legs and arms are heavy, confusion, pain in head (not a headache though).

Symptoms I've had but aren't around everyday....

Urinary incontinence
Blurred Vision
Memory issues, mis-spelling my name

I think that's all for now. I'm currently waiting for another appt with a Neurology Helth Centre where I think I will see more then one neuro. I can't wait.

Take care

[Melissa072]

Do you mind if I ask what your symptons have been?

Melissa

[shawnie31]

Thanks for your reply. I also have issues with balance. They have sent me to physio for is but it really didn't help me with my balance issues. EENT has ruled out an inner ear as being the cause for my balance issue.

The last neuro I saw didn't seem to think that my balance issue was really a problem. My ankles seem to be locking up when I go down stairs now too so I really make sure to be holding on the something.

I was just prescribed Baclofen for my spasms, so far it's working really well it's really been helping me to sleep and function better during the day. I hope it lasts.

Take care

[shoshin]

This is a tricky question. I don't think you can get dx'd with MS without some symptoms, but some things don't show up on the exam. However, you can get something called Radiologically Isolated Syndrome where people have an MRI for another reason and turn out to have suspicious-looking lesions without any symptoms.

I think there are few things to keep in mind. You certainly can have MS without anything showing up an exam yet or at the time you have the exam. There seem to be a few reasons for this, such as:

1. It's early in the game and nothing has tipped over into grossly abnormal. MS can still be working its evil even when you feel fine.

2. Not all neuros are as thorough or effective on the exam as they should be.

3. Some neuros tend to discount things they can't actually see, like sensory symptoms.

4. You as the patient can know subjectively that something is wrong long before it shows up on a neuro exam. I think there's some fudge room and that the exam is probably just not sensitive enough to pick up everything. In my case, I had balance problems such that I really could not use stairs without holding on to the railing and could not go very fast, certainly couldn't bound up or down stairs, for several years before any balance problems showed up on exam. This is one reason why it's important to get a neuro who will actually listen to you.

5. Some neuros don't keep a sufficiently open mind. Six weeks before I saw the neuro who dx'd me, I went back to neuro #1, who did a whole new patient exam as I hadn't been there in a while. His final conclusion was that I had somehow developed "hypersensitive nerves." Neuro #3, who dx'd me, started over from the beginning with an open mind, ordered more tests, and eventually worked his way around to MS. So far as I could tell, I didn't change between the two appointments, just the neuro changed.

6. You could be in remission at the time of the exam.

That doesn't really answer your question, but I guess they are things to keep in mind.

sho

[shermay]

Many years ago when I was dx., my Neuro dx me with just the exam.  He was the best neuro in the area at that time - he is now retired, so he had many years of experience under his belt.

I presented myself at his office as a private patient, fit, strong, but with double vision.  He ordered the MRI, which came back positive, but it was only when I moved to France, and I had to have copies of all my Dr's notes that I found the letter he wrote to my GP, just after examining me, to say that I had MS - like I said this was before the MRI,

Debs

[milwrite]

It makes sense that when your symptoms are milder in the beginning that your neuro exam could still be normal, but it seems to me that with MS you need treatment to prevent the disease from progressing & your symptoms getting worse & your neuro exam becoming abnormal.

Wobbly, I'm so sorry you had to wait 4 years to get diagnosed.

Shawnie, I know what you mean. I'm relieved when the Neuro is leading away from MS, but then I'm fearful, because I don't know if I believe him and I still don't know what's going on. I hope you get more answers soon.

milwrite

[shawnie31]

I'm sorry about your Dx and I am fearful of one but also anxious all in the same breath to find out what is going on. If you have a minute can you tell me what you remember that was abnormal with your exam? Just wondering...

Thanks

[Wobbly]

Hi there... four years ago when I started having symptoms, of Vertigo and leg weakness... I saw a Neuro and my Neuro exam was normal... then after awhile of more symptoms... my exam started showing things.  I got Dx a few months ago with PPMS.. and my Neuro exam shows quite abit abnormal..

hang in there..
wobbly
dx

[LATW]

I have a friend who was dx'd with a normal neuro exam however she had Optic Neuritis and several lesions in the "typical" MS areas.

That was 2 years ago.  Her neuro exam is no longer normal.

LA dx'd MS 2008