Intermittent hot hands/feet

[loubird222]

Hi,
Over the last year I have noticed my hands and feet will randomly get bright red and burn up. This happens on my feet more often at night or in the summer time, and it is bilateral. It happens on my hands randomly and usually only occurs in one hand at a time.
I have not been diagnosed with MS. Three years ago I had a brain MRI that showed numerous lesions in a "typical MS pattern" (although I'm not sure where exactly they were), but had no lesions on my spinal cord. My last MRI was 1.5 years ago and there had been no changes. At that time my neurologist decided that he didn't need to follow me anymore unless I were to develop symptoms- but he felt given the lack of changes and symptoms that I probably didn't have MS. The only other possible MS related symptom I've had was three years ago I had random severe pain while looking in my peripheral vision of my left eye- the neurologist and ophthalmologist were unsure if this was considered optic neuritis or not.
My question is- should I notify my neurologist of this? It does not cause pain, just discomfort. I don't want to seem like a hypochondriac but am slightly concerned that this could be MS.
Thanks for your input!

[supermum_ms]

I don't know what country your from but you should still be able to get copies of your MRI reports and your neurologists reports, your GP may even have copies if he/she was the referring doctor, the report will provide you with more details about the T2 lesions.

If your MRI was stating a "typical pattern for demyelination disorder" this wouldn't be the standard wording in the differentials, your report will definitely have identified each of the specific locations, noted if any of the lesions enhanced with contrast, possible included number, size, shape, dawsons finger etc etc

To meet the MS Mcdonald diagnostic criteria, you needed to have at least 1 T2 lesion in 2 out of the 4 MS specifically identified locations, periventricular, juxtacortical, infratentorial, or the spinal cord and you only needed to have 1 lesion enhance with other's not to have MRI evidence consistent with MS.

see..... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084507/ .....for more information on the diagnostic criteria for MS

In regards to your burning red hands and feet, Erythromelalgia would actually be 1 of the possibilities, there are 2 types primary or secondary but Erythromelalgia is classed as quite rare, most doctors wouldn't ever see it in clinical practice. Secondary from what i understand is the type associated with autoimmune conditions, though they are more commonly associated with Rheumatological conditions eg systemic lupus erythematosus (SLE), rheumatoid arthritis, scleroderma etc.

Whilst Erythromelalgia does have an association with neurological conditions like MS, it's not the most likely explanation in comparison to the more common causes and if there are any other's in your family who've experienced this too, then it would be familial (genetic) which from what i can work out, hasn't been associated with MS.

see.... http://www.drpribut.com/sports/erythromelalgia.htm .....for more information on Erythromelalgia

Cheers.............JJ  

[Woodstock23]

Hi loubird222 this is my first time to post on the forum but I had to respond to your post as I wanted to say that it may be worth looking into Erythromelalgia which can sometimes be secondary to MS. I am not a medical professional but, to my untrained ear, your symptoms do sound very similar. Definitely worth mentioning to your neurologist anyway. Best of luck with it all.

[loubird222]

Thank you so much for your response! The results of the first brain MRI were in a "typical pattern for demyelination disorder" but I had two other MRIs since (last one was 1.5 years ago) that showed no changes, and since I was asymptomatic the neurologist felt that I no longer needed to be followed unless symptoms appear. And yes, I do get migraines so that was what he eventually decided the lesions are most likely from- just the amount and pattern was concerning at first. I will probably send a note to my GP.

[supermum_ms]

Hi and welcome,

MS doesn't generally cause any symptom to be symmetrical, or experienced in all peripherals (both hands and feet) and if you are experiencing hot, red hands and feet with or without actual swelling, whilst it's 'less likely' to be related to a neurological condition like MS......it's not normally something someone of your age would be experiencing. I definitely think it's worth you bringing it to the attention of your GP but keep in mind it could be some type of allergy, medication reaction etc and not always something of medical significance....

As for your MRI showing the "typical MS pattern" I would absolutely recommend you double check all your actual written neurological records! Any neurologist dismissing a patient when their MRI is showing evidence of MS is unquestionably negligent and the only explanation that i can fathom is...

a) the MRI instead said 'un-typical MS pattern' and you are mis-remembering after all these years.  

b) over a time period you still didn't have any changes to your MRI's, and with the addition of not having any neurologically abnormal clinical signs, neurological symptoms, visually abnormal test evidence consistent with ON etc etc and MS probably wouldn't be the most likely explanation for the totality of your test evidence, was migraine or a viral explanation mentioned at the time?

c) the neurologist is a bumbling idiot when it comes to MS, which honestly can happen 'sometimes' although it is the least likely scenario if the totality of your test results isn't consistent or suggestive of a neurological condition going on.

From my perspective contacting this particular neurologist or getting a second opinion regarding MS, would totally depend on what your diagnostic test evidence actual was 3 years ago. Apart from the 'typical MS pattern' comment, none of the symptoms you've mentioned would usually put MS on anyones list of possible causes otherwise....double check and if it does state 'typical MS pattern' then you should definitely consider getting a second neurological opinion.

I don't think you need to make an appointment with any neurologist because of specifically experiencing hot red hands and feet, your GP is more likely to identify the cause and he or she will refer you to the type of specialist you need to see, that is if something does turn up in your general test results.

Cheers........JJ