Odds of MS diagnosis at appointment

[BBella128]

Hello all. I am new here, although I have been reading a lot of posts over the past several weeks. I have never ever before posted in a forum, but I wondered if you would be able to give me some insight as I am on my journey towards a possible diagnosis of MS.

My story begins approximately 9-10 years ago when I was 28. It started with a strange feeling on my tongue. It was numb, like I had burned it. I knew I hadn't,  and then I realized that the right side of my face was also feeling numb. Soon after, my right side and leg were also numb. I never lost motor function, but the numbness persisted for weeks. My GP was immediately suspicious of MS due to my age and gender and she sent me to a neuro for workup.

Long story short, I did have a lesion on my T- spine and eventually was told that it was transverse myelitis. After a couple of follow up MRIs with no new lesions, I was released from the specialist and told to call back if any new symptoms came up. I still have decreased sensation and tingling in my thigh if I walk a moderate distance, but all other symptoms completely resolved.

So now, all this time later, my shin and most of my foot on the left side are numb. Again, no loss of motor function, although it feels weak, or tired. It's going on 5 or 6 weeks now with no improvement despite a course of steroids. So far a lumbar MRI has ruled out pinched nerve, slipped disc, etc. My doc has put in the referral for a brain MRI and an EMG on that leg. I also have an appointment with the MS clinic that I was worked up at previously.  That is next week.

Also, about two weeks before I came to see my doc about the numbness in my leg, I had been in to see her because of dizzy spells I had been having for the past couple of months that were getting more and more frequent. I was concerned about my blood pressure and wanted to talk with her about decreasing my Wellbutrin since that can cause high BP. (Sidenote, my BP was fine.) At that visit, as she has every single time since my first referral to neuro, she asked me if I had had any more MS-like symptoms. Little did we know that I'd be back in just a couple of weeks with this numbness. Not once did I attribute the dizziness as a possible MS symptom. (I only realized that it could be after I started my crazy googling following the numbness.)

So now my question is, based on my history, do you think it is likely to get a diagnosis of MS at this upcoming appointment? Transverse myelitis never really explained the facial numbness. And it wasn't "complete", which I've read can many times be retrospectively seen as a first MS episode. Also, the McDonald criteria has been updated since I was last worked up. Do my new symptoms satisfy the new criteria for a diagnosis? Does the amount of time lapsed between "episodes" make any difference? Also, based on my symptoms, do you think the brain MRI alone will show anything? Or should I push harder for C and T spine imaging? Would I be more likely to have spinal lesions since that is what showed itself the last time? Or do my symptoms seem to be explainable by brain lesions?

Any insight is greatly appreciated. And if anyone can clarify the McDonald criteria, please do.

Thanks so much for reading.

[aspen2]

Hi Bella!

I would be surprised if you were given a diagnosis at your first appointment, no matter how much the symptoms look like they could be ms.  There are still other conditions that could manifest with ms-like symptoms, and cause similar lesions.

I imagine since you've already had a  documented spinal lesion, your doctors don't feel the need to re-image it at this point.  The spine is one McDonald criteria location; the others are lesions found that are in the juxtacortical, periventricular, or infratentorial areas of the brain.  Another or the same lesion in your spinal cord would not change what happens at this appointment.  The dizziness would be due to a lesion in the brain, if related to ms and not some systemic illness.  Any lesion that showed up now in your brain that was NOT there ten years ago would be new and meet dissemination in time IF (and it`s a big if) a neurologist decided it was characteristic of ms plaque.

Should you have lesions in ms-typical places in your current brain mri, I still think they may do more ruling out of other possibilities, unless everything looks absolutely textbook (which isn't too often the case).  MS lesions have a characteristic shape, as well as being more likely in certain locations.

So yes, your current imaging is key, and at this point I don't believe they will need more information from your spine (towards a diagnosis -- however if you do have ms, they will need updated scans to figure out treatment).

(((Hugs))). The process can sometimes be quick, but more commonly it drags on.