Aa
Possible MS or just anxiety?
How important is contrast? I recently went to a neurologist to get tested for MS. I am a 45 year old male with a brother that has ms. The doctor did a variety of tests in the office and said that my symptoms don't suggest MS and my balance and coordination would never be this good if I had MS. He ordered an MRI without contrast which came back clean, but showed spinal stenosis of the cervical spine. The possible symptoms I complained about were a cold leg and burning on my thighs. These problems come and go so he said they were more than likely caused by anxiety or another spine problem. I got another MRI of lower spine but haven't been back to see him yet. I don't see any problems nor does my physical therapist.
Should I accept his diagnosis or ask for another MRI with contrast. He said that 95% of MS shows up without contrast especially in older patients. The fact that I have no lesions means that it's conclusive.
Should I accept his diagnosis or ask for another MRI with contrast. He said that 95% of MS shows up without contrast especially in older patients. The fact that I have no lesions means that it's conclusive.
Hi, I've seen you dive in and post with some wonderful support and experience. Would you copy and paste this post to a new thread so we all can meet you? Here it may just get buried in viny's post.
Just highlight and copy your info, then click on the green button that says "Post a Question". Paste your info into a new thread. I would like to cdomment on what you have told us, but I want it to be Your thread.
See you on the front page.
Quix
Just highlight and copy your info, then click on the green button that says "Post a Question". Paste your info into a new thread. I would like to cdomment on what you have told us, but I want it to be Your thread.
See you on the front page.
Quix
Just wanted to add my two cents worth about balance and MS and to reiterate what Quix said:
"(your) balance and coordination would never be this good if (you) had MS. Oh, Poppycock!! This guy knows nothing about MS except something he read in a list somewhere. Balance and coordination are not always affected in MS. Some people have problems and some don't. MS doesn't have rules about which symptoms someone gets and when they happen and how severe they are. Many thousands of people with MS don't have balance problems, especially early in the disease."
Poppycock is right!! I have had definite MS for 10 years. My major symptoms are disabling fatigue, fatigue, and more fatigue. But I can stand on one leg, close my eyes, lean back, hop, and touch my nose with perfect balance.
Everyone's MS is different. Good luck to you and your brother.
"(your) balance and coordination would never be this good if (you) had MS. Oh, Poppycock!! This guy knows nothing about MS except something he read in a list somewhere. Balance and coordination are not always affected in MS. Some people have problems and some don't. MS doesn't have rules about which symptoms someone gets and when they happen and how severe they are. Many thousands of people with MS don't have balance problems, especially early in the disease."
Poppycock is right!! I have had definite MS for 10 years. My major symptoms are disabling fatigue, fatigue, and more fatigue. But I can stand on one leg, close my eyes, lean back, hop, and touch my nose with perfect balance.
Everyone's MS is different. Good luck to you and your brother.
wow...is this useful information!
I had surgery for spinal stenosis and cervical myelopathy in 2002. Ten days later, I had a four level lumbar fusion with instrumentation, in which the surgeon damaged the nerve roots. Both of my legs have a degree of numbness, feel cold all of the time, and feel like they weigh 100 lbs apiece. I was informed by my doc. that if I still have those symptoms, they were caused by nerve damage and that ANY tingling, loss of sensation, burning, weakness, etc. was ALWAYS caused by nerve damage, either by compression or actual damage. Since my surgery, however, clinical studies show my back still has stenosis (something we all get as we get older), but there is no obvious impingement at this time.
Having said all of that, my balance is terrible. If I pick up my foot to put my jeans on, over I go like a punching clown. I am constantly falling down,and have injured my head and body many times, I am walking out of my shoes regularly and then cannot pick up my legs to slip back into them. I sleep a lot. Not because I feel sleepy, I am thoroughly mentally but mostly physically exhausted. I was once diagnosed with EB syndrome. Sometimes I am so terribly weak, lifting my head off a pillow takes everything I have got.
This sounds awful, but I can walk into the bathroom to take a shower and then change my mind because it just takes too much energy. I try to eat well, but due to nausea and lack of appetite, I just cannot force myself...either I don't have energy to cook or I am simply not hungry. I do take multivitamins, drink Ensure, and use magnesium, calcium, B-12, and fish oil as supplements. I am reconsidering living alone because I have fallen so many times. This is a horrible thought for me and my Type A personality. I used to snow and water ski, sky dive, play tennis, and work out four to five times a week and was an office manager in a law firm. Now, I can simply rise from a chair and my legs are too weak to hold me up. I don't actually fall down every time, it's more like they just slowly give out.
My hands are always trembling and I can walk down a hall and 9 times out of 10, slowly "drift" as if I were drunk. Lastly, my vision has worsened quite dramatically in the last year.
I am considering making an appt. with another doctor to get an opinion on whether these symptoms could truly be manifestations of MS, as it has been mentioned as a "possibility" in the past. Do you have an opinion as to whether I am wasting my time and all of these could be related to back/neck issues or could some of these "inconveniences" be related to MS? I hate to give up more precious cash if I am simply dreaming of a supported, definitive diagnosis once and for all.
Thanks so much for taking the time to read this. I am at my wits end.
Peace,
AtlantaJana
I had surgery for spinal stenosis and cervical myelopathy in 2002. Ten days later, I had a four level lumbar fusion with instrumentation, in which the surgeon damaged the nerve roots. Both of my legs have a degree of numbness, feel cold all of the time, and feel like they weigh 100 lbs apiece. I was informed by my doc. that if I still have those symptoms, they were caused by nerve damage and that ANY tingling, loss of sensation, burning, weakness, etc. was ALWAYS caused by nerve damage, either by compression or actual damage. Since my surgery, however, clinical studies show my back still has stenosis (something we all get as we get older), but there is no obvious impingement at this time.
Having said all of that, my balance is terrible. If I pick up my foot to put my jeans on, over I go like a punching clown. I am constantly falling down,and have injured my head and body many times, I am walking out of my shoes regularly and then cannot pick up my legs to slip back into them. I sleep a lot. Not because I feel sleepy, I am thoroughly mentally but mostly physically exhausted. I was once diagnosed with EB syndrome. Sometimes I am so terribly weak, lifting my head off a pillow takes everything I have got.
This sounds awful, but I can walk into the bathroom to take a shower and then change my mind because it just takes too much energy. I try to eat well, but due to nausea and lack of appetite, I just cannot force myself...either I don't have energy to cook or I am simply not hungry. I do take multivitamins, drink Ensure, and use magnesium, calcium, B-12, and fish oil as supplements. I am reconsidering living alone because I have fallen so many times. This is a horrible thought for me and my Type A personality. I used to snow and water ski, sky dive, play tennis, and work out four to five times a week and was an office manager in a law firm. Now, I can simply rise from a chair and my legs are too weak to hold me up. I don't actually fall down every time, it's more like they just slowly give out.
My hands are always trembling and I can walk down a hall and 9 times out of 10, slowly "drift" as if I were drunk. Lastly, my vision has worsened quite dramatically in the last year.
I am considering making an appt. with another doctor to get an opinion on whether these symptoms could truly be manifestations of MS, as it has been mentioned as a "possibility" in the past. Do you have an opinion as to whether I am wasting my time and all of these could be related to back/neck issues or could some of these "inconveniences" be related to MS? I hate to give up more precious cash if I am simply dreaming of a supported, definitive diagnosis once and for all.
Thanks so much for taking the time to read this. I am at my wits end.
Peace,
AtlantaJana
Well, yes, you are beyond the average age of presentation (20 to 40), but that doesn't rule you out at all. MS has been diagnosed at 18 months of age and shown to present in the 70's. We have many members whose MS was found in their 50's and 60's. My first symptom was at 47.
The cold leg still should be evaluated for full vascular function, though it may be a neurologic problem. My reading of the genetic literature still puts you between 2 - 5% chance with a brother with MS. Still do you dismiss a person just because their chance is lower? Sounds pretty cavalier to me.
Sounds like you had a good MRI.
The sinuses are separated from the eyes by bone. I don't understand the statement that they would be pressing on the eyes. Ii is well known that the MRI way Over Reports sinus disease. To evaluate the true extent of sinus problems the gold standard is a CT scan without contrast. You should see an ENT specialist.
I still don't think there is enough info to dismiss nor to diagnose MS. My recommendation is still a second opinion.
Finally, you need a good assessment of how much pressure is being put on the spinal cord by the cervical stenosis.
My opinion.
Quix
The cold leg still should be evaluated for full vascular function, though it may be a neurologic problem. My reading of the genetic literature still puts you between 2 - 5% chance with a brother with MS. Still do you dismiss a person just because their chance is lower? Sounds pretty cavalier to me.
Sounds like you had a good MRI.
The sinuses are separated from the eyes by bone. I don't understand the statement that they would be pressing on the eyes. Ii is well known that the MRI way Over Reports sinus disease. To evaluate the true extent of sinus problems the gold standard is a CT scan without contrast. You should see an ENT specialist.
I still don't think there is enough info to dismiss nor to diagnose MS. My recommendation is still a second opinion.
Finally, you need a good assessment of how much pressure is being put on the spinal cord by the cervical stenosis.
My opinion.
Quix
Hello
Just to clear up a couple things. My leg is actually cold 69 degrees while my other leg is 83 degrees. This will go away when I run in place for a few minutes. The foot stays cold and will burn in the shower and be fine for a few hours.
The MRI was of my brain and cervical spine with a 3 tesla closed MRI
Besides the stenosis they found both of my sinus cavities were pressing on my eyes. I have sinus problems all winter.
The doctor said that the majority of people would show signs way before 45 years old and that two men in the same family would be less than 2% statistically. I know that the sooner I get diagnosed the better chances I have, but I certainly don't want to influence their decision and be wrong. I bet there are people out there that are diagnosed with MS that don't have it.
My brother has been very fortunate in that he has had it for over twenty years and still functions at least 90% of normal. He is on copaxon
Just to clear up a couple things. My leg is actually cold 69 degrees while my other leg is 83 degrees. This will go away when I run in place for a few minutes. The foot stays cold and will burn in the shower and be fine for a few hours.
The MRI was of my brain and cervical spine with a 3 tesla closed MRI
Besides the stenosis they found both of my sinus cavities were pressing on my eyes. I have sinus problems all winter.
The doctor said that the majority of people would show signs way before 45 years old and that two men in the same family would be less than 2% statistically. I know that the sooner I get diagnosed the better chances I have, but I certainly don't want to influence their decision and be wrong. I bet there are people out there that are diagnosed with MS that don't have it.
My brother has been very fortunate in that he has had it for over twenty years and still functions at least 90% of normal. He is on copaxon
Hi, and Welcome to the forum. I see why you are concerned with a brother with MS. That raises your risk from about 1 in 800 to about 1 in 25 or 30. So, it's a major deal.
However, the neuro you saw was a dud, a dufus and falls into the category we call DUMB - Doctors with Unfounded Medical Beliefs. He doesn't know what he is talking about.
First though, I need to ask about the spinal stenosis. This can be almost an exact mimic of MS if the stenosis is severe enough to compress the spinal cord, and it could cause the symptoms you are complaining of. Depending on the degree of narrowing, that may be your answer.
Here, though is a discussion of why you should not depend on this neurologist's knowledge of MS.
Anxiety does not cause specific localized symptoms. Using that to explain neurologic symptoms when you don't know the cause is the product of a very mediocre mind. Perhaps you do have some anxiety. Thinking you might have MS can certainly cause this.
Or that your problems are due "to some other spinal problem". Well, now, that is certainly a lot of help. I hope he is motivated to find out what "other kind of spinal problem you have." That's his job. If he thinks it is due to compression of the cord from the cervical stenosis, then I hope he referred to for an opinion from a neurosurgeon. If not, then he hasn't done his job, has he?
A neurologist's job is only not to tell you what "isn't" causing your problem, but to work reasonably to find out what it is.
A cold leg (occurring just on one leg) and burning in the thighs could certainly be early symptoms of MS, along with a bunch of other things. Poor balance and incoordination are classic MS symptoms. MS comes up, of course, because you have it in the family.
(your) balance and coordination would never be this good if (you) had MS. Oh, Poppycock!! This guy knows nothing about MS except something he read in a list somewhere. Balance and coordination are not always affected in MS. Some people have problems and some don't. MS doesn't have rules about which symptoms someone gets and when they happen and how severe they are. Many thousands of people with MS don't have balance problems, especially early in the disease.
Did you have an MRI of the brain and cervical cord? If you had both, then it becomes less likely that you have MS just on a statistical basis. But we know that MS with a normal MRI is possible, seen early in 5% or so. However, there are few neurologists who will diagnose MS with a negative MRI. One of the things you might want to check is the power of the machine. Open machines are typically too low to consistently show the smaller MS lesions. Old machines are often too weak also. No, a negative MRI is NOT conclusive. It sounds like this guy is willing to write off the 1 in 20 people who might have a negative MRI - sounds lazy.
I don't think that what you need is another MRI unless you haven't had at least both one of the brain and of the cervical spine. What you need is a doctor that knows something more about multiple sclerosis.
When he did the neuro exam, which should have been lengthy (30 or 40 minutes) did you have any abnormal findings like reflexes that werre too hyper, or balance problems or decreased sensation in your legs where you feel the burning?
Did this yahoo send a batch of blood tests looking for other reasons that you might have these problems? like a CBC, ESR, HgA1C, ANA, B12, VDRL, at least? The burning sensation is called a paresthesia. We have a Health Page on this you might want to read.
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Paresthesias---Things-That-Go-BUZZ-in-the-Night/show/378?cid=36
Is your leg truly cold or does it feel cold? If it is truly cold, he should have referred you for some vascular studies to make sure the circulation is okay. If it feels cold, but isn't, it is another paresthesia.
Should you have had contrast? The Protocol for MRI for MS recommends that contrast be used. However, it truly would be unusual for a person to have lesions that would only show up after contrast - possible, but unusual. Contrast is most useful in showing how active the inflammation is that causes the lesion in the first place.
I think you should seek a different opinion from someone a little more conversant with how MS really presents. And he sounds like he worships the almighty MRI which is a good, but imperfect tool to be used alongside a thorough history and physical exam. The MRI cannot be used in place of a good brain.
Does it sound to me like you might have MS? I can't tell, you have suspicious symptoms and a positive family history, but the diagnosis (or exclusion) of MS takes a lot more than it appears this neurologist appears to have given you.
I hope to hear more of your story.
Quix, MD
However, the neuro you saw was a dud, a dufus and falls into the category we call DUMB - Doctors with Unfounded Medical Beliefs. He doesn't know what he is talking about.
First though, I need to ask about the spinal stenosis. This can be almost an exact mimic of MS if the stenosis is severe enough to compress the spinal cord, and it could cause the symptoms you are complaining of. Depending on the degree of narrowing, that may be your answer.
Here, though is a discussion of why you should not depend on this neurologist's knowledge of MS.
Anxiety does not cause specific localized symptoms. Using that to explain neurologic symptoms when you don't know the cause is the product of a very mediocre mind. Perhaps you do have some anxiety. Thinking you might have MS can certainly cause this.
Or that your problems are due "to some other spinal problem". Well, now, that is certainly a lot of help. I hope he is motivated to find out what "other kind of spinal problem you have." That's his job. If he thinks it is due to compression of the cord from the cervical stenosis, then I hope he referred to for an opinion from a neurosurgeon. If not, then he hasn't done his job, has he?
A neurologist's job is only not to tell you what "isn't" causing your problem, but to work reasonably to find out what it is.
A cold leg (occurring just on one leg) and burning in the thighs could certainly be early symptoms of MS, along with a bunch of other things. Poor balance and incoordination are classic MS symptoms. MS comes up, of course, because you have it in the family.
(your) balance and coordination would never be this good if (you) had MS. Oh, Poppycock!! This guy knows nothing about MS except something he read in a list somewhere. Balance and coordination are not always affected in MS. Some people have problems and some don't. MS doesn't have rules about which symptoms someone gets and when they happen and how severe they are. Many thousands of people with MS don't have balance problems, especially early in the disease.
Did you have an MRI of the brain and cervical cord? If you had both, then it becomes less likely that you have MS just on a statistical basis. But we know that MS with a normal MRI is possible, seen early in 5% or so. However, there are few neurologists who will diagnose MS with a negative MRI. One of the things you might want to check is the power of the machine. Open machines are typically too low to consistently show the smaller MS lesions. Old machines are often too weak also. No, a negative MRI is NOT conclusive. It sounds like this guy is willing to write off the 1 in 20 people who might have a negative MRI - sounds lazy.
I don't think that what you need is another MRI unless you haven't had at least both one of the brain and of the cervical spine. What you need is a doctor that knows something more about multiple sclerosis.
When he did the neuro exam, which should have been lengthy (30 or 40 minutes) did you have any abnormal findings like reflexes that werre too hyper, or balance problems or decreased sensation in your legs where you feel the burning?
Did this yahoo send a batch of blood tests looking for other reasons that you might have these problems? like a CBC, ESR, HgA1C, ANA, B12, VDRL, at least? The burning sensation is called a paresthesia. We have a Health Page on this you might want to read.
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Paresthesias---Things-That-Go-BUZZ-in-the-Night/show/378?cid=36
Is your leg truly cold or does it feel cold? If it is truly cold, he should have referred you for some vascular studies to make sure the circulation is okay. If it feels cold, but isn't, it is another paresthesia.
Should you have had contrast? The Protocol for MRI for MS recommends that contrast be used. However, it truly would be unusual for a person to have lesions that would only show up after contrast - possible, but unusual. Contrast is most useful in showing how active the inflammation is that causes the lesion in the first place.
I think you should seek a different opinion from someone a little more conversant with how MS really presents. And he sounds like he worships the almighty MRI which is a good, but imperfect tool to be used alongside a thorough history and physical exam. The MRI cannot be used in place of a good brain.
Does it sound to me like you might have MS? I can't tell, you have suspicious symptoms and a positive family history, but the diagnosis (or exclusion) of MS takes a lot more than it appears this neurologist appears to have given you.
I hope to hear more of your story.
Quix, MD
COMMUNITY LEADER
Dont know about you, but i'm getting a little tired of 45 being classed as 'old age' sheesh my twit of a neuro said it could be senile dementia when I asked what could be causing my cognitive and speach problems, ahhhhhm what, so senility starts before 40, I dont think so!
Anxiety seems to get chucked around a lot, you dont have to have anxiety just unexplained sx and thats enough these days. It maybe nerve, PAD, Periferal neuropophy or vein related, not necessarily MS, though with a close family history i'd of though exactly the same thing. Ask your self, do i live with anxiety and specifically health anxiety? If its no and definetely no then 'anxiety' is the least likely cause, still worth finding the cause of your unexplain sx.
I'm not sure if your neuro was trying to be reasuring or just showing his ignorance of MS, there is no magic age but because your 45 he expected you to have less mobility, had MS since your 20's and have a truck load of lesions, your zero for three in his thinking. Its true by old school records, after 20 years an MSer will have significant mobility issues and lesion load, they didn't have DMD's back then to slow it down, and if you didn't develope MS until your late 30's early 40's then your mobility score is a mute point at this stage of the disease.
Regarding MS being ruled out, if you have neurological sx, clinically observable sx consistent with MS, have not had an MRI of brain and spine using standard MS protocol, and do not have an alternate dx that covers all your sx (eg. Lupus, Lyme etc), then MS can not as yet be taken off the table at this time. It is a good idea to have all MS mimics ruled out, mental health cleared for psychosomatic causation, vit D, B etc MS is one explanation but there are others, tick them off until nothing is left. MS can only be discounted when there is a dx of something else that equally explains your sx.
Good luck!
Cheers.............JJ
Anxiety seems to get chucked around a lot, you dont have to have anxiety just unexplained sx and thats enough these days. It maybe nerve, PAD, Periferal neuropophy or vein related, not necessarily MS, though with a close family history i'd of though exactly the same thing. Ask your self, do i live with anxiety and specifically health anxiety? If its no and definetely no then 'anxiety' is the least likely cause, still worth finding the cause of your unexplain sx.
I'm not sure if your neuro was trying to be reasuring or just showing his ignorance of MS, there is no magic age but because your 45 he expected you to have less mobility, had MS since your 20's and have a truck load of lesions, your zero for three in his thinking. Its true by old school records, after 20 years an MSer will have significant mobility issues and lesion load, they didn't have DMD's back then to slow it down, and if you didn't develope MS until your late 30's early 40's then your mobility score is a mute point at this stage of the disease.
Regarding MS being ruled out, if you have neurological sx, clinically observable sx consistent with MS, have not had an MRI of brain and spine using standard MS protocol, and do not have an alternate dx that covers all your sx (eg. Lupus, Lyme etc), then MS can not as yet be taken off the table at this time. It is a good idea to have all MS mimics ruled out, mental health cleared for psychosomatic causation, vit D, B etc MS is one explanation but there are others, tick them off until nothing is left. MS can only be discounted when there is a dx of something else that equally explains your sx.
Good luck!
Cheers.............JJ
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