What constitutes a relapse?

[mathgirl24]

The tingling is back in my left hand.  I have had loss of sensation in it for a while now.  Now I also have a warm sensation in my lower left leg that I haven't had before.

Background:
April - June this year had an attack of tingling, numbness, (left side) and double vision. This was not my first attack of these symptoms.  They happened the summer before but went away so I didn't think much of it.

Went to neuro for the first time during this
Exam: Babinski on left side, nothing else noted
MRI normal
EMG normal

Started feeling better once fall came and have felt great since then.  Now these symptoms have popped back up in the last couple days.  I am in limbo land still and was wondering if I do have MS, would this be considered a relapse?  The tingling and numbness is worse this time too.

I'm definitely going to mark it down so when I go back to the neuro in March she can see the timeline.

[supermum_ms]

hmmmm I actually fail the Romberg test even with my eyes open, standing feet together or looking up brings on the wobble-board wobble (cerebellar sign). A disruption like a nudge, someone stepping into my personal space unexpectedly, taking a sudden step and my balance totally goes out the window, its a fight with gravity and i'm lucky if i stay on my feet lol eyes closed it's practically instantaneous and i often don't even realise i'm going down....good video examples of the Romberg are shown on the physio pedia site or the neuro exam site

http://www.physio-pedia.com/Romberg_Test
http://www.neuroexam.com/neuroexam/content.php?p=37

It's not usually very accurate doing any of the neuro tests on your self,  generally people with true proprioceptive problems will sway when their gaze is diverted from the ground and the situation worsens when the eyes are closed.

IF you become wobbly whilst you are testing for Romberg but your not typically loosing your balance at other times too eg no matter what your doing when ever you close your eyes when standing - washing your hair in the shower, walking into a dark environment or the light goes out on you, doing laundry/dishes, kissing, sneezing, laughing, talking etc you really could just be misinterpreting it.

Usually a false positive Romberg is more likely if you can remain stable with eyes open even when your gaze is diverted from the ground, or your doing something at the same time but you can get very unsteady and or loose balance when your eyes are closed doing the test.

Off the top of my head a positive Romberg could indicate either vestibular or proprioceptive issue, and i think most commonly its related to spinal issues (spinal stenosis) and Vitamin B12 deficiency. If there was nothing abnormal at all showing up on your spinal MRI and EMG to be honest i'm not really sure about any of the other possible causes of everything.....i still think it's worthwhile contacting your neuro on monday.

Cheers........JJ    

[supermum_ms]

Hey there,

Unfortunately the issues when no other abnormality but the 'babinski' is found during the neuro exam, is that the babinski can be easily misinterpreted, incorrectly performed, hyper withdrawal response, severe physical exhaustion, transient extensor plantar response, its non specific and even just benign.

Your neuro was basically interpreting your toes going up on the left (babinski sign) as not necessarily meaningful which can be true but if you remember, you also had 'loss of sensation on left side' mentioned in your neurological assessment report too!

Whilst i get why your neuro could see the babinski as not necessarily meaningful, it's a lot harder for me to understand why together these 2 detected neurological abnormalities are not being seen as suggestive of a spinal causation....?

You had the EMG which typically detects permanent (and sometimes the intermittent) peripheral nerve issues and your EMG was normal, but if you've only had the normal brain MRI and nothing else looking at your spine, it's possible the explanation is still coming from your spine.  

There is potential of this being a relapse although it still doesn't necessarily indicate it has anything to do with MS relapses, because flare ups of symptoms are not unique to MS but i really don't think you should wait until March before you see your neuro about this.

When your in limbo, the return of some or all of your prior experienced symptoms, with the addition of something along the same line but totally new, it should warrant an earlier appointment even if all it achieves is the event being on put on record by your neurologist.

Let us know how you get on..

CHeers........JJ  

[mathgirl24]

Thanks so much!  I did have a brain and c spine MRI with and without contrast.  She also used the EMG machine (whatever it is called) to check the nerves in my neck.  

I also believe I have a positive Romberg test too.  I don't fall over the second I close my eyes but i can't make it more than 15 seconds.  When she did the exam though she only had me stand there about 5 seconds top with my eyes closed.  I was under the impression you were supposed to be able to stand there for a full minute without loosing your balance.

Since it's the weekend, I'll have to contact the neuro on Monday.

[HVAC]

I know this is frustrating. Can you have someone do a video you on your phone or camera for the doctor? With a normal MRI it makes it harder for a diagnosis. Lets hope your neurological exam has changed. I would call the neurologist and try to get an appointment. The worst that can happen is they do nothing.
Alex