What type of doctor should I follow up with?

[SLYR]

Last summer I was having pain in my arms and legs and muscle weakness. I have thyroid disease but all of my thyroid panels were and are normal. My b12 level was 222 but my doctor did not feel like this was the cause of my problem but gave me b12 injections that did not improve my symptoms. My vit. D was 30. She felt like my symptoms might be indicative of MS and ordered an MRI. After the MRI, the radiologist office called and told me my results were normal. My doctor had wanted me to see a neurologist who specializes in MS but I was frustrated with all of the tests and getting no information. After about 4 months, my symptoms stopped (May-Sept '15). Now, this a couple of weeks ago, I started having symptoms again. Pain and weakness in my legs and arms, occasional tremor in one of my hands, severe fatigue and some urinary symptoms. I thought I would pursue some additional testing and requested my medical records. I had never seen the MRI report and when I read it, it turns out it was not clear like they told me it was. In bold letters, the radiologist had written: "There are three punctate foci of nonenhancing T2 signal abnormality in the subcortical white matter of the right frontal lobe. Possible etiologies include post inflammatory change, migraine headache, demyelination or other nonspecific gliosis. Correlation with CSF studies may be of benefit." I have not had migraines.  So based on a period of symptoms, several months of no symptoms, return of symptoms, and last year's MRI, I don't know whether I should see a neurologist a rheumatologist or what my next steps should be?

[HVAC]

I would see the MS Specialist. Neurologists specialize so make sure it is a MS Specialist.

[SLYR]

Thank you!

[supermum_ms]

Hi and welcome back,

I think you should probably see your rheumatologist if you have a preexisting thyroid disease....thyroid conditions can mimic some of the symptoms known to MS and if it isn't the answer you can get the rheumatologist to refer you to a neurologist for further assessments.

MS wouldn't be the most likely explanation when symptoms are in all peripheral limbs though, it's one of the red flags pointing away from neurological conditions like MS, because MS doesn't 'usually' present or cause bilateral symptoms in both upper and lower limbs, there still could be a neurological explanation but it's just less likely to be lesion related...

In regards to the 3 T2 subcortical brain lesions in your frontal lobe....having a few 'non specific' subcortical or frontal lobe lesions is not typically classified as abnormal, MRI reports have a standard list that mentions potential causes when the lesions are in common locations, micro or tiny (1-3mm) etc If you had a history of migraines and you had quite a few tiny lesions, migraine would be a possibility but since there's only 3 in a common location, migraine would be a less likely explanation as would demyelinating conditions like MS. The most likely explanation is the most common which is non specific ischemia (normal micro vascular) or viral eg mono etc  

Hope that helps......JJ