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CNS Inflammation/MS/Next Steps?
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CNS Inflammation/MS/Next Steps?


  Hi,
  Wondering about possible diagnoses, treatments and next steps you suggest to help "curb" these symptoms and begin preventive measures.
  4 weeks ago I experienced two consecutive evenings of intense headaches in the back brain stem area of my head (unusual for me, as headaches are not a frequent occurence). I took two advil and sleet it off.
  Two days later(while on vacation in CA) I had numbness in my lip that spread to the whole left side of my face/mouth/head within the day. This went on for one week. I visited a local neurologist on day three who suspected a herpes virus (lip/cold sore, which I never have had), he prescribed Valtrex (1/day) and recommended an MRI that was unable to be scheduled in CA.
  The second week numbness spread to lower middle back, top of thighs and upper arms, my general physician ordered an MRI and reported I had scattered white spots all over my brain/brain stem and diagnosed MS, made an appointment with a second neurologist. Prescribes Deltasone (generic of Prednisone 20MG, one a day) in hopes to relieve pressure related to numbness.
  Week three, visit neurologist, got a thorough exam, looked at MRI and diagnosed me with CNS Inflammation. Saw no indication in the MRI of many white spots, just white shading on brain stem and one white spot on cross section of brain. He says to think of myself as a question mark and observe. Prescribes lower dosage of Deltasone. Two days later I'm in bed all day, can't stand up and find my balance, changes prescription to 2 pills over weekend. Weekend I'm very tired, can do one activity and need to rest, sleep majority of time with reoccuring symptoms of lightheaded, congestedness in head, just feeling completely out of it.
  After weekend he changes my Deltasone dosage to 1,2,1,2, every other day. I'm not sure if the drug or dosage is affecting my symptoms, however the numbness has decreased in pressure and thickness. Monday (1/26) will be the last of the prescription.
  Early Symptoms (1st week): Left side facial/mouth/head numbness/tingling (including teeth/tongue), strong pressue in face and teeth and temple, headaches, fatigue, numbness feels like 5 shots of novecain, 5" thick
  Second Week: spreads to arms, thighs, back, subtle spinal pain, fatigue, headaches, lightheadness, numbness continues, pressue/congested head/face, insecure balance/strength
  Third week: numbness isolated to face/head, mouth (changes from 5" thickness to 3" and altercates), lightheaded/strong congestion, nausea, balance, headaches, fatigued almost limp, felt so weak
  Fourth week: numbness isolated to face/head, mouth (changes from 3" thickness to 1" and altercates), dizziness, lightheaded/strong head congestion, nausea, balance, strong headaches, muddled hearing, lower back pain, fatigued
  I just turned 33 (1/22), healthy eating habits, maybe not as much exercise as I should, but always active (yoga, tennis, walking), did have mononueclerosis for 3 months (with recovery symptoms including nose bleeds) at age 13.
  Thank you, in advance, for your response. This is affecting my daily performance and abilities at work. My symptoms can alter, but none have seemed to really quite subside. I would be encouraged by any additional information and suggestions to next steps and treatments.
Dear Heidi:
Sorry to hear about your illness.  I guess I have a problem with one physician saying that your have "white" spots all over your MRI and then another saying that there is only one "white" spot with some shading in your brainstem, and calling it "CNS inflammation".  Did any one of the doctors perform a LP and analyze the CSF?  What was your blood work like?  Although sometimes we can see inflammation on the MRI, if we are worried about vasculitis(type of CNS inflammation) we order an angiogram, or if it is tissue inflammation than the diagnosis of MS becomes the likely entity.  Without seeing the MRI, the blood work and doing the physical exam it is hard to comment on the possible diagnosis.  There seems to be some confusion.  I think the best idea, is to gather all the information and seek a second opinion from a good neurologist who is familiar with MS.  Have him/her go over you with a fine tooth comb, review all the lab work and MRI.  To just leave you with a dignosis of "CNS inflammation" is not
appropriate.  Steroid treatment will affect MS, brain tumors, vasculitis, pseudotumor cerebri etc.  
Sincerely,
CCF Neuro[P] MD




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