Aa
Can it be MS or behcet? what signs should I watch and report to my doctor?
Hello, I'm 33 male, about a month ago while rubbing my right eye, I suddenly noticed blurred vision in left eye, I immediately saw an ophthalmologist, my visual acuity was 5/10. It took about two weeks for different diagnostic exams to be completed and they diagnosed me with retrobulbar neuritis. VEP test showed my left eye P100 was 119mSec and my right eye P100 was 109mSec. my brain T2 MRI(without injection) test was normal and also electroencephalography was normal. in particular optic nerve shows no lesion.
without treatment after a month from onset of beginning the symptom, my visual acuity is about 8/10. It certainly depends on temperature and worsen with increase of temperature(7/10) and becomes better with decrease in temperature(Cold weather 9/10). I also suspect of is behcet disease.I performed a pathergy test on myself(with a sterile needle) and after 24h I developed small brown bumps at site of puncture. while it is small but I look at it with a good magnifier and it is almost identical with what I saw on pictures of positive tests but it is smaller. I also sometimes have aphtus in mouth but I can't recall how many times a year. last time I had it about 2 weeks ago and it disappeared after a few days. prior to that I'm not sure. but I'm sure about 6-7 years ago I had a very bad and painful aphtus in mouth that annoyed me very badly for several months. Some times I see unexplained red bumps on my shoulder, back and arm but it goes away after a few days/weeks. yesterday I felt that I have fever I felt cold and I had small involuntary movements(every few minutes) in fingers and muscles of hand and foot especially tongue and mouth. today I'm much better but not 100%Ok. I don't have trouble standing with closed eyes.What symptoms can suggest MS what symptoms should I notice and follow and report to my doctor in future appointments?I'm ready to explain my symptoms in detail and post documents if it helps.what exams should I ask my doctor to perform? thanks.
without treatment after a month from onset of beginning the symptom, my visual acuity is about 8/10. It certainly depends on temperature and worsen with increase of temperature(7/10) and becomes better with decrease in temperature(Cold weather 9/10). I also suspect of is behcet disease.I performed a pathergy test on myself(with a sterile needle) and after 24h I developed small brown bumps at site of puncture. while it is small but I look at it with a good magnifier and it is almost identical with what I saw on pictures of positive tests but it is smaller. I also sometimes have aphtus in mouth but I can't recall how many times a year. last time I had it about 2 weeks ago and it disappeared after a few days. prior to that I'm not sure. but I'm sure about 6-7 years ago I had a very bad and painful aphtus in mouth that annoyed me very badly for several months. Some times I see unexplained red bumps on my shoulder, back and arm but it goes away after a few days/weeks. yesterday I felt that I have fever I felt cold and I had small involuntary movements(every few minutes) in fingers and muscles of hand and foot especially tongue and mouth. today I'm much better but not 100%Ok. I don't have trouble standing with closed eyes.What symptoms can suggest MS what symptoms should I notice and follow and report to my doctor in future appointments?I'm ready to explain my symptoms in detail and post documents if it helps.what exams should I ask my doctor to perform? thanks.
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to obtain a history from you and examine you, I can not comment on whether or not you have MS, or Behcet or other condition. However, I will try to provide you with some information regarding this matter.
MS is an inflammatory demyelinating disease that affects the central nervous system (in this including the optic nerves causing neuritis). To make the diagnosis there is specific criteria, in which objective neurologic findings are present affecting 2 or more locations in the nervous system in 2 or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and needed as it helps determining the presence of white matter lesions in 2 or more locations, however there are multiple conditions producing MRI changes that could be mistaken for MS, and the MRI should be reviewed properly and correlated to the symptoms. When the diagnosis is in doubt, a spinal tap to study the CSF is helpful, and if there is still some doubt, there are other tests such as evoked potentials that can help.
The symptoms you report may or may not be related to MS, as optic neuritis can be present isolated. However when a young patient presents with optic neuritis there is always the doubt if there could be MS underlying, and further work up may be required, such as a follow up MRI (with gadolinium is preferred), and a spinal tap if highly suspected.
Regarding Behcet’s, this is an inflammatory condition, which has multiple clinical manifestations. Usually presents with recurrent and painful oral aphthous ulcerations, with a recurrence pattern being at least more than 3 times in one year. Other manifestations include genital ulcers, eye lesions (more often the anterior eye than neuritis), skin lesions, and a positive pathergy test. The diagnosis is made clinically, and no specific lab test exists, but usually inflammatory markers (sedimentation rate and CRP) are elevated.
As I told you, without being able to obtain a detailed history and physical examination, I cannot give you a diagnosis of what you have.
I think it is very important to make an appropriate diagnosis in order to treat the specific underlying condition. You should discuss your findings with your neurologist, and consider the diagnoses you mentioned above. If the suspicion is high, the tests described should be considered. If you develop skin or oral lesions as you described, it may be helpful to obtain pictures to show your doctors when you visit them, as usually by the time you get to your appointment not every lesion is present.
I hope this information is useful. Good luck.
Without the ability to obtain a history from you and examine you, I can not comment on whether or not you have MS, or Behcet or other condition. However, I will try to provide you with some information regarding this matter.
MS is an inflammatory demyelinating disease that affects the central nervous system (in this including the optic nerves causing neuritis). To make the diagnosis there is specific criteria, in which objective neurologic findings are present affecting 2 or more locations in the nervous system in 2 or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and needed as it helps determining the presence of white matter lesions in 2 or more locations, however there are multiple conditions producing MRI changes that could be mistaken for MS, and the MRI should be reviewed properly and correlated to the symptoms. When the diagnosis is in doubt, a spinal tap to study the CSF is helpful, and if there is still some doubt, there are other tests such as evoked potentials that can help.
The symptoms you report may or may not be related to MS, as optic neuritis can be present isolated. However when a young patient presents with optic neuritis there is always the doubt if there could be MS underlying, and further work up may be required, such as a follow up MRI (with gadolinium is preferred), and a spinal tap if highly suspected.
Regarding Behcet’s, this is an inflammatory condition, which has multiple clinical manifestations. Usually presents with recurrent and painful oral aphthous ulcerations, with a recurrence pattern being at least more than 3 times in one year. Other manifestations include genital ulcers, eye lesions (more often the anterior eye than neuritis), skin lesions, and a positive pathergy test. The diagnosis is made clinically, and no specific lab test exists, but usually inflammatory markers (sedimentation rate and CRP) are elevated.
As I told you, without being able to obtain a detailed history and physical examination, I cannot give you a diagnosis of what you have.
I think it is very important to make an appropriate diagnosis in order to treat the specific underlying condition. You should discuss your findings with your neurologist, and consider the diagnoses you mentioned above. If the suspicion is high, the tests described should be considered. If you develop skin or oral lesions as you described, it may be helpful to obtain pictures to show your doctors when you visit them, as usually by the time you get to your appointment not every lesion is present.
I hope this information is useful. Good luck.
Thanks Dr.Cheng-Ching, Some more questions, if you please...
1- dose any two lesions and any two attacks is enough to diagnose clinically definite MS or the lesion should correspond to attack I mean if optic neuritis is an attack should its corresponding lesion be visible in MRI and if another attack let's say in cranial nerve happens should its specific lesion be visible to be qualified as clinically definite MS or any two lesion and any two unrelated attack is clinically definite MS?
2-what is clinical definition of attack? I mean two days ago I had small involuntary movements(like ticks in fingers and muscles of hand and foot) and more like tremor in muscles of tongue and mouth. can it be defined as an attack?
3- today I felt a tiredness and uncomfortable feeling in back of my neck? I only took MRI of brain. should I ask my doctor to write an MRI of neck? is it necessary to get an MRI of hole spinal cord? if so with or without injection?
4- I had a detailed immunological test that its results will be evident in few days(max a week). One neurologist said that I should do a spinal tap. I didn't and I was planning to wait for my immunological results to be ready and consult with other neurologists before making decision. could it be some kind of emergency to do spinal tap and it is better to do it as soon as possible. dose spinal tap can prove or rule out MS unambiguously?
5- I read about a news in BBC about a drug,Alemtuzumab, that can reverse MS
news.bbc.co.uk/2/hi/health/7680641.stm
is it really as exciting as it reported?
thanks many times
1- dose any two lesions and any two attacks is enough to diagnose clinically definite MS or the lesion should correspond to attack I mean if optic neuritis is an attack should its corresponding lesion be visible in MRI and if another attack let's say in cranial nerve happens should its specific lesion be visible to be qualified as clinically definite MS or any two lesion and any two unrelated attack is clinically definite MS?
2-what is clinical definition of attack? I mean two days ago I had small involuntary movements(like ticks in fingers and muscles of hand and foot) and more like tremor in muscles of tongue and mouth. can it be defined as an attack?
3- today I felt a tiredness and uncomfortable feeling in back of my neck? I only took MRI of brain. should I ask my doctor to write an MRI of neck? is it necessary to get an MRI of hole spinal cord? if so with or without injection?
4- I had a detailed immunological test that its results will be evident in few days(max a week). One neurologist said that I should do a spinal tap. I didn't and I was planning to wait for my immunological results to be ready and consult with other neurologists before making decision. could it be some kind of emergency to do spinal tap and it is better to do it as soon as possible. dose spinal tap can prove or rule out MS unambiguously?
5- I read about a news in BBC about a drug,Alemtuzumab, that can reverse MS
news.bbc.co.uk/2/hi/health/7680641.stm
is it really as exciting as it reported?
thanks many times
Hello, I just wanted to add that last night, I woke up of sleep and again experienced a condition similar two a few days ago. while involuntary movements from a few days ago still was present but it had reduced greatly but last night I woke up and had involuntary movements all over my body, my back neck felt uncomfortable and I felt stiffness in back of my neck while I easily could move my neck but it was uncomfortable but I has visible shake all over my body hands, feet, belly, arm, face. It was somehow like fever and chill it was completely sudden, prior to a few days ago I don't remember such symptoms. I again slept and now that I type this message I feel much better but on the whole worse that yesterday I feel a slight (stiffness/numbness) in my hands and feet. can it be MS (i mean can an MS attack cause sudden involuntary movement all over the body or it causes in a specific and isolated limb?)?
I forgot to say that it is about some days to weeks that I experience abnormal gastrointestinal problems, I mean first I didn't pay much attention but maybe it is also important. sometimes I feel cramp and pain, I have a slight diarrhea. I don't see any blood but there should be something wrong with my intestine.
I plan to see a neurologist today even my immunologic results are not ready but in last appointment prior to start of involuntary movements a neurologist examined me thoroughly and he didn't find anything wrong. please if you suspect a condition that can cause these symptoms tell me so I ask my neurologist to perform checks and rules it out.
thank you.
I forgot to say that it is about some days to weeks that I experience abnormal gastrointestinal problems, I mean first I didn't pay much attention but maybe it is also important. sometimes I feel cramp and pain, I have a slight diarrhea. I don't see any blood but there should be something wrong with my intestine.
I plan to see a neurologist today even my immunologic results are not ready but in last appointment prior to start of involuntary movements a neurologist examined me thoroughly and he didn't find anything wrong. please if you suspect a condition that can cause these symptoms tell me so I ask my neurologist to perform checks and rules it out.
thank you.
hello, I contacted the laboratory and they said my immunologic test is ready this is my test result:
ESR 1stHour 6mm/hr
CRP <6 mg/l
VDRL negative
FANA negative
ANCA <1
Anti-Cardiolipin IgG 4.1GPLU/ml
Anti-Cardiolipin IgM 3.5 MPLU/ml
Anti Phospholipid IgG(ELISA) 3.4U/ml
Anti-Phospholipid IgM 4.7 U/ml
Anti B2-Glycoprotein G/M/A Negative
Protein C 118%
Protein S 124%
Lupus Anti Coagulant Negative
Homocystein 15 Micro mol/L
ESR 1stHour 6mm/hr
CRP <6 mg/l
VDRL negative
FANA negative
ANCA <1
Anti-Cardiolipin IgG 4.1GPLU/ml
Anti-Cardiolipin IgM 3.5 MPLU/ml
Anti Phospholipid IgG(ELISA) 3.4U/ml
Anti-Phospholipid IgM 4.7 U/ml
Anti B2-Glycoprotein G/M/A Negative
Protein C 118%
Protein S 124%
Lupus Anti Coagulant Negative
Homocystein 15 Micro mol/L
Hello, I just visited a neurologist. and He said my Lab results do not show anything abnormal. I showed him my MRI result and surprisingly he said two plaques are visible around corpus callosum though previous neurologist had told me that I do not have plaques. I feel today's neurologist examined me with much more precision. Even radiologist report about my T2 MRI(without injection) is this
"Axial, coronal and sagittal sections are taken.
white and gray matter differentiation is normal in signal intensities and MR_anatomy.
Venticular system, aqueduct and C.S.F are normal.
No tumor, signal changes and midline shift is noted.
Pons, brachium cereblli and cerebello-pontine angles are normal.
parasellar, perisellar and sellar regions and pituitary gland are normal.
medulla ablongata, bulb, upper cervical cord show no abnormality"
I told him about involuntary movements and asked him if it can be sign of MS and he said because it happened suddenly and in different limbs righ, left hand foot, belly, head, it can't be related to MS. he examined me thoroughly and he said he didn't find anything abnormal. except he asked me to force my head(while standing) down and asked my how you felt. I felt a very slight I don't know maybe joy , maybe cold in my shoulder and middle of my spinal cord but I told him it was slight and when he with his hand bend my neck a little more slightly than what I did(this time I was lying) I didn't feel that. he said was that like electric shock, I said no not at all it was much more slight. he also said while he examined my belly muscle by pulling a sharp object on it, right side didn't respond as good as left side. on the whole he said his examinations couldn't find anything abnormal. but on his report he noted Lehmitt sign. I said should I have an MRI of spinal cord and he said it doesn't give us any useful information. he said 80% I have MS and in his report he noted CIS MS. I showed him the pathergy test I performed on myself and he said it is negative, it should be much bigger to be considered positive. he asked me to repeat VEP again and said if it was positive again then I have to do spinal tap. he gave some vitamins. but regarding to involuntary movements he didn't find any reason and said it may be related to your anxiety but I insisted I am not that much anxious to have such vivid symptoms that I never had before. please if you know any other condition that can be tested and ruled out, mention it to ask my neurologist to perform checks and rule it out.
"Axial, coronal and sagittal sections are taken.
white and gray matter differentiation is normal in signal intensities and MR_anatomy.
Venticular system, aqueduct and C.S.F are normal.
No tumor, signal changes and midline shift is noted.
Pons, brachium cereblli and cerebello-pontine angles are normal.
parasellar, perisellar and sellar regions and pituitary gland are normal.
medulla ablongata, bulb, upper cervical cord show no abnormality"
I told him about involuntary movements and asked him if it can be sign of MS and he said because it happened suddenly and in different limbs righ, left hand foot, belly, head, it can't be related to MS. he examined me thoroughly and he said he didn't find anything abnormal. except he asked me to force my head(while standing) down and asked my how you felt. I felt a very slight I don't know maybe joy , maybe cold in my shoulder and middle of my spinal cord but I told him it was slight and when he with his hand bend my neck a little more slightly than what I did(this time I was lying) I didn't feel that. he said was that like electric shock, I said no not at all it was much more slight. he also said while he examined my belly muscle by pulling a sharp object on it, right side didn't respond as good as left side. on the whole he said his examinations couldn't find anything abnormal. but on his report he noted Lehmitt sign. I said should I have an MRI of spinal cord and he said it doesn't give us any useful information. he said 80% I have MS and in his report he noted CIS MS. I showed him the pathergy test I performed on myself and he said it is negative, it should be much bigger to be considered positive. he asked me to repeat VEP again and said if it was positive again then I have to do spinal tap. he gave some vitamins. but regarding to involuntary movements he didn't find any reason and said it may be related to your anxiety but I insisted I am not that much anxious to have such vivid symptoms that I never had before. please if you know any other condition that can be tested and ruled out, mention it to ask my neurologist to perform checks and rule it out.
Hello,
shaking still continues especially and has worsen today, I also have nausea(slight) and dizziness for several hours that continues till now. I also feel restless when shaking problem worsens. I also performed Lehmitt sign myself several times and I think maybe I'm negative because either i do not feel anything when I bend my head down or the sensation is very very slight. I do not have fever. my temp is 36. involuntary movements especially prominent in neck, hands and head (especially mouth) but also sometimes feet and trunk. the neurologist who examined me said it is related to my anxiety but I really do not think so. can I have CNS infection? should I see another neurologist. I never had such symptoms. please if you suspect any condition tell me to ask my doctor to check it.
shaking still continues especially and has worsen today, I also have nausea(slight) and dizziness for several hours that continues till now. I also feel restless when shaking problem worsens. I also performed Lehmitt sign myself several times and I think maybe I'm negative because either i do not feel anything when I bend my head down or the sensation is very very slight. I do not have fever. my temp is 36. involuntary movements especially prominent in neck, hands and head (especially mouth) but also sometimes feet and trunk. the neurologist who examined me said it is related to my anxiety but I really do not think so. can I have CNS infection? should I see another neurologist. I never had such symptoms. please if you suspect any condition tell me to ask my doctor to check it.
You are reading content posted in the Neurology Forum
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
