Having MS work-up at present

Hello-  I am a just now 40 year old female that went to my PCP Dec 20 with a 1 month history of dizziness/spacial strangeness, nausea and headaches.  No relief with tylenol, advil, meclizine. I had also been there in the fall with c/o headache and noticing my BP's were high - 160's/100's.  No history before this of high BP.  MRI on 12/23/10 showed 15 lesions in my brain with 2 measuring 1cm and 1.2cm (the largest).  The impression was all the normal- demylinization, vasculitis, cancer, of which it was suggested that futher studies to be performed to diagnose.  I am a nurse at a large cancer hospital x18 years.  After talking to our Neuro Onc NP, the MS NP there, my PCP, and a neuro radiologist, all feel the most likely cause is MS.   I had all the blood work to rule out infections, and all came back negative, except a "slightly positive ANA, not high enough to cause changes in white matter" (per my PCP).  I had and MRI 12/29/10 with contrast to help rule out cancer/vasculitis and provide another supporting dx of MS.  I have not received these results.

My question is, could HTN cause this many white matter lesion changes alone??  Before the whole MS thing, I went on a no salt diet in Oct, having my blood pressure lowered to 130's/90's.  With the holidays, I was not as watchful of my diet.  Have noticed just walking upstairs, 1 flight, my pressure is 176/102.  With rest it will return to 130's/90's.  I am an avid tennis player - 3x week, and played this am with increase in symptoms again - dizziness, spacial stuff, and headache.  Just feel in limbo, looking for any additional information possible.  Not sure if I should call my PCP back to look into the blood pressure thing again, or wait until the MS thing is completed.  Just not sure if they are related or independent of each other.
Thoughts?

[Christopher R Newey, DO]

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 a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

There are multiple causes for plaques in the brain. Most often, these are due to what is called "chronic small vessel disease", literally meaning diseased small vessels that supply blood flow to the brain. This is not an uncommon process in the brain and increases with age. This is not a disease in and of itself but rather is a reflection of unhealthy blood vessels, damaged by years of plaque build-up. This is most often due to a combination of several factors including the following: high blood pressure, diabetes, smoking, and high cholesterol. If these factors are well controlled, the damage to the brain can be stabilized and further damage prevented.

However, some plaques can be quite characteristic of multiple sclerosis (MS), as well as other demyelinating diseases or inflammatory processes such as vasculitis.

MS is an inflammatory demyelinating disease that affects the central nervous system. To make the diagnosis there are 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. MRIs are 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. It sounds like your physicians are doing this already. If there is still doubt or question what your lesions are, a lumbar puncture (LP) is very useful as well as evoked potentials.

I highly suggest you discuss your symptoms and concerns with your physician. I would also recommend you seeing a neurologist who specializes or has experience with multiple sclerosis.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.