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Is it MS; if not, what could it be?
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Is it MS; if not, what could it be?

I'm a 54 yr. old man with a history of urinary urgency (thought to be prostate related), GERD, including swallowing difficulties; arthritis in the hip and back, and degenerative disc disease in my back and neck.  Three weeks ago I developed tingling in my face, mouth and tongue, and some dizziness.  Brain MRI, nuclear stress test, corotid artery test, and echo cardiogram were all negative.  Doctors thought symptoms might be related to a night mouthguard I had been wearing for about 6 weeks for nightime teeth grinding and referred me back to my dentist to check the fit.  Dentist said very unlikely that guard was causing the problem, and noticed some irregularities on my tongue that could be associated with auto-immune conditions, and referred me to an oral surgeon.  Oral surgeon took an MRI of my jaw, upper neck and sinus cavities, and results were all normal.  He said that if I were a younger female, MS would be the most logical diagnosis and didn't rule it out.  He did not rule out anxiety driven problem, since I am an anxious person under pressure now, but thought my symptoms were too specific to the facial nerves to be only psychological.  He referred me back to the neurologist.  During this entire time, the symptoms come and go, though they have been more frequent the last few days.  I have an appointment with my rheumotologist and neurologist late next week.  I have also noticed that my neck has been hurting me more lately, and I am encourged that all my imaging has been negative. Wondering though whether bladder and swallowing were early signs of MS.
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Avatar_n_tn
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   The symptoms you describe are non-specific and could be related to several different causes.  First, it is unlikely to be MS (multiple sclerosis), given that your MRI was normal and the description of the symptoms is atypical for MS.  However, I would recommend that you complete your MS workup, to be sure.  I would make sure your MRI included GAD contrast and a saggital flair (specific MRI sequence, your neurologist would know).  I would also recommend a Cervical spine MRI with GAD to look for additional possible lesions.  I would also suggest a lumbar puncture (spinal tap) to look for inflammation in your spinal fluid (Tourtelotte, IgG index, oligoclonal bands).  Your spinal fluid should also be sent off to screen for a variety of less likely possibilites such as lyme titers, cytology (for cancer/lymphoma), paraneoplastic panel and EBV/CMV titiers.  A visual evoked potential can look for past evidence of optic neuritis. Bladder dysfunction and swallowing difficulities can be associated with MS, but very late in the course.  These are not typical early or even mid-course symtptoms and are unlikely to be realted.  
Anxiety is another possibility for your symptoms.  This is often related to hyperventilation (unknown to the patient).  This causes tingling around the mouth area and often in the finger tips on both sides.  These symptoms can often be reproduced by asking the patient to hyperventilate (deep, rapid breaths for 1-5 minutes).  You should also have your calcium checked with ionized fraction, since some electrolyte disruptions can also cause similar symptoms.
The final possibility is posterior circulation TIA (transient ischemic attacks/small strokes) to work you up for this I would suggest an MRA (MR angiogram), and make sure your MRI was done with diffusion weighted imaging.  A Trancranial doppler study of the posterior circulation may also help with this concern.
I hope this has been helpful.
15 Comments
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Avatar_n_tn
What medicines have you taken for your urinary problems and/or infections? Have you taken cipro or levaquin?
What other drugs have you taken for your other health issues?
Are you exposed to toxics at work or enjoying your hobbies?

Some drugs for rheumatic diseases, many antibiotics (cipro, levaquin, nitrofurantoin-macrobid), antimalarials (lariam) and other drugs cause all your symptoms and more, so it is always recommended to rule out that causes.
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johnflox - good questions.  I did have a bad reaction to cipro several years ago, so my doctors have stayed away from it and levaquin since then.  In the past few years, I have only taken bactrim.  So far, my internist, cardiologist, neurologist and oral surgeon have considered whether any of my meds, or combination of my meds could be causing my symptoms and all have concluded that it is not drug related.
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Avatar_n_tn
Thanks for your comments, Jenny.  I haven't had leg problems, other than those associated with my arthritic hips and sciatic nerve problems.  So, your info is somewhat comforting on the MS front.  I too have disk problems, so maybe it's all tied up in that, though both my oral surgeon and one neurologist told me that they doubt the face tingling is associated with a disk because those nerves originate in the brain and not anywhere in the spinal column.
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Avatar_n_tn
a test that you need to have is for the HLA 27B. systemic disease called ankylosing spondylitis, some of the symptoms you describe sound like AS. generally overlooked disease in women, usually gone to far before it is diagnosed in women, causes tingling numbness pain in hips, throughout joints in body tendons and ligaments, a chronic form of arthritis, 3 times more likely in men than women.
i have had it since i was 17 at 36 was recently diagnosed after pure agony. i have facial tingling numbness, you see it affects joints throughout body.
if you don't have insurance the test runs about $150 dollars.
with the hip involvement it is worth testing for, generally though it should have been detected before the age of 40. although in some cases i believe that people are misdiagnosed.
good luck i hope this gives you another insight as to what it could be!
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Avatar_n_tn
Since I have a history of early onset arthritis throughout my spine and hips, I have been tested for anklyosing spondalitis on several occassions, though not recently.  All prior tests were negative, though one rheumatologist wondered whether I was in the small percentage that had a non-aggressive form of that condition and did not show that antibody.  Based on my very limited knowledge of the condition, I'm surprised to hear that it could cause face tingling, if that's what you're saying.
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Avatar_n_tn
For the past 7 months I have had minor back aches, I thought was from our brand new too soft mattress, as well as numbness in my feet and blurred lines off and on in my eyes, oh yeah and frequent trips to urinate.  The other day while at work i experienced loss of sight in my left eye for about ten minutes.  Later that night my husband told me to go to the er about my eye.  So I did, the doctor ( she also had me do a diabetes test strip and blood which was normal ) sent me to an opthomologist which told me that i didnt have any retina problems and he asked if i had headaches, i said I had a few and mentioned my back ache and my blurred vision / blindness.  So he ordered me an mri and said I should see a neurologist for migranes (migraines).  The mri showed non-specific white spots in the subquarter and ventrinuclear part of my brain.  He asked if i were diabetic I told him they tested me in the er said I was fine, i have had hiv tests and came back negative in the past and have been with my husband for 2 years and both of us are faithful.  I am wondering now if I have ms , i have been getting some pins and needle feelings throughout my body in the past few days since the eye went out, and my back also hurts on and off.  I have an appointment with my doctor ( pcp ) on friday. I dont have any bites that i know of at least from lymme disease.  I do live in North America and I am 34 female.
And I am a pack a day smoker :(.  So please wb.
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Avatar_n_tn
Take the opthal. advice. He probably saw that retina was ok but
vascular area behind eye was showing something & that's why the
?'s & mri. Smoking causes fluid pressure that can be seen
during exam & that could be IIH or other things. 'Idiopathic
Intracranial Hypertension' is like our hi BP only from spine
fluid that circulates around brain & back down. Constriction
can cause hdaches or none. The spots on mri if near ventricles,
shows that some type of attack on neuron firing took place.
Doesn't always mean ms, can be hypertension in vascular/vessels
but generally eye-doc doesn't order mri unless it's to rule in/
out a problem. Please do a fol-up w/ a gd. neuro or ask Dr.
for a referral. Get copy of all tests for hm-file. Your sympts.
lean towards many things. The smoking may be constricting &
causing inflamed vascular response 'inside' vessels. Bloodwk
like a glucose tolerance should be done also. The strips are a
quicky test & doesn't determine how you use your insulin in the
pancreas. Wish you well.
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Avatar_n_tn
First I would like to say Thank You, for taking the time and responding so fast.  I really appreciate it alot.  Secondly I did read som information on wikepedia about IIH, It said most commonly overweight women, I am only 117 llbs 5 feet tall.  So maybe I could still have that from smoking but definatly not food.  Any way I do appreciate your advice. I did go to my pcp today and he kind of blew it off and told me to go see a neurologist anyway, he said i probably have migranes (migraines).  Which I hardly ever have headaches, although my vision went wiggly on my left eye during work today for a few minutes.  I called for an appt with a neuro today alot off them in my area were booked threw november even january.  I called again and told the secretary about my mri and she is supposed to send for it on monday and see if the doctors will fit me in.  I will keep you posted.

Thanks again , T.
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Avatar_n_tn
Hi sorry to post again but I forgot to tell you I did get a copy of the mri report, I stated :

'several tiny areas of nonspecific hyperintensity in the subcortical and periventricular white matter.  Differential diagnosis includes small vessel ischemic gliotic change, demyelinating disease, Lyme disease and other unusual entitntes.

Impression:  There are a few tiny areas of nonspecific hyperintensity in the subcortical and periventricular white matter bilaterally. Please see above. No other significant findings.  

( and the above part was underlined )

Ok so just wanted you to see the actual hi-tech wordings.

Thanks again.
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Avatar_n_tn
This sheds different light. The hyperintensity in the sub/peri
areas mentioned are significant since they are 'bilateral'.
Myelin is 'fat' that insulates neurons. If the nerve-neuron
has a slt malfunction, it fires. A slt firing sort of melts the
fat & demyelinates or takes away it's insulation. Up to Neuro
to look at big-picture + clinical tests in ofc. Could be just
an ischemic attack liked mentioned. Those can even be from a
stressful event/bleeding vessel that seals itself. I had mri &
was asked all kinds of ?'s. It was no to all. Turns out I had
a slt ischemic attack (gliosis), that happened leaked long time
& sealed. I never had any problem/pain/hdache/dizzy/just zip.
They said it was an old area so we figured it happened abt the
time I had to deal w/ a death. (Heavy stress)! Since yours are
non-specific (not large enough to mention sz), doc will still
have to suspect vascular problem. Smoking isn't going to make
this get better. Not preaching, just know the physiology. The bilateral could be early symptom of MS but vague. I have no
idea what this report has to do w/ lyme or why mentioned! Films
need viewing soon to eval. I think my dear, you got lucky!
No, don't think it's IIH but weight really isn't a factor.
Skinny folks get it too. Hope you get in soon. I'll ck post.
Your Opthal. went beyond most in the field. Wish you luck &
hope it's something simple.
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Avatar_n_tn
Hi, Thanks again for posting so soon.  I really appreciate it.  Sorry If my spelling is awful I know, lol.  So I know the opth. dr. was very good, I told him how much I appreciate that he sent me, I also let him know that I knew most dr. would have sent me packing to my pcp.  And I told my eye dr., that i appreciated her sending me to him, and thought he was very educated.  You are too :) tk, for the help, info, and advice.
I could tell you are great with your responses and Also the way you word things, so as not too worry me.  But to be honest with you I have had alot of relatives die young from cancer, who did not even smoke and told me to quit.  Guess that is why I kept smoking duh, so I just had a memory of an event about two years ago and thought it might be related, I did just have a death in my family as well, my sons father commited suicide in 2004.  He was 43.  Anyway about a month or so after his death I woke up one morning and had a very bad stiff neck and could not move it without alot of pain, I lay on the floor of my living room and called my sons aunt to help me with my son and bring me to my doctor, he gave me muscle relievers for the pain and after about a week of soreness it went away.  It just dawned on me after reading some ms stories about how it can occur years apart I wasnt sure if it was related.  Ok sorry to burn your ear out.  Thanks again, T.

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Avatar_n_tn
hi there

yes you can get tingling in the face from AS.  everone who has this disease is different because it is unique to you so to say.  it depends on where the inflammation, damge is in the spinal column, i have facial, tongue cheek tingling, i have had it for two years now 24/7.  i tested postive for the gene, i'm not sure whether there is a percentage of people who have the disease but test negative for the disease, i thought that medical research has shown that people who have As are positive for the HLA 27B gene.  anways i think that it is certainly something to do with your spine so you need to find a really good doctor prefably one that is in his/her 40-50's they have been round long enough but are usually up to date, i was lucky enough to come across a doctor that had been at the mayo clinic, after 2 visits i  was diagnosed I am soon to take enbrel, two shots a week.  even if you do not have a definant diagnosis they could at least treat you like you have the disease, if thats want they think that you are in a small percentage of people that can have it,  they though i had lupus i tersted postive i am in that 5% that have postive ana, but then again i always seem to be in that small percentage that tests postive for rheumatic diseases, i just found a terrific doctor i have had this chronically for 6 years, onset was 17, iam 36.  the tingling can be cold like someone laying on your face, cold weather can make you worse and so can the sun and altitude.  good luck
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Avatar_n_tn
so a few years ago when i was a freshman in high school i got this numbness in my finger, spread to my arm, i was temporarily paralyzed for about 6 months. it was a big mystery, i was getting MRIs and junk and it eventually went away but i've been a little obsessed with trying to figure it all out because i was never told what i had. it spread a little up my neck into my cheek at one point but only a bit. i was told at one point that i could have MS, or that it may be permenant, or parsonage-turner syndrome, or a brain tumor, spinal cord tumor...and on and on, none of them were determined to be acurate. to be more exact, it started with a numbness in my thumb, then to the rest of my fingers, then weakness, withen 12 hours i couldn't move it, then 24 i couldn't feel it. i was just wanting some professional thought because i can't stop thinking about it
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Does anyone know what a UBO is on and MRI. I have suffered from fibromylgia (fibromyalgia) with worsening symptoms over the past two years, so that I am unable to work. I have had several MRI scans, that show I have 9 UBOs. Evryone tells me that it is not MS, but the lesions look like what you se in MS. An MRA intially should some occlusion of the cerebral arteries and a reat was normal. I am 50 years old. In 1991 I had an MRI because I had migraines and I was told that I had one UBO. No one can tell me what this means. Has anyone else heard about it. How about the doc?
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