MRI suggests ALS or MS

[shferolie]

I am seeing a spine doctor and as of November we have scheduled a laminaplasty for the first part of February.  I have pronounced spinal stenosis with a myelomalacia at the level of C5.  I am only 29 but have skeletal dysplasia.  My doctor wanted a more recent MRI before the surgery for a better reference because my first MRI was over a year old.  However with this MRI the radiologist saw the Myelomalacia and said something about it being leisions suggesting it may be ALS or MS. The radiologist however didn't have the first MRI to compare.  Is it possible to detect such conditions with a MRI?  I have no weakness, just numbness and tingling in my arms and hands (mostly hands) with flexing my neck. My symptoms have gotten a little worse since the first MRI but not much.  He has referred me to a neurologist before we go ahead with my surgery, and I am in knots worrying about this.  Do you have any advice?  Does this sound at all like ALS?

[CCF-Neuro-M.D.-PW]

There is no way of radiologically diagnosing ALS. Myelomalacia just means thinning of the spinal cord at that level, and is most commonly due to an old or chronic injury at that level (like degenerative spine disease)
ALS would be an extremely rare cuase of this finding and others would be much more common
I have not seen the scan so my advise is somewhat limited though

MS can be identified by MRI but if myelomalacia is the only finding in teh cord, it is still very non-specific and most likely due to chronic injury over time from your stenosis. If you have had discrete episodes over time of neurological symptoms like loss of vision, weakness or clumisness on one side etc, then a further evaluation for MS might be warranted due to the clinical picture (and not the MRI finding above)

Good luck

[markbos]

ALS does not show up on MRI.  It is best diagnosed with EMG testing.  Clinically, the symptoms include muscle weakness and twitching (fasciculation), but never sensory changes since ALS is a purely motor neuron disease.  You do not seem to have any of the symptoms of ALS.

MS plaques can show up on a cervical spine MRI.  MS is part of the differential diagnosis for patients with spinal cord damage, especially if caused by stenosis. It is reasonable to be worked up for MS with further MRI (brain), VEP and/or CSF testing.  However, in the absence of any motor weakness, visual problems, brainstem dysfunction, sphincter disturbances or other neurological problems, MS would seem unlikely.  The sensation changes your experiencing in your arms are called Lhermitte's sign which indicates some type of spinal cord damage, but does not specify a cause in and of itself.  I think seeing a neurologist before your surgery would be a good idea.      

[shferolie]

Thanks!  I have been in knots worrying about this, and you have made me feel much more at ease.  You really seem to know a lot about this.  Are you a doctor or studying to be?  Thanks for your imput.

Are you saying that people with stenosis are more likely to get MS?

[markbos]

People with stenosis are not more likely to get MS.  They are 2 entirely different problems.  Spinal stenosis can cause cord damage by direct compression, while MS can demyelinate/inflame parts of the cord.  Sorry, if my phrasing was confusing to you.  Since both spinal stenosis and MS can effect the spinal cord, there can be similar symptoms/exam findings for both problems, hence the need to consider both possibilities in a differential diagnosis.

[shferolie]

I see.  Thanks.  I have another question for you.  Is there a difference between myelomalacia and leisions?  I'm not sure why the first MRI showed myelomalacia and the second leisions.  Also do you think the radiologist was just mistaken when he suggested the MRI showings to be ALS along with MS?

[markbos]

Unfortunately, I am not a radiologist, so I am unable to comment on different lesions of the cord and their appearance on MRI.  As with all medical specialists, there is quite a bit of variation among radiologists and their skill level.  I think the best thing to do when questions such as these arise is to have another radiologist (preferably at a university hospital or large specialty medical group) look at both MRI's and comment on them. My best guess about the ALS on the report is that it may be a dictation error.  Errors on radiology reports are not that uncommon-I've seen quite a few myself.

[motheroftwo]

ALS in the later stages can show up on a mri, but not in all pals.

[shferolie]

I am going to see a neurologist tomorrow and my spine doctor has sent my my films and MRI report to take with me.  It also includes ADEM as a possibility.  Do you know much about this and whether or not it is likely?

[markbos]

ADEM is an acronym for acute disseminated encephalomyelitis (ADEM).  It results in demyelination of the CNS and can look similar to MS on MRI which is probably why it was mentioned.  It seems very unlikely, based upon your symptoms, that you have ADEM.  The signs and symptoms typically include headache, fever, alterations of consciousness, paraplegia or quadriplegia if there is spinal cord involvment and multiple neurological abnormalities.  Neurological signs often involve many different areas of the nervous system, which does not seem to be your case.  It is typically caused by a vaccination or infection such as measles, mumps, herpes, influenza or upper respiratory tract infections.  

Good luck with the neurologist tomorrow and be sure to ask him the questions you posted on this forum.

[markbos]

Severe pain is not typically seen in ALS.  Generally speaking, muscle twitching (fasciculations) in the absence of muscle atrophy, abnormal reflexes or neurological weakness determined by exam (not simply feeling tired) are usually nothing signficant.  The fact that EMG testing was normal is good.  However, I would recommend that you be periodically seen by a neurologist to check for any change in your condition.  It sounds like you may have benign fasciculation syndrome (BFS), although I cannot make a diagnosis over the internet.  Only 5-10% of ALS cases are transmitted in a genetic (usually autosomal dominant) manner.  In fact, if your grandfather had it, but did not pass it on to either of your parents, you wouldn't have it if it was autosomal dominant.  I would also recommend that you have a thorough work up by a primary care physician for the fatigue that you are experiencing.  It's good they already checked your thyroid.

[shferolie]

I went to my neurologist today, and he's "99% sure it is not MS".  We have scheduled an MRI(brain) for next week to be absolutely sure but I feel really confident. I didn't really ask him about the rest of the suspected problems(ADEM,tumor, and something else, myletis i think) because he had my MRI and reports in front of him and I would assume he would be concerned if he thought it was anything else. (at least I hope)  Anyway, you are a godsend, and I appreciate you sharing your knoweldge and calming my nerves.  I don't even know how I came upon this discussion board, but I'm really glad I did. Thank you!

[tuff]

Hi there,  I am 39. I have controlled hypo-thryoid. I am wondering if this sounds like MS or not.  This past summer I had a terrible time in the heat and ended up staying in a lot to avoid it.  I just couldn't stand to be in it.  Throughout the fall I was always fanning myself as I felt overheated for days at a time.  I am usually the coldest person in the room so this is very unusual for me.

In November, in bed, my left leg started tingling - like asleep.  It was still doing it in the morning and both feet had pins.  It lasted about 4 days took and break for a day and came back.  It has now been off and on - mostly on since then.  Also - in November I was in a store and was unable to make it to the bathroom for a bowel movment and had an accident!

I now get shocks in my feet when I walk along with the pins.  My left arm and left leg goes weak but mainly my arm.  I get full body fasculations whenever I sit or rest.  It makes my left big toe move by itself.

I have had eye pain for days at a time.  At the end of one of the days my eye started drooping a bit - somebody else noticed it.

I am getting an MRI tomorrow.  My question is:  Could all this be in my head or does it sound like MS?  Thanks!

[markbos]

6t5frlane
I am unaware of MS symptoms from the RA drugs you mentioned, but that area is not really in my specialty.  I would ask the neurologists on this website what they think.  Your doctor (rheumatologist?) who prescribed those medications should know the answer to your question.

[mlw2112]

I am a 40 yr. old male. I have been having a twitch in my right calf for at least 5 years. It started to progress into a gait problem, kind of a drop foot. I also have had on/off low back pain. My GP sent me for an EMG, which was said to be normal, then an MRI on the lumbar region, which I was told was "normal...just do some stretches". I then went to a chiropractor who said my pelvis was shifted up and forward on the right side. He thought the twitching was odd enough to call in a neurologist. I had an EMG from that neurologist who frightened me with talk of MS and tumors. He pointed out a loss of dexterity on my right hand, which I really had not noticed but am now very aware of.It also feels cold sometimes. With his suggestion, I had another MRI on the cervical area. This did not show him anything so he order another view of the cervical. Still nothing. I was not liking where this was going so I went to another neurologist who sent me for a thoracic and a brain MRI after he administered an EMG. He said the radiologist noted something that "could be" a sign MS.I think it was white areas in the film.The neorologist said "I am not impressed" and told me the faciculations in the calf was "myokemia" and prescribed an anti depressent which I did not take. He never addressed any lumbar pain or loss of hand dexterity. I got fed up and went to be Rolfed, which helped with the back pain but not the twitching or hand dexterity loss.I have just finished Lumbar Decompression Theray on the DRX-9000 which has immensly helped with the low back pain but not on the twitching or hand. I don't know where to go from here and worry about eventually being wheelchair bound. Any sugeestions or insight would be great. Thanks.

[mlw2112]

I forgot to add that i have a positive Babinski on the right side.

[sa58]

Finally a site where I will be understood! Hello, I'm a 48 year old Mom of 4 teenagers. Have had no health issues, other then the need to loose 30 pounds! In June 05 ended up in hospital with profound anemia for 5 days. Transfusions and IV iron took care of that problem. Scheduled Hysterectomy for 8/05, seemed to be no problems. Estrogen patch in place and feeling well. Oh yes, by the way in July had started with a pretty strict workout cardio everyday strength training 3 days a week. Lost 20 pounds in two months prior to surgery. Took 2 months off, felt great and back to training. One month after surgery my right calf started with fasiculations. Moved on to the left leg, feet, and now basically the whole body 24/7. As you all know sleeping is very difficult.
Went through ALL blood work between GYN,internist, and Nuerologist. All came out fine no more anemia, enzeymes were fine ,Thyroid good. Showed no weakness or breakdown of muscle. Just feel like a bag of popcorn in the mircrowave.
Was diagnosed after EMG with Benign Fasiculations. Of course I worry.... if ALS, would I have other symtoms by now? I feel silly and selfish for even asking with others suffering so much. But my mind,.. nights are so bad. I have never been one to focus so much on myself, not good at it, and truly don't like this. Need to move on.  Has anyone heard of this occuring after surgery, particularly a Hysterectomy?
Thank you for your time, you are all in my prayers.
Sharon

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