MS and heart condition PFO

[kello]

My sister was diagnosed 2 years ago with MS after two episodes of optic neuritus (sp?) and other sporadic and unexplainable symptoms (numbness and weakness).  Her brain was scanned and showed one lesion.  She is taking daily injections of Copaxone and has recovered basically 100% from the optic neuritus and other symptoms.  She has fatigue, but otherwise feels well.

Since then she had a heart echo done and was told she had PFO, (I think that's what it's called, it's the condition where at birth one of the vessels or something doesn't completely close off).  The doctors said the PFO could cause strokes in the future.  I have read that PFO can sometimes cause brain lesions.  I have three questions:

1.  Could MS lesions be confused with stroke or PFO lesions?  Do they look different?  Is there some relationship?

2.  In the future, if the PFO does cause problems, how is she to distinguish between an MS episode versus a stroke?

3.  Any thoughts or recommendations for her?

Thank you.

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

It can be difficult to differentiate a MS lesion, and a stroke. However, PFO's result in embolic stroke (a clot going from the heart to the brain), and these are typically located in the periphery of the brain, while MS lesions are typically deep. If there is any confusion, then the diagnosis of MS can be established by performing a spinal fluid analysis.

A PFO causes stroke by allowing a clot to pass from the body into the outgoing cirulation (i.e. to the brain) without being filtered in the lung. Therefore, in order to have a stroke an individual has to have a clot somewhere in there body that breaks free, then the clot travels to the right side of the heart and has to travel through the PFO to the left side of the heart, and then be pumped to the brain. Therefore, any condition which predisposes women to have clots, such as smoking, birth control pills, or clotting disorders, should be avoided or treated. However, if your sister has an event it may be difficult to differentiate between MS and Stroke.

What I would recommend is for your sister to be seen by a Stroke Neurologist. He/she will evaluate your sister and determine what her risk for future stroke is. If the PFO is small, and she has no clotting risk factors, then the stroke risk is small. However, if her risk is high they may recommend medical treatment or possibly closure of the PFO. Good luck.

[jan]

I have had several MRI's with the differential of chronic small vessel ischemic change or MS.  It seems every neuro thinks it is MS and that is why I keep getting sent for MRI's.  However, after 5 yrs I still have just one lesion.  I didn't develop symptoms until 2 1/2 yrs ago.

Anyway, I have been told my symptoms are MS symptoms and yet haven't rec'd the diagnosis of MS (I know it calls for 2 lesions).  My current neuro gave me the diag and then back peddled.  She won't say it is a stroke, though.  She says the lesion isn't typical or the location for a stroke.  At one point said it was def. a MS lesion.  

Well, I could go on.  I guess my question to you is, how are to quote you, "Stroke signs are easily recognized and are different from MS"?

I would appreciate any info.