MS and worried

About 3 ½ to 4 months ago I noticed I had tingling in my arms and hands along with a heavy feeling. I also had pain in my chest, especially right under my collar bone. I also had a pain between my shoulder blades. One month prior too this I had done something to my lower back in the gym and it was very stiff. My lumbar MRI showed degenerative disk changes at L4-5 and L5-S1.My cervical MRI was normal. The doctor had noted I test positive for thoracic outlet. So I began doing physio and had improvement. When I raise my hands up and pull my elbows back slightly and open and close my hands I can recreate the symptoms in my arms. Brain MRI only had two white spots and were not located in areas that are more typical of MS according to Neuro.3 months after my symptoms began I had a spinal tap and will receive those results. What is bothering me is I have now recently developed both bladder/sexual problems. I have been urinating more frequently and my sexual arousal seem diminished. When I went to get my spinal tap two weeks ago I again noticed I was urinating more frequently while I was at the clinic. They made an attempt to do the tap but were not able to get the needle in and I had to wait several hours to have it done using x-ray. I was very stressed during this time. I got the puncture done and went home, but the urination frequency continued. Also, the next day I noticed my sexual arousal was decreased.

My questions are this:
1. I am a very anxious individual, and have been diagnosed with OCD. Previous to this whole health issue I was obsessioning about my health. I had fears of cancer etc… Could the urination/sexual problems be caused by my stress over the MS issue? I don’t feel anxious all the time however, but I have been stressed waiting on my spinal tap results.

2. Would negative Spinal tap  be a good sign even after 4 months of symptoms?

[Shazia Alam, 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.

Multiple sclerosis is a disease that primarily affects the central nervous system (brain, spinal cord, nerves from the eye, the optic nerves). Symptoms may be mild to severe, ranging from tingling and numbness to paralysis. There is not one test alone or one symptom that can diagnose MS, but there are well-established criteria that help neurologists make the diagnosis. These include taking a thorough history, doing a thorough physical exam, conducting an MRI of the brain and sometimes the spine, and sometimes ancillary testing such as lumbar puncture and evoked potentials. If an MRI of the brain and spine is normal, the diagnosis of MS becomes highly unlikely.

Your clinical history and examination does sound like Thoracic Outlet syndrome, however I cannot 100% say you do not have MS since I have not examined you.  MS can present with bladder/sexual dysfunction, but usually in the form of a neurogenic/spastic bladder—meaning you can’t urinate and need the help of a catheter to urinate.  Sexual dysfunction is usually manifestated the inability to achieve an orgasm or vaginal dryness, and loss of libido.  

Your LP results if positive for MS, would display signs of inflammation. When the diagnosis is in doubt, LP to study the CSF is helpful, and if there is still some doubt, there are other tests such as evoked potentials that can help.

When a neurologist is considering the diagnosis of MS, the criteria he/she may use include (1) evidence of damage in at least two separate parts of the central nervous system (CNS) (2) lack of another explanation for the damage (3) specific MRI findings (4) specific findings on CSF (fluid taken from around the brain/spine through a procedure called lumbar puncture) (4) results of visual evoked potentials (a test of how the nerve from the eye, the optic nerve, is functioning.

I would recommend having your urine checked for infections because of your increased frequency.  

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

[Canucks117]

Just to note my lumbar and cervical MRI were done 1 month following onset of symptoms and my brain MRI was 2 months. I just had my spinal tap done over 3 months after my symptoms began and should find out today the results. I am going for visual evoked potential test soon.

[Canucks117]

Sorry one final question, MS symptoms wouldn't wax and wane during an "attack". Nor would symptoms be change with body position. I did some streatching for my TOS and it significantly increased the tingling and pain in my arms.