PTM 3 yrs ago - Return of MS-like symptoms

[jicommon]

Dear Dr:

I am a 34/m, 6'5'' 275lbs had high bp 140/100 & high chol now on meds


6/99 1st episode: numbness in R arm R leg R trunk, Lhermitte's a few days later.  Visited neuro, office exam normal, brain MRI neuro said normal. C- Spine MRI, revealed a PTM - One small lesion in the white matter of my spinal cord - neuro said it explained symptoms perfectly. HAd L eye pain 2 mos later but vison normal EP normal. next 2 years everything was fine except my arms and legs would always "go to sleep" much quicker than before.  

6/01 int. mild tingling in rght side of my face- would resolve in minutes.  Saw different neuro - office exam normal.C spine mri was unclear(said i moved) but radiolgist said there was a possible bulging disk.

Brain MRI  9/13/01:  " 1cm focus of increased T2 signal near the right frontal horn.  smaller similar focus of increased t2 signal near the left frontal horn.  These do not enhance, do not have mass effect. Also a punctate focus of increased t2 signal in the right frontal lobe also non enhancing.

Impression:  3 foci of abnormal t2 signal the largest of which is 1cm. this is a non-specific finding and can be seen in an ischemic or demyelinating process.  However,it is not a typical pattern for MS.  No abnormal enhancement to indicate underlying mass." Neuro said do nothing.

No further symptoms until 5/12/03
Numbness in R upper trunk only also began having stabbing pain in R chest around nipple which would increase if pressure was applied. also unususal itching burning sensat in R back, R leg seems a bit wobly....

[jicommon]

Thank you very much for your response.  Just as a clarification, the discomfort in my chest is not a tightness/pressure sensation.  The sensation is one of intermittent stabbing pain, which is occurring soley in my right upper chest, there is no pain anywhere to the left of the sternum. However, when I touch my R chest, especially the sternum (even lightly)I get a wave of sharp pains which radiate outward to the right side of my chest. Even wearing my shoulder seatbelt is enough to activate the pain. This pain has lessened somewhat over the last 2 days.  

Is this symptom consistent with MS or does it bring any other conditions to mind?

When one gets an MS like "flare up" do the symptoms typically take more than 1 week to manifest themselves?

Thanks,

Ian

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

Please keep in mind that I have never seen your MRI and cannot accurately comment on your case until I have done so.  I can only make an educated guess as to your condition based on the info you have provided. Ok, having said that...

1.Yes hypertension can certainly cause nonspecific lesions on the MRI in the areas that you describe.  Most likely these are clinically silent, meaning they are not related to your symptoms and do not appear to be causing any new ones.

2+3.Chest tightness can be part of stress as well as cardiac symptoms, but they can also be caused by demyelinating lesions of the spinal cord.  We have a number of patients with spinal cord MS or even other injuries that manifest symptomatically as tightness around the chest or even an asymmetric chest pressure/tightness similar to what you describe.  In someone with a known history of transverse myelitis, this would alert me to the possibility of a new lesion and less likely to attribute it to stress.  An MRI of the cervical AND thoracic spine should be considered at this point.

4.Although I don't personally know Dr. Kerr, Johns Hopkins has a reputable neurological center with top notch physicians.  If this is closest to you, then I would recommend the second opinion there.  If you are willing to travel, the Cleveland Clinic has the MEllen center where our neurologists are all MS specialists and frequently deal with diseases like Transverse Myelitis.

Finally, if there is indeed a new lesion on the spinal cord, it amy be time to consider one of the ABC drugs for MS for long term maintenance therapy.  Good luck.

[jicommon]

Sorry to keep tacking on, but I thought of another important question.

Would it make since to see Dr. Kerr down at Johns Hopkins? It seems like he is running one of the only clinics devoted to TM. (I get the impression that my neuro is not an MS expert, and if I have MS I want to know right away so I can start treatment asap)  I live in CT so the trip to Cleveland would not be too bad if there is someone you think I should see at CCF.  I am open to anything, I just want to figure out what is going on with my condition.

Thanks again,

Ian

[jicommon]

These questions relate to an earlier episode I had in 1999 whihc I posted on and MD RPS wrote a response.  It can be found under the search heading "Partial Transverse Myelitis" on this forum.

Sorry I ran out of room to post the questions on the initial post - I really tried to fit everything in.

The questions are:

I am not sure if the first MRI in 10/99 picked up the brain issues or not - my neuro just said it was normal.
Undersanding the limitations of the internet, can you comment on what the latest mri findings might mean?  Does my high BP paly a role in this? (BP is now controlled with meds, but I only started on meds a year ago))  Also have high triglicerides taking lipitor for this.

Do you think the stabbing R chest pains/itching burning patches in the R back are caused by my neuroligical issues even though the pain increases dramatically when I press on my R chest? I saw the 2nd neuro yesterday and he did not seem to take the chest pain seriously "I'm not a cardiologist" was his quote, as I recall.  The pain is real, and it was enough to wake me up last night.  I tried advil but it did not help much - can you recommend what type of DR to see if it is not neurolocical - I would really like to get something for the pain if it is going to continue.

Does the return of symptoms indicate MS?

Since the new symptoms have started only a few days ago I am concerned about more problems appearing if this is an MS like excaserbation - can you tell me if I am likley to have more neuro issues appear during this episode or do they typically come all at once?

Thanks so much for listening to this long question.

Ian