What could this be?

[matildajpenny]

Thank you for reading this and I hope you might be able to help.

About 6 weeks ago entirely out of the blue I developed a weakness in my right arm and a lesser weakness in my right leg. My right foot also feels odd, almost as though I have a soft onject underneath it. My doc referred me to a neurologist who, after the physical exam sent me for a brain MRI- which was clear My EMG was also clear and I am waiting for a spinal MRI. I have also had twitiching muscles for about 5 months- all over  my body- but no pain at all.

What could these symptoms be due to? I imagine that a clear brain MRI must rule out MS (?) which was my big fear as I seemed to have some of the symptoms.

Thanks

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

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 and story that you present are non-specific and could represent a number of different pathologies.  Just given the symptoms that you describe (without knowing the further testing) I would suspect a brain tumor, multiple scelrosis, a stroke, or even possible ALS.  However, the testing that you decribe make these possibilities less likely.  I would have expected the MRI of the brain to be abnormal if the your symptoms were due to a brain tumor or MS.  I would also have expected your EMG to be abnormal if your symptoms were due to ALS (which presents with fasiculations (twitching), weakness and atrophy).  I agree with your doctors, that you need an MRI of your spine to evaluate for demyelination, tumor, vascular malformation, etc.  If this is also negative, you may consider a lumbar puncture (for inflammation, IgG index, oligoclonal bands), visual evoked potentials (to look for past evidence of optic neuritis) and a somatosensory evoked potential (to look for functional deficits in your spinal cord).  If nothing is found then I would suggest that you should go to a major academic center to have your tests repeated and get a fresh perspective on your case.
I hope this has been helpful.

[matildajpenny]

I am 38 years old, female and otherwise in good health.

[robertmillerfoundation.org]

Hi, I'm sorry to hear about your troubles.  While yo're waiting for the doctor to reply, I thought that I would give you something to go on based on my limited understanding of medicine.  Yes, you are correct in assuming that the brain MRI (I have had many myself) is a very good screening tool to rule out MS.  To my understanding, in most cases a spinal tap will not be performed to check for MS with a normal brain MRI.  Believe me when I tell you that a normal MRI is good news, even though it can be frustrating at the same time since you still don't know what is wrong with you.  I believe that the MRI of your spine is a very logical next step considering that sometimes narrowing of the vertabrae or rarely a tumor can be affecting your spinal cord.  It is encouraging that  your weakness is bilateral since strokes or brain tumors normally would cause unilateral weakness.  All in all, I believe you are going to be okay, I don't think you have a terrible disease from the sound of things. There is an outside chance you may end up getting spinal tap, but don't worry about that, it's not nearly as bad as people make it out to be.   I hope you find out what is wrong with you.

[Annie62]

MRIs are a good screening tool to rule in/out MS but they don't rule it out 100% of the time, especially in the beginning stages (and somtimes apparently even after years of symptoms--I just learned that).  I have had negative brain and C-spine MRIs and have had symptoms for 17 years and yet an MS specialist is doing a lumbar puncture on me next month to rule out/in MS.  There are people who are dxd by lumbar puncture with neg. MRIs.  Don't know if your doctor will recommend it as a next step or not.  

[matildajpenny]

Thank you for your help. My weakness is not bilateral- it is only on one side- right arm and slightly in my right leg- but the brain MRI will have ruled out a stroke or tumor, I'm sure.