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ms or post acdf surgery symptoms?
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ms or post acdf surgery symptoms?

41 y/o F having stinging sensation that begins in mid back for past 2 years. Once it begins other parts of my body respond whether it is pain tingling weakness etc. Acdf surgery was 6/10. However prior to surgery experienced balance problems, dizziness, joint pain, numbness and tingling in lips, fingers, and right arm, visual disturbances, and fatigue. Past MRI of brain showed one lesion in the subcortical region which was never addresses even with my symptoms. To date symptoms are more often and the tingling in my lips now include tingling in my forehead and cheeks. New MRI impression showsI had a MRI done recently and this is what the impression is “Multiple deep white matter T2 and FLAIR hyperintense lesions within the bilateral frontal lobes and posterior right parietal lobe with are consistent with demyelination. There is no evidence of active demyelination". Is this to say ms should now be considered a possibility? I have had positive Ana, negative ssa positive ssb, low b12 and low vitmin d which i now yak supplements for but i have to add the vitamin d was 17 and b12 was 200. Lupus i am told is ruled out, diabetes is ruled out, ra negative no vascular concerns and heart is good. Please tell me your thought. Thank you!!
Avatar_dr_m_tn
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.

Without the ability to examine and obtain a history, I cannot tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Some of the symptoms you reported would make a physician suspect a multiple sclerosis.

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 visual evoked potentials ((a test of how the nerve from the eye, the optic nerve, is functioning). If an MRI of the brain and spine is normal, the diagnosis of MS becomes highly unlikely. Alternatively, if someone has several lesions on the brain MRI, but they have not had distinct episodes of neurologic symptoms, or they have specific findings on neurologic examination, then a diagnosis of MS cannot be made.

Patients who have MS usually have symptoms like: sudden loss of vision in an eye from optic neuritis, sudden weakness, numbness or stiffness in one or more limbs, loss of balance and incoordination.

It is difficult for me to determine if you have MS without being able to get a detailed history, without being able to examine you, and without being able to see the MRI. However, if you have had increase in the white matter lesions as per the impression of the MRI, MS and other demyelinating diseases would be on the differential. Among the labs you mentioned, I noted your B12 was quite low, that can also cause lesions which mimic MS.

Cervical compressive radiculopathy (I am presuming you got the ACDF surgery for that) cant  explain all the symptoms you described, only part of them.

I would recommend seeing a neurologist and taking all the actual MRI films to him so that he can take a detailed history do an exam and see the MRIs to tell you what the nature of the white matter lesions in your brain are and if you need more workup.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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Avatar_f_tn
Hello. well to be honest you answer is already in your post. you have low B12  and low Vit D .you are  Deficient in both. They can both cause the symptoms you discribed.
Have you been told what caused you vit B12 ? was it because of intrinsic factor or dietry ? if it was the intrinsic factors then im afraid you will get very little if any B12 via supplements as you will be unable to absorb it in the stomach. Therefore you will need injections and this is for life. Many Doctors give injections every 12 weeks but considering you have neurological symptoms you should 1st get a loading dose of 6 injections over 2 weeks followed by 4 weekly injections. you need to get your levels up in the 1000 plus before it can even start to repair the damage that may have already been caused. A Baby is born with levels of 2000. B12 is a water soluble Vitamin therefore you can not overdose on it so please do not let any one tell you differently. It annoys me so much when doctors dismiss a B12 deficiency. this can cause a condition known as Pernicious Anaemia . Pernicious meaning fatal. with adequate Treatment you will see a remarkable change in your health. B12 is needed in every cell in your body.It would  also have been advisable to have had your folate and ferritin tested before you started B12 Therapy but still have them checked. Folate and B12 work together. and Low Iron will need supplementin also. Good Luck ;-)X
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Avatar_f_tn
The bigger question is what is causing the low B12 and Vitamin D?  

I suggest you find a LLMD, a Lyme Literate Medical Doctor and get checked out for Lyme Disease. It can cause every symptom you mention, along with the vitamin deficiencies.  Lyme often mimics autoimmune disorders, such as MS, Lupus, and Hashimoto's, as well as other conditions, such as Chronic Fatigue Syndrome and Fibromyalgia. A hallmark of Lyme is that symptoms come and go and vary in intensity. Symptoms are often described as "vague" and "weird."

Many doctors are unfamiliar with the symptoms of late stage Lyme and do not know how to diagnose or treat it. They don't know that antibody tests are often false negative and that half of patients don't recall a tick bite or a rash.

I encourage you to come post on the Lyme Disease forum.
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Avatar_f_tn
Because of the symptoms and the 4 ticks that were pulled off of me after an ATV accident in 2007, I actually brought Lyme up last year, to my then neuro, and he looked at me like I was crazy. Does LD also cause lesions in the frontal and parietal lobes??   I will definitely check out the LD forum. Thank you!!
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Avatar_f_tn
Sorry I am so slow to respond. I just got the email indicating a new comment here.  I definitely encourage you to come to the Lyme forum. Given that the more likely conditions have been excluded, Lyme is a possibility given your tick bites. You could also have a coinfection, such as Bartonella or Babesia, infections also transmitted by ticks.
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