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Neurology (Expert Forum)
Carpal Tunnel and MS study
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Carpal Tunnel and MS study
by Nanners123, Mar 03, 2007 12:00AM
For the last six months I have been given several tests for the purpose of ruling out MS. I have had various symptoms that may be consistent with MS for several years, however, never thought much about them as they woud occur and remit in cycles a couple times a year. Most recently, I went to the ENT because of severe shooting pains in my right ear that would wake me up in the middle of the night. Also, for the past year my arms and mostly hands would go numb and tingle in the middle of the night causing to me wake several times. The ENT happen to give me a paper to fill out asking about dizziness. I just so happen to have had one of my severe attacks weeks earlier so was able to describe in detail my symtoms. He sent me for ENG and other tests. The other tests were normal but the ENG indicated my ear pain may be centrally caused. I then began the workup with neurologist. I have had MRI of Brain w/wo (Normal), MRI of lower Lumbar w/wo (Normal but tiny herniation T3-4), , VEP X2 six months apart (both indicating abmormality in left eye),Blood test for Lymes (Normal), ANA/SED rate (Normal), Lumbar puncture (Normal). Five days after Lumbar puncture I expeienced localized numbness & pain in left thigh. EMG's show carpal tunnel. EMG two years ago showed Carpal tunnel in left wrist only now both. I searched the internet for Carpal tunnel and MS and came across a study which seemed to indicate that Carpal Tunnel may mask MS. Can you tell me more about that? Also, should I be looking to have any other tests due to abnormal ENG and VEP?
Doctor's Answer
by CCF-Neuro-M.D.-SH, Mar 08, 2007 12:00AM
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.
Multiple sclerosis (MS) is a disease caused when your immune system attacks your nervous system. Specifically it attacks the 'insulation' (Myelin) of 'wires' (axons) of nerve cells in the brain and spinal cord. Without the 'insulation' around the nerve processes the signals are slowed down and can get crossed (causing weakness, numbness and pain). These immune attacks typically occur in discrete episodes with symptoms lasting for a few days to a few weeks. At first the attacks resolve completely, but over time they often build up to result in permanent disability. The first attack of MS is called a 'clinically isolated syndrome' [CIS](before MS can be diagnosed). When someone presents with a CIS then additional tests are done to look for signs of demyelination. Some of these tests include visual evoked potentials (VEP), which looks for sign of past optic neuritis [demyelination of the optic nerves]; MRI of the brain and Cervical spine to look for demyelination plaques; lumbar puncture to look for signs of inflammation in the spinal fluid; somatosensory evoked potentials (SSEP) to look for demyelination in the spinal cord and brain stem auditory evoked potential (BAEP) to look for brain stem demyelination. There are some conditions that can cause similar symptoms to those experienced by patients with MS. 2 of those conditions, you have mentioned, inner ear problems and carpal tunnel syndrome. Inner ear problems can cause room spinning, loss of balance, ringing in the ears and hearing loss. When these type symptoms are encountered then an ENG (electro-nystagnogram) can help differentiate between and ear problem or a central problem (brain problem). Similarly carpal tunnel syndrome can cause numbness and weakness in the hands (as can MS), and a nerve conduction study can differentiate between the 2. Your abnormal VEP on the left suggests that you have likely had a past episode of optic neuritis in the left eye (a possible clinically isolated syndrome). The abnormal ENG is non-specific but may relate a possible brain stem demyelination lesion (although it was not seen on your MRI). I would suggest that you get the nerve conduction study to evaluate for carpal tunnel syndrome and get a repeat MRI of the brain and cervical spine with contrast. MS is a disease that changes over time and if your initial MRI is 'normal' it may become abnormal if you aquire new lesions.
I hope this has been helpful.
Multiple sclerosis (MS) is a disease caused when your immune system attacks your nervous system. Specifically it attacks the 'insulation' (Myelin) of 'wires' (axons) of nerve cells in the brain and spinal cord. Without the 'insulation' around the nerve processes the signals are slowed down and can get crossed (causing weakness, numbness and pain). These immune attacks typically occur in discrete episodes with symptoms lasting for a few days to a few weeks. At first the attacks resolve completely, but over time they often build up to result in permanent disability. The first attack of MS is called a 'clinically isolated syndrome' [CIS](before MS can be diagnosed). When someone presents with a CIS then additional tests are done to look for signs of demyelination. Some of these tests include visual evoked potentials (VEP), which looks for sign of past optic neuritis [demyelination of the optic nerves]; MRI of the brain and Cervical spine to look for demyelination plaques; lumbar puncture to look for signs of inflammation in the spinal fluid; somatosensory evoked potentials (SSEP) to look for demyelination in the spinal cord and brain stem auditory evoked potential (BAEP) to look for brain stem demyelination. There are some conditions that can cause similar symptoms to those experienced by patients with MS. 2 of those conditions, you have mentioned, inner ear problems and carpal tunnel syndrome. Inner ear problems can cause room spinning, loss of balance, ringing in the ears and hearing loss. When these type symptoms are encountered then an ENG (electro-nystagnogram) can help differentiate between and ear problem or a central problem (brain problem). Similarly carpal tunnel syndrome can cause numbness and weakness in the hands (as can MS), and a nerve conduction study can differentiate between the 2. Your abnormal VEP on the left suggests that you have likely had a past episode of optic neuritis in the left eye (a possible clinically isolated syndrome). The abnormal ENG is non-specific but may relate a possible brain stem demyelination lesion (although it was not seen on your MRI). I would suggest that you get the nerve conduction study to evaluate for carpal tunnel syndrome and get a repeat MRI of the brain and cervical spine with contrast. MS is a disease that changes over time and if your initial MRI is 'normal' it may become abnormal if you aquire new lesions.
I hope this has been helpful.
I'm sorry for all you pain. I can understand how frustatring it can be not having a formal dx... Adding up to all the symptoms there is always a ghost to fight with: our own minds wondering what we could have... I have been having sensory symptoms for 2 years, and can't find out what is wrong. I also have a carpal tunnel like problem, but mine is close to the elbow join, so both my hand and forearm go numb. My doctor also thinks they are not related to the other symptoms I have.
Jon McKee,
Would you mind sharing with me what symptoms you had/have?? I also have a numbish feeling that travels on my legs, tingling, needle sensation. My major symptoms is on my face, where I have a fullfillness sensation under my skin all the times, sometimes worse, sometimes not that bad. I wonder about the sensations I have on my legs, sometimes arms, because they can come and go in minutes, what seems not to be a MS pattern... Anyways, I hope you are doing fine, it's really scary having neurological problems that you don't know how far they will go. I have ups and downs, now I have been able to start putting my life back together (I'm 31), but I'm always scaried of my health in the future.
All the best for all of you.
rcs2