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Neurology (Expert Forum)
MS or POTS
Answered by
Esteban Cheng-Ching, MD - Neurology, Internal Medicine
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
MS or POTS
by flowerbug17, Jul 23, 2008 09:31AM
I am a 42 yr old female No history tobacco, drug or alcohol use. Over the past 2 yr. I have been experiencing some vague neurological symptoms: left foot drag occasionally, decreased coordination at times, numbness and pain, episode of searing pains through chest and arms on 2 occasions (very scary), pain in left thigh, blurry vision intermittently (with longest vision problem lasting few weeks) at the same time frame as the blurry vision I also had tremendous brain fog. I felt like I was on autopilot and couldn't recall most of the day (this has since improved somewhat). I have fatigue and a history of PVC's and tachycardia, very occasional migraine HA, periodic dizziness, no other major health problems.
So I went to local neurologist (Nov 2007). and inquired about M.S. He did blood work: ANA, Chem. 14, B12, and Sed. rate- all okay, but MRI brain showed "a few scattered white matter lesions". I was then sent to 2 neurologist in Indy. (Dec 2007- Mar 2008) The first doc felt that I had strokes from and atrial septal defect- I had a Trans Esophageal Echocardiogram, it was good- no problem there. The next doc said he felt it wasn't MS and ordered MRI cervical and thoracic spine and evoked potentials-all okay. But he does have me set up for another MRI brain in 1 yr. after initial MRI. I spoke with a nurse friend and she asked more questions and stated she had to go to Mayo and there was diagnosed with POTS. After we talked I feel like this could be what is going on with me. Does anyone have advice, and does anyone know where to find a doctor or clinic for autonomic neurological conditions? I still feel crummy some days and seem to have more questions now than before. Any replies would be appreciated!!
So I went to local neurologist (Nov 2007). and inquired about M.S. He did blood work: ANA, Chem. 14, B12, and Sed. rate- all okay, but MRI brain showed "a few scattered white matter lesions". I was then sent to 2 neurologist in Indy. (Dec 2007- Mar 2008) The first doc felt that I had strokes from and atrial septal defect- I had a Trans Esophageal Echocardiogram, it was good- no problem there. The next doc said he felt it wasn't MS and ordered MRI cervical and thoracic spine and evoked potentials-all okay. But he does have me set up for another MRI brain in 1 yr. after initial MRI. I spoke with a nurse friend and she asked more questions and stated she had to go to Mayo and there was diagnosed with POTS. After we talked I feel like this could be what is going on with me. Does anyone have advice, and does anyone know where to find a doctor or clinic for autonomic neurological conditions? I still feel crummy some days and seem to have more questions now than before. Any replies would be appreciated!!
Doctor's Answer
by Esteban Cheng-Ching, MD, Jul 25, 2008 01:47PM
, Jul 25, 2008 01:47PM
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 your doctor.
Without the ability to take a history and examine you, I can not tell you what the cause of your symptoms is. However, I will try to give you some information.
The symptoms you describe are multiple and nonspecific. Some of them may present along with others in different neurologic conditions, one of them being MS as you mentioned, but the symptoms themselves are not diagnostic and not specific for this condition.
MS is a demyelinating disorder that affects the central nervous system. It manifests with focal neurologic deficits, such as visual loss, numbness, weakness, coordination problems, etc. There are criteria to make the diagnosis, and the criteria uses clinical evaluation (history, symptoms and physical signs), along with imaging such as MRI, and sometimes (not all the time) other tests are required, such as lumbar puncture and evoked potentials.
To make the diagnosis, basically there should be some objective evidence of at least 2 or more events, affecting 2 or more areas of the brain. Therefore your history helps if there have been clear episodes of focal neurologic deficits in 2 or more occasions, and there should be confirmation with MRI showing 2 or more lesions consistent with MS. Sometimes it is not as easy as this, and either the clinical findings are not evident, or the MRI findings are not clear neither, and so repeated imaging over time helps. If there is still doubt, the other tests should be considered.
“White matter” lesions in an MRI are nonspecific, and should be taken into the context of the patient’s history. Could be related to MS, but also could be related to hypertension, or diabetes, and even these “white matter” lesions could be just an incidental finding, and many times the clear cause is not known, but should be observed over time if there is any concern.
Regarding POTS, again the symptoms you describe are nonspecific, and could be related to a condition like this, but may not. Patient’s with POTS describe dizziness, lightheadedness, weakness, blurred vision and fatigue mainly upon standing. Also palpitations, tremulousness, anxiety and GI symptoms. All these symptoms are nonspecific. The key finding in POTS is an exaggerated increase in heart rate on standing, and this is objectively evaluated with tilt table testing. Patients with other autonomic disorders, such as autonomic neuropathies or specific problems with the autonomic nervous system can have similar findings. Detailed history and examination can help suggesting a possible diagnosis of autonomic disorders or POTS.
There are physicians who are specialized in autonomic disorders and deal with POTS and other autonomic conditions. Usually they are under a subspecialty of Neurology. However as it is not clear if this could be the problem, I think you should discuss this possibility with your neurologist, and if needed, get an consultation with an autonomic disorders specialist. There are neurologist who see autonomic disorders at the Cleveland Clinic, however I think you should discuss this possibility first with your neurologist.
Without being able to obtain a history and examine you, and without being able to see the images of the MRI, I cannot tell you what you have. I think that discussing your concerns with your neurologist, and having a repeat MRI will help determine the diagnosis. I hope this helps.
Without the ability to take a history and examine you, I can not tell you what the cause of your symptoms is. However, I will try to give you some information.
The symptoms you describe are multiple and nonspecific. Some of them may present along with others in different neurologic conditions, one of them being MS as you mentioned, but the symptoms themselves are not diagnostic and not specific for this condition.
MS is a demyelinating disorder that affects the central nervous system. It manifests with focal neurologic deficits, such as visual loss, numbness, weakness, coordination problems, etc. There are criteria to make the diagnosis, and the criteria uses clinical evaluation (history, symptoms and physical signs), along with imaging such as MRI, and sometimes (not all the time) other tests are required, such as lumbar puncture and evoked potentials.
To make the diagnosis, basically there should be some objective evidence of at least 2 or more events, affecting 2 or more areas of the brain. Therefore your history helps if there have been clear episodes of focal neurologic deficits in 2 or more occasions, and there should be confirmation with MRI showing 2 or more lesions consistent with MS. Sometimes it is not as easy as this, and either the clinical findings are not evident, or the MRI findings are not clear neither, and so repeated imaging over time helps. If there is still doubt, the other tests should be considered.
“White matter” lesions in an MRI are nonspecific, and should be taken into the context of the patient’s history. Could be related to MS, but also could be related to hypertension, or diabetes, and even these “white matter” lesions could be just an incidental finding, and many times the clear cause is not known, but should be observed over time if there is any concern.
Regarding POTS, again the symptoms you describe are nonspecific, and could be related to a condition like this, but may not. Patient’s with POTS describe dizziness, lightheadedness, weakness, blurred vision and fatigue mainly upon standing. Also palpitations, tremulousness, anxiety and GI symptoms. All these symptoms are nonspecific. The key finding in POTS is an exaggerated increase in heart rate on standing, and this is objectively evaluated with tilt table testing. Patients with other autonomic disorders, such as autonomic neuropathies or specific problems with the autonomic nervous system can have similar findings. Detailed history and examination can help suggesting a possible diagnosis of autonomic disorders or POTS.
There are physicians who are specialized in autonomic disorders and deal with POTS and other autonomic conditions. Usually they are under a subspecialty of Neurology. However as it is not clear if this could be the problem, I think you should discuss this possibility with your neurologist, and if needed, get an consultation with an autonomic disorders specialist. There are neurologist who see autonomic disorders at the Cleveland Clinic, however I think you should discuss this possibility first with your neurologist.
Without being able to obtain a history and examine you, and without being able to see the images of the MRI, I cannot tell you what you have. I think that discussing your concerns with your neurologist, and having a repeat MRI will help determine the diagnosis. I hope this helps.
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I will also follow up with MS specialist In Indy in Dec. Again thank you for your time and reply.
Again, you should discuss with your neurologist to see if your problems are consistent with autonomic disorders, and if there is concern about this problem you should see an autonomic disorders specialist.