Can it be MS with out spots on MRI?

[Clark5]

Hello, I am being "worked up" for; left sided weakness, headache, hypothyroid, NIDDM,peripheral neuropathy, leg cramps, hyper-coag state, CVA.  Due to symptoms of: migraines with left eye twitching and pain additionally I feel like I see a fog, bruising easily, inability to maintain sleep, on edge crabby, can not remember things, can not find the word but I know what I want to say, have to go to the bathroom always (urinate) and now, legs feel heavy  as if they have shin splints and I have not been running or walking a lot,dizziness, inability to tolerate heat or cold. I had an MRI of brain with contrast and it showed something in the frontal area of high frequency but noting else.  My neuro exam was not normal.  I have not had a spinal tap yet, just 17 tubes of blood and am registered for a sleep study. It seems to me they are trying to rule everything out but no mention of MS, yet the work up seem to be like an MS work up. I am anxious to know something.I have been having these problems on and off for the past 2 years.  I am 44 years old and have been in good health only taking BCP'S and 10mg Lipitor due to elevated triglycerided (have had this problem since teen yeard, mother stroked at a young age also had bells paulsy).
Any ideas for what is going on?

[Clark5]

Well, you are correct, I write as I am thinking (which is often not orderly, and just serves to confuse people).  I do have a time line of sorts in a journal and did give it to the neurologist NP.  

Speaking informally, I was afraid of going to see a physician again, you see 2 years ago I had some neurological symptoms; dizziness, balance disturbances, numbness, and forgetfulness.
To make a long story short, my physician told me to take some diazepam, and just take care of my children.

I was angry and dishearten, for perhaps he was right and I was just stressed.  Well, my symptoms waxed and waned, I returned and my physician told me once again that I was overworked and wanted to start Prozac. Well, that was it I looked for another internist. I went to one recommended by a friend who is a nurse.

I started with a new physician who recommended a neurologist.  So, now I am getting someone to listen and look over my concerns and symptoms.

  I was started on lamictal, to help with preventing the migraines and with the crabbiness; my symptoms were affecting my family (they walked lightly around me for fear of me yelling or being crabby)

I am in the medical field, research area.  
I was told that I have left sided weakness and peripheral neuropathy.

The bruising is a different problem however the blood tests will hopefully show something, family history of Berger’s diseases also.

I am waiting for some clarification, even a diagnosis of depression (I do not think that I am, but some direction would be helpful)

Thank-you for your thoughts and concern.

[Quixotic1]

Welcome.  Just showing my age here. Can we call you Dave???  :)  I hope you enjoy our show.  We are the best thing in MS forums going, though all of a sudden we have more new people than we ever have had and things seem chaotic.  I am the resident physician, having been a pediatrician in my former life.  I have MS and am disabled.  I always like to see medical professionals here hoping they will stay and share their experience.  I am not official and haven't been in practice for more tan 6 years.

Are you saying that you have all those things (CVA, hypercoag state, thyroid, etc) or they are sending blooding to rule those out?

If MS is suspected, first the neuro should take a detailed history and do a very detailed exam.  If the H & P suggest a white matter disorder then the next step is almost always an MRI which should be of the brain and spine.

Also they doctor must rule out the known mimics of MS which are many of the things you mentioned, autoimmune vasculitis, thyroid, vitamin deficiency, metabolic problems, hypercoagulability, infection (HIV, Lyme, Syphilis, HTLV I & II), sarcoidosis, and others - thus the 17 tubes of blood.  MS is a diagnosis of exclusion.  One of the requirements is that "all other reasonable causes for the symptoms and findings must be ruled out."

I'm amazed they let you take BCP's into your 40's with a family history of young stroke.  Did you have a cardiology consult first?

Then, if the mimics are ruled out and the H &P do not show a characteristic Relapse and Remitting pattern and if the MRI is not diagnostic, they would do the supporting tests for MS which would include an LP and, with your history of vision difficulties, a Visual Evoked Response looking for evidence of prior Optic Neuritis.

So you are correct.  They are doing a workup for MS in the proper sequence, even though they haven't mentioned MS.  During this part of it it seems as though they are looking for something else - and they are.  They are being thorough about looking for the things that mimic MS - this is very good.  Some docs discuss their suspicions with the patient.  I was of that belief.  If you don't the patient will often dwell on worse things than the doctor is suspecting.  Some docs keep their cards very close to their chest.  I think this raises the patient's anxiety, but it is a matter of opinion.  As someone in the medical field, you already have your suspicions.

Is the easy bruisability new?  It is NOT a part of MS, though most of the other things you mention can be.

It would help us if you could sort your symptoms into a timeline, when things first got weird, how long they lasted, whether any of your symptoms have remitted.  Have you had more than one onset of symptoms, either the same ones or different?  That is so important is MS is even being considered.

Also if when you post if you could separate your thoughts into separate paragraphs.  Many of us, including me, have great difficulty with eye tracking.  We get lost in the long paragraphs and lose information.

Agian, welcome.

Quix, MD

[young at heart]

WELCOME TO OUR CYBER FAMILY, MY ORIGINAL BRAIN MRI SHOWED NO LESIONS BUT BRAIN ATROPHY,MORE THAN LIKELY PAST LESIONS.

A MS DIAGNOSIS IS DONE BY RULING OUT OTHER DISORDERES FIRST.

THE MRI'S SHOULD BE READ BY THE NEUROLOGIST ,NOT BY JUST GOING BY THE MRI REPORT.

T

[Clark5]

Thank-you for your help and interest in me.  I am not sure what was all was wrong with my neuro evale, I have to adimt that I was a bit taken back and probably tried to deny.  I thought that it was all migraine and probably thyroid.  I do remember being told that I had left sided weakness, my left side of my face was lower (especially my eye). Additionally i was told that I had right sided, peripheral neuropathy.  I do know that when I was told to close my eyes, i could not keep my balance and the NP had to help keep me up, although it is wierd that i can hop on one foot fine ( I do that with my 3 year old at home a lot to a Raffi song).  My blood tests should come in next week.  Oh, I still need to schedule a sleep study. So I find it helpfull to hear what other patients have to say.

[Sonaya]

Firstly welcome to the MS forum.  Many of us here are in a similar situation to yourself whereby we are going through assorted testing, MS may or may not be on the cards for some of us.  We call it Limbo Land.  We are in Limbo until we have a diagnosis of sorts.
Whilst your doctors may not come straight out and mention MS to you, I think they are probably waiting until some of your results come in to start speculating.   You are right  however, in thinking that it does seem fairly standard for a MS workup?  I definately feel they are going to be looking at that but its a process of elimination.  Because so many other illnesses can cause MS type symptoms.  Ive learnt here that the girls use the term MIMIC because so many illnesses do mimic MS.

Myself for example have many symptoms similar to you and have had already many of the tests you mention.  MS was not immediately mentioned to me when mine first started only 5mths ago but as I got through the barrage of tests, it did get brought up along the way.  And then ruled out and then brought up again, etc etc.

You mentioned having a lot of blood taking for various tests?  Do you have those results back yet?  When do you follow up all these results with your neuro?

You are in the right place here definately.  Some of us are just starting the testing and workups, some are half way through, some have a possible diagnosis that might not be MS but hang here because truly the ladies are a wonderfully supportive bunch.

We know the frustration and the emotional roller coaster that goes with trying to find out what is wrong wi th us.  And even for those that have the diagnosis, they have good days and bad and this forum seems to be wonderful for just being allowed to vent.

I know you will get lots of support and advise and learn much here .
Sonaya

[TiredPT]

Just found a thread by Quix on MRIs and lesions.  Good read that may help!!

[TiredPT]

Welcome to the forum!!!

Don't know that I am the best to answer . . . . pretty new here myself.  But I do know that MS is very hard to diagnose and from what I have read, it is easier to rule the other things out first since those (i.e., NIDDM, kidney problems, hypothyroid) can be easily tested for.  I have a feeling that many of us have been down this same road.  People can have MS for years (because can have years between exacerbations) and still nothing major showing on the tests.  I am a physical therapist -- example I have is a patient that presented to me with a diagnosis of thigh muscle strain.  She had been sitting cross-legged on the floor painting for several hours the day before and woke up the next morning with all this pain and muscle spasm in one leg.  In the history, she reported that she has been under a neurologist's care for 2 years and received disability due to chronic severe headaches.  She was working full time and a fully functioning member of society . . . . then bam, woke up one morning with a headache that has persisted for 2 years.  In the course of a few sessions, I saw a progression to a definite neuro problem and contacted her PCP.  An MRI was ordered and found regions suggestive of a demyelinating process.  She had already had several brain scans due to the headaches, the most recent less than a year ago.  I can't help but believe that the headaches were the onset of MS but the damage just wasn't apparent on the MRI.

Quix speaks of the difference between a 1.5T and a 3T MRI -- I believe this has to do with the intensity of the magnet which would result in a better image, but not for sure.  She is the local physician (also MS sufferer) that hangs out here and is very helpful.

I have chronic high EBV (Epstein Barr Virus) titers and suffer from many of the things you mention when I go back into an exacerbation of the problems -- including the severe urinary urgency and frequency.  A lot of the things that you mention can be attributed to so much so it is wonderful that your physician is taking such an aggressive role in trying to discover what is going on.

What was abnormal about your neuro exam??