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262527 tn?1285385259

Found underlying problem, want some opinions!

Hello,

I have been diagnosed with MS (6/2007) and have went through a lot of medical tesing including 3 MRI's ranging from 4/2007 to 12/2007.

I recently went through my MRI images again and noticed a problem area on all the images in the maxillary sinus area. The concern for me after seeing this was of the maxillofacial surgery I had 6 years ago.

I took my MRI's and had them checked by an ENT doctor. After looking at the images and putting a probe up my nose he confirmed a massive infection within my entire maxillary sinus. I then had an additional CT scan which looked identical to my MRI's but showed a series of screws that had punctured the sinus. I now need surgery to remove this hardware and all the infected tissue. He said that this has been like this for a minimum of 1 year 2 months per the MRI images I have and is concerned of how long it has been since the surgery.

I can not believe I had such a bad infection for so long without having some major pain. The surgeon said I do not have the feeling as a lot of nerves were affected from the surgery just like the odd feeling with my gums and the roof of my mouth. The ENT doctor said this could affect and/or cause a worsening of my MS.

I cannot have the surgery done until the end of next month due to doctors scheduling and I have read some pretty creepy stuff about complications of sinus infections. One thing I seen on Web MD and this is what it says -Complications of sinusitis usually involve the spread of the infection beyond the sinuses. The facial bones can become infected (osteomyelitis), or the lining of the brain can become infected (meningitis). The infection can spread outside the sinus and create a pocket of pus (abscess) in an eye socket, the brain, or facial tissue.

Is there a correlation here between the sinus thing and the MS thing?

Does anyone think that once this surgery is complete I may get rid of my symptoms?

Please let me know any information, thoughts or opinions.

Thanks.

Rob
5 Responses
147426 tn?1317269232
Wow...This interesting news!  I can speak a little to how this would affect MS and why you had little pain from it.

From your description it sounds like you have have the sinus abcess and MS together for the last couple years.   Don't your neurological symptoms date back a few years, too?  If your underlying problem is MS (have you and your doctors settled on that or is the Dx still cloudy?) then having any kind of infection could keep the MS acting up badly.

Any process that stimulates the immune system also seems to put people with MS into relapse.  This is, of course, referring to people with Relapsing Remitting MS.  A simple cold or infected sore, an outbreak of Herpes, a urinary infection - any such thing is likely to initiate a relapse and the longer the infection, the longer or severe the MS symptoms can be.

The ENT is right.  The sinuses themselves don't have much sensation.  Pain is caused by any pressure from the build up of mucous or pus.  In the maxillary sinues you tend to feel this as pressure under the cheekbone or it may feel like your upper teeth on that side are rotten.  (Why did you have to have screws put in your sinus?)

But, for some time last summer (and fall? When did you stop the antibiotics?) you were on heavy duty antibiotics for the suspected Lyme Disease.  The antibiotics they use most commonly for Lyme disease are also ones used often in treating sinus infections.  So, those antiobiotics could have kept the sinus abcess/infection under control.  But, the antiobiotics may well NOT have cured the sinus thing for two reasons.  One, if there is enough infection and build-up of pus then the antibiotics alone can't clear the infection.  It can only be treated by opening it up and draining it.  Two, the body doesn't like "foreign bodies" like the screws.  Even though they use the least reactive metals available, like titanium, once an infection gets started around a foreign body it is next to impossible to clear it up.

Now, once it is cleared up, you should have less stimulation to cause the MS to flare up.  Are you also asking if this abcess could have caused all your symptoms and lab findings?   Don't you have many brain lesions on MRI and oligoclonal bands in your CSF?  No, I don't think the sinus infection could have caused those.  If it did it would have to be by "seeding" the infection into your brain and causing brain abcesses.  You would have been very sick!!!  Deathly sick.

If the sinusitis had eroded through the sinus wall, or followed the screws, into the brain, you would have had signs of a brain abcess on MRI.  This abcess would have been on the outside of the brain (at the place where the pus from the sinus leaked over) and should have looked distinct from the T2 lesions that are characteristic of MS.  I can't imagine that they would have mistaken a brain abcess for the lesions of MS.  They are too different.

So, it seems to me that you would have had both things going on.  I would be interested in what your neurologist has to say about this.

Has your MRI changed in the last year?  Do you know if your Sed Rate, a blood test is elevated?

Well, I hope this discovery will be something that will allow you to get better.  Others will likely chime in.

What's been happening since the winter with your symptoms and your health?

Quix
220917 tn?1309788081
Hey!  It's good to see you back here!  It's been a long time!

Man, you just don't want to keep things simple, do you?  Quix is right -- WOW.

I am not going to pretend I have a good idea about what you two are talking about.  I don't.  I mean, I know what sinuses are, and I understand about the infection, sort of, but WOW.  That's insane. To have had the infection that long, being on the Lyme antibiotics, not know about the infection, the surgical screws, the effects of MS...OY!

I would like to know, like Quix, what your neuro says, and how you've been feeling.  What is the plan now?

Feel well,

Momzilla*
262527 tn?1285385259
Yes, my neurological symptoms date back to March of last year and shortly after I had my first MRI in June of last year which shows this infection. As you know, I been diagnosed by two Neurologists and I am still with the second one and he did clarify I have Relapsing Remitting MS, and he says to get the sinus thing cleared up but did not have much at all to say about this but he is aware of the surgery I had and am having. Also, you mentioned titanium; these are the screws and plates they used in my surgery.

Yes, I was asking if possible, could this of been the original problem as this potentially could have been a problem for many years as I do not know when it started but likely several years as the surgery was 6 years ago. My family and I cannot help but see a correlation here between the two, but again we are not doctors and have a lot of optimism. You are right, I did have several brain lesions and oligoclonal bands.

I have not had another MRI since December of last year. This MRI report stated there are now multiple demyelinating plaques within the identified within the pons, anterior medulla and pontomedullary junction as well as in the region of the left cerebral peduncle. I am not sure what a lot of this means but it does not sound good. If I write the report out and post sometime would you be so kind to translate it in layman’s terms as you have done for me on the last 2?

I do not know of this Sed Rate, would this be within the testing for MS? I did recently have high white blood cells and liver enzymes, which caused more tests, but nothing came out of it.

The way things been going for me seems a bit systematic, as December 20th of last year I had a problem with my legs and walking (this while with Lyme doctor) and put me back on IV rocephin and it did go away after a couple weeks but this was my second big scare with more serious symptoms and as you know I had my first scare with double vision that came in during this Lyme treatment too. So, March 16th I had same walking problems with major balance issues and fatigue, where after about 30 foot distances I hardly could move one leg, this is when I called it quits with the Lyme treatment and ask my Neurologist to help me and he had me do the 5 day 1000 mg solu-medrol protocol and after several weeks I recovered not only from all my walking, balance and fatigue problems I also got rid of my double vision too. He said that was pretty amazing after having it foe 5 months, either way I was glad to take the prism off my glasses.

Recently, on June 13th same thing but with a wicked heavy feeling in my left arm and my fingers and grip were moving really slow, when I tried to open and close them quickly I was getting a super slow motion. My Neurologist said he would do the 5 day protocol again as I was having new symptoms. Again these major symptoms went away.

During remission I still have all of my original symptoms - numbness, l'hermitte's and sensation issues but I can deal with these. The systematic part is these blowouts have been happening every 3 months. What do you make of that?

Well that’s me, and how are you doing? I see you are very active here helping many people and friends, that is so awesome, I hope you know how much everybody (including me) appreciates you and your help and I hope you get a lot of satisfaction out of this and it helps you feel better also.

Thanks,

Rob
338416 tn?1420049302
Whew!  That's a lot of stuff to put up with.  

Well, people with MS do get sick from other things.  Another possibility is that you weren't feeling any pain, because you've lost sensation in the areas of your face that were affected.  I know of one guy with MS who went to the doctor for some pain - turned out his appendix was about to burst, and had to be taken out immediately.  But the pain this guy was feeling wasn't in his abdomen, it was somewhere else (don't remember where!)

Rob, have you recently been diagnosed?  It seems like people who have just been diagnosed have a lot more flares their first year.  I had four - one big one that I took oral steroid for, and three small ones, which didn't need steroids.  Each one was about a month to two months apart.
262527 tn?1285385259
It is nice to hear from you, yes it has been a long time but I cannot keep myself away from here. This is really a great place, I just have not posted in a while, as you can see I have been busy keeping things complicated LOL.

My Neurologists does not have much at all to say at this time but my plans are to have this surgery next month and wait a bit after the surgery to see how my symptoms are doing before resuming with the MS medication.

If you have any questions, please let me know.

Well I hope everything is going good for you and take care of yourself.

Rob
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