MS or Not? Looking for your opinions

[Lulu54]

This will be lengthy so thanks in advance for sticking with me.  I wonder what you all think, when you put all my medical info together – MS or NOT?

From my medical record and tests-

Female, 53 years old. Myocardial infarct January 2008. History of tobacco and alcohol use.   I have since quit everything, including caffeine and chocolate.

This is not associated with arterial disease, because my arteries are not clogged.  Less than 10% blockage anywhere, according to cardiac catherization/angiogram.  However, my cholesterol and triglycerides continue to be high since I can't take statins.  

In the past three months have been tested for and cleared of all problems with the following: stomach, colon, mammogram, pap smear, abdominal ultrasound, esophagus, CT chest scan , nuclear stress test for heart (all ok!), gallbladder.  Is there anything else I should have tested?

I just got the results of my blood tests and everything is within normal range or is negative, with the exception of slight glucose elevations and a small percentage above normal for my C Reactive Protein at  4.75. This includes chemistry, immunology, endocrine and hematology – they ran every blood test and I even know I don’t have Lyme disease, Rocky Mountain spotted fever or syphilis  ;-)   Negative for Lupus, RA, and everything else as well.  This was my $3,103 worth of blood lab work.

EMG – “Clinical correlation: This patient presents with both lower and upper motor neuron findings on EMG and physical examination respectively.  I think her chief complaint of footdrop/dragging her right lower limb as well as the numbness may in fact relate more to an upper motor neuron process than the peripheral neuropathy or possible fairly mild radiculopathy. Of course there can be some overlap with the upper and lower motor neuron processes.  But certainly neither of these lower motor neuron diagnoses would explain her increased reflexes and positive Babinski sign.  An ischemic event n the anterior cerebral artery could explain this, The incidence of CVA is increased in individuals with coronary artery disease. A demyelinating disorder cannot be ruled out either.  …. Further evaluation with an MRI of the brain and possibly also the lumbar spine should be considered.”

So the MRI’s were done, and here’s those report summaries:

Brain MRI with and without contrast:
There is moderate white matter disease. Periventricular and to a lesser extent subcortical, and also a lesion involving the posterior limb of the left internal capsule.  No brachium pontis lesions are seen. No medial temporal lobe or definite corpus callosal lesions are see. One slightly ovoid lesion is seen in the right frontal white matter posteriorly. A number of these lesions show a vague rim of increased T1 signal due to lipid leaching , and this occurs commonly with demyelinating disease such as MS. Additionally, one of the lesions in the right frontal white matter is active and enhances … There is also an active enhancing lesion shown in the left parietal white matter ….  Punctuate lesion, which is enhancing, in the left frontal white matter…. There is also some blackhole formation bilaterally, greater on the right, which indicated severe axonal desctruction.
Impression: Moderate white matter disease in keeping with a demyelinating process such as MS with at least three active enhancing lesions shown.  There also is some blackhole formation bilaterally, greater on the right, which indicates severe axonal destruction.

MRI Spine Thoracic w/o Contrast
Impression: No abnormal signal is seen within the thoracic cord. No compression deformity is seen.

MRI Spine Lumbar w/o Contrast
Impression: Multilevel discogenic changes are seen throughout the lumbar spine.  There is a disc protrusion seen at L5-S1 which effaces the ventral thecal sac and abuts the descending S1 nerve roots as well as the exiting L5 nerve roots.  (there’s more in the details but this is the summary paragraph)

MRI Spine Cervical w/o Contrast
Impression: Multi-level discogenic changes, most notable at C4-C5 and C5-C6.  At C5-C6 there is a circumferential disc osteophyte complex with left parasagittal disc protrusion which effaces the ventral CSF and cord.  There is a focal area of abnormal signal seen within the left lateral and peripheral aspect of the cord which may represent a focal area of demyelination or edema.  (there’s  more in the details but this is the summary paragraph)


My LP is scheduled for early September and a repeat EMG and CT scans are on the calendar for the end of September.  

So what does it look like to you ?

Thanks for joining in the sleuthing!

Laura

[Lulu54]

I'm taking the liberty to BUMP this - does anyone else have an opinion?  

Thanks so much,
Laura

[Lulu54]

Truthfully I'm at the point I just would like to know what's going on and get DMD treatment started. I've spent too much time this year in heart mode to let this one throw me.  I'm already a survivor - did you know 2/3 of all women heart attack vicitims don't live?  I've already beat those odds and this isn't going to stop me living either.  

MS is just going to be a minor and sometimes major inconvenience but it is doable.  Its just the stress of waiting to get it labeled and getting on with treatment.  All the test results are pretty conclusive to me - and I 've only seen the neuro once (this month!) so I will give him the benefit of the doubt and work through the process how he wants it done.

Thanks for giving your input - I value all  of the opinions here as much as the doctors themselves.

Be well,
Laura

[Rena705]

WOW...you sure have gone through it haven't you!  I am afraid that I would tend to agree with Deb and Jon and I am sure that the LP will tell the rest of the story.  I am sorry that the dr. feels the LP necessary but at least then we shall hope that there are no further questions and you will be able to get on with the disease modifying drugs if they decide without a doubt that you have MS.  Personally from the results you have shown I would say that you have MS without a doubt and like Deb said...the black holes indicate that you have had it a long time.

Please let us know what the LP shows though ok?  We will be here for you regardless of what the outcome and sometimes you need a shoulder of someone that is not going to be judgemental and understands what you are going through ok?  We are here for you 24/7 and although it gets kind of quiet on Fridays and the weekends, please don't despair if you don't get a response immediately...we will get to you as soon as we can.

Lots of Hugs,

Rena

[Lulu54]

Thanks Jon for your insight.

I've spent the past 6+ months doing diagnosis by elimination for the microvascular angina/heart stuff and now I'm back to eliminating things from the MS mimic possibiities.  This is very frustrating, but I'm trying to learn patience.  ;-)

I excluded the list of symptoms because it would have been too much! They all fit the classic list of symptoms, and fortunately nothing besides my footdrop and incontinence issues tend to stick around long.

Getting extras eyes to review all of this is very help to my state of mind.  

Be well,
Laura

[JonM]

Sorry this is happening to you.  The MRI of the brain sounds very typical of MS.  Also the cervical indication of a focal area (lesion) is always MS, if it really is a lesion.

The LP may reveal more.  Usually MS is diagnosed from MRI studies and from your clininal presentation of symptoms. All other tests can shed light on this being MS but are used more to rule out other diseases/conditions.

Thank goodness it looks like you're (otherwise) in good health.

Jon

[Lulu54]

Thanks Deb for taking the time to wade through all that.  I forgot to include that I also had the DEXA scan and my bone density is excellent.  Virtually every test comes out A+.

I keep looking at it all and wondering if there is something obvious I have overlooked.  I just gave you the medical facts and didn't even get into my symptoms, which also fit MS.  

Thanks again,
Laura

[Deb61]

Girl, there's no doubt in my mind that you have MS.  If the doctor won't diagnosis you with this, you need to see someone else.  Two black holes in your brain indicates you've had MS for a llllooooonnnngggg time.  

Everything points to MS.  I don't understand why you have to go through an LP.  However, this will more than likely show what the doctor is looking for.  Perhaps the doctor is differentiating between the different types of MS, that's all I can figure out.  

Deb