MS? or something else?

[Alderica]

Hi all!
I'll try and condense my medical history into as brief as space as possible, but I am very much concerned by a flare-up of symptoms which I thought had gone away years ago.
In 1995 (aged 26) I started suffering from attacks of vertigo which lapsed into unspecific dizziness; these could go on for a couple of weeks and sometimes I would find myself suffering visual disturbances - I had trouble focusing and sometimes it would seem as if there was a milky veil over my eyes. I went through a battery of tests - MRI, spinal tap, inner ear function - but they found no abnormalities. This came and went from 1995 to 1997 and then stopped for a couple of years.
In 1999 they came back, and this time I found I was having difficulties walking. At the worst times, I couldn't walk more than 50 m without crutches because my legs were paralytically weak and would sometimes stop working altogether (over the years I have even developed a weird wide-legged gait to compensate for the feeling of instability). Again, neurological and other tests found no abnormalities and I was shunted off to a psychosomatic clinic for several weeks with the diagnosis "conversion disorder". Things improved a lot while I was there; I was also put on anti-depressants (which I am still taking) and underwent several years of psychotherapy. From 2003 onwards I was able to lead a pretty much normal life, provided I didn't let myself get too tired (fatigue has been a problem since my son was born in 2001).
I'm now 42, and this year  - about 4 weeks ago, in fact - the symptoms came back absolutely unexpectedly. I woke up one morning with mild vertigo and assumed I must have caught some kind of virus. However, the old pattern reasserted itself... vertigo and dizziness (which went away as long as I lay or sat still and would get worse the day after any exertion), then this paralytical weakness in my legs (which also get really painful if I rest them after periods of exertion). I finally went to see my family doctor, who thought she could observe some neurological weakness (sagging) in the right side of my face (I didn't notice it though) and numbness in the right cheek, arm and leg (again only slight). So she sent me off to the local university hospital with a suspected minor stroke.
I have just spent a week there undergoing more tests, and the dizziness was diagnosed as vestibular neuropathy probably caused by inflammation of the balance nerve (the balance organ in my right inner is functioning less well than the left, and they also detected some loss of hearing (high frequencies) in both ears). They said they could not find any reason for the gait problems or weakness, but the report I received contained the following information:
Anisocoria (my right pupil is a bit bigger than the left)
Hyperactive patellar reflexes with a widened reflex zone
MRI: isolated T2-hypertense periventricular lesions, frontal r., unspecific genesis.
They didn't manage to do a lumbar puncture, I have to go back for that.
I would be really grateful for any thoughts and comments on my case history - grateful thanks in advance!

[Alderica]

That's very enlightening... I'm all the more annoyed that the spinal MRI report said "No sign of pathological enhancement with contrast agent" when they didn't even use contrast agent - in too much of a hurry or something!
Thanks a lot for your help Karen, I really appreciate it :-)

[Karen99]

So, yes they can be seen but are seen best with contrast.  The spine is more difficult to image than the brain to look for lesions.  A T3 machine is best, especially for spine imaging.  

All of mine can be seen on a 1.5 Tesla strength. (brain & C-spine)

Perhaps the LP will give you an answer.  The thing about those is that not everyone with MS will have O-bands in their CSF.  I didn't, just a slightly elevated protein level.  

Don't be too worried about having a lumbar puncture.  I've seen many, many done without fluroscopy (sp?) guidance.  I've had two done.  The first was a "traumatic tap" which caused blood in the CSF.  No biggie- got up and went out to lunch.  The 2nd one went smoothly but got a horrid headache.  

There has been a lot of discussion on LP's.  Use the "search this community" option (just under those annoying ads, just above "recent activity"

Be hydrated, rest, no lifting for a couple of days and drink caffeine to avoid  any possible headache.  Lot's of folks never get one.  

[Karen99]

The health pages say it best:  (it can be complicated)
http://www.medhelp.org/health_pages/Multiple-Sclerosis/How-MRIs-Show-Lesions-in-MS/show/23?cid=36

For the most part all visible lesions can be seen without contrast.  They show up as T2 Hyperintensities just like all lesions.  The problem is that the neurologist can't tell if a lesion is old or new.  So new activity will be missed and the MRI may be erroneously dismissed as "unchanged" or "no progression."  In the inflammation of new lesions there is a breach in the blood-brain barrier. Wherever there is a break in the blood-brain barrier, the contrast will leak into the brain tissue and the areas will "highlight" or "enhance." They show up as even brighter than the brain around them and brighter than an old, scarred lesion. So new lesions will appear as "enhancing," or "active."

[Alderica]

Hi Karen,

Yes, they did an MRI of the cervical and thoracic spine but didn't bother with the contrast agent for that one... I'm not best pleased about that, especially as they wrote in the report that they had. Am I right in thinking that these lesions can only be detected by contrast agent?
Excellent resources, btw - thanks for the link! :-)

[Karen99]

Hi and welcome to the forum.  My observation is that you have lesions (pleural).  Have they ever done a cervical spine MRI or even a thoracic MRI?  Perhaps it would be beneficial to make sure you don't have any lesions in those areas.  That could explain your leg weakness.  

What explanations are your doctors offering you?

Obviously, you are concerned about possible MS.  The health pages contain explanations about MRI's, symptoms, etc.  Give them a read:
http://www.medhelp.org/health_pages/list?cid=36

Come back and ask more questions.