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Re: MS or Vasculitis?
Posted By CCF Neurology M.D./TJW on September 13, 1998 at 14:25:38:

In Reply to: MS or Vasculitis? posted by Lori on September 13, 1998 at 13:54:32:

I have been seeing a neurologist for many months now for these symptoms:
numbness in hands,feet,ear, tongue, thigh; pain in lower back and right thigh; dizziness, urinary frequency/hesitancy;cognitive problems, i.e. memory, word finding; flashing lights that leave blind spots in my vision.
We discuss MS and he says before MRI my diagnosis would have been possible MS, (my MRI showed no lesions).  But when I leave his office I notice that he writes "vasculitis" as the diagnosis on my treatment slip.
We never discuss vasculitis, but from what I read on the internet, it is not something that should be "watched", it should be treated.
I know that you cannot read his mind and tell me why he writes this, and it is a shame I only notice it after I leave, but would vasculitis cause the above symptoms and should I be concerned enough about the possibility to seek treatment elsewhere.  My neurologist seems to be taking the "wait and see" approach that is described as  common in an MS diagnosis.

Could you tell me if vasculitis is a possiblity with the above symptoms and should I be seeking some immediate treatment?  I do have the "bleeding under the skin" spots I believe they call petechia on my ankles.  Is this only a symptom of vasculitis, or can it accompany MS?  I have had an ANA test for Lupus. It was negative.
Thank you

Dear Lori:
From the symptoms you listed in your letter, I can certainly understand
why the notion of "possible MS" has been entertained as a diagnosis. You
don't list any other lab or other test results (besides the brain MRI
and the serum ANA), so it is hard for me to remark about the likelyhood
of this being MS or vasculitis. Primary CNS vasculitis can also lead
to these symptoms, and like MS usually results in eventual abnormalities
on MRI. A spinal tap could help sort this out--Has this been done?
As to your question regarding the emergent necessity of treatment in the
case of vasculitis, I would agree that immediate treatment would be indicated
if your case was clear cut vasculitis, but I cannot establish this with the
information you provided.
If you desire to reply with some additional information( including any
pertinent findings from your physical exam), I would be happy to re-reply.
I am always open to the wishes of patients for second opinions if there
is any question as to the diagnosis, or the recommended treatment. Please
feel free to pursue this, as I sense your uneasiness with your management
thus far.
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