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Re: Undiagnosed neurological problems

Posted By Barb on December 03, 1998 at 01:36:17:

In Reply to: Re: Undiagnosed neurological problems posted by CCF Neuro MD MJD on November 28, 1998 at 12:47:07:

I was diagnosed with MS with physical exam when I was 21 years old.  I dismissed this diagnosis and went on with my life.  My symptoms then were vertigo, weakness, falling down, numbness and tingling, nystagmus.
I'm now 48.  Approximately one year ago, I had a pretty sudden onset of left-sided weakness, tingling and numbness, accompanied by pain.  MRI of brain showed "minimal white matter abnormalities" and neuro showed me 2 spots/lesions on the MRI.  Spinal tap showed raised proteins, no oligoclonal bands.  I have not been diagnosed with anything.  EMGs normal, no PN, no porphyria, now she's looking for amyloidosis and wants to do a nerve biopsy. I do not want this biopsy.  I believe the original dx of MS was correct.  I have autonomic problems too, orthostatic hypotension, lack of sweat response.  I am on no treatment.  
During recent physical exam, I had nystagmus, one pupil less reactive than the other, hyperreflexes.  I have had pain in one eye in the past, never sought treatment, went away on its own, though I have some double/blurry vision off and on.  Neuro says not MS, keeps on looking for other causes for which I have no symptoms.  Is it time to have that nerve biopsy and why should or shouldn't I?  Do the eye problems sound like ON?
I appreciate your consideration of my concerns.

A nerve biopsy is helpful in checking for causes of peripheral neuropathy like amyloidosis or  inflammatory etiologies.  When amyloidosis affects the peripheral nerves, it causes a neuropathy with decreased pain and temperature sensation, pain and tingling in the hands and feet, and autonomic problems.  Sensory loss is often present distally on exam with little/no weakness and decreased reflexes (though in amyloid, reflexes can be OK).  
The first question is Do you have a neuropathy?  Certainly you describe some features - numbness and tingling (you didn't say where, is it bilateral?) , lack of a sweat response.  But certainly the vertigo, left sided weakness, eye problems are not due to peripheral neuropathy.  So you have to ask your neurologist what accounts for all the symptoms.  Is he suggesting two disorders - one a neuropathy and one causing the other problems?  Also, how convinced he is that this is a peripheral nerve problem?  Remember, central nervous systme disorders like MS can cause pain and sensory complaints in the hands and feet.  A nerve biopsy is a pretty safe procedure and they typically biopsy only sensory nerves and not nerves controlling muscle strength.  But obviously you don't have to have it if you don't want to.  Ask your doctor how convinced he is that these complaints are due to peripheral neuropathy?  Also, if your nerve complaints are slowly/non- progressive or mild, you may choose to wait and not be so aggressive.  But if your doctor has high suspicions for peripheral neuropathy, you may want an answer.
Optic neuritis is a painful (especially on eye movements), generally subacute (over days) decrease in vision in one eye.  What you're describing now does not sound like optic neuritis, but the pain you had in the past and the pupil abnormalities you note now may  be the results of a past optic neuritis.  Visual evoked responses (VERs), a test measuring the speed of a visual impulse through your visual system, is an easy way of picking up an old optic nerve problem, and is comonly used as an aid in the diagnosis of MS.  If you have not had that already, this may help in your diagnosis.
Thank you so much for your quick and informative response!!!
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