Question for Dr AbhijeetMD

[Melissa072]

Hi Dr,
I am a white female aged 35 years, last June I suffered from a dull ache similar to sinus pain across whole face, jaw area, eyebrows, cheeks, etc for about 3/4/weeks, no medication stopped pain, then July face pain left and had tingling hands, feet, groin, had a mri of whole spine and brain July 24, all clear, bloodwork all fine, nerver conduction test fine, tingling persisted 24/7 so went to 2 neuro for another opinion he made me walk, touch toes, hold arms out etc eyes closed, tapped my legs and told me ms very unlikely, although I insisted on another mri which I have next week. My face has had a numbish feel to it since June, I had altered sensation up both arms, now gone, altered sensation up both legs still there, under both feel numbish, both ankles burn off and on, groin tingling comes and goes, I also had a couple weeks where I twitched all over very fast more noticable in bed and at rest, for last couple months I have felt off balance worse when I look up or to side too quickly. I am worried about ms although 2 neuros have said otherwise, I also had lower back pain last x-mas similar to period pain had a ct of spine and it said early OA, I also had the lower back pain about 2 year ago as well. With all the clear and neg tests is ms still likely, should I have further tests, if it's not ms then what else could it be, couple G.P's told me stress and post viral. I am so confused and frustrated at this point I am willing to take any advice.
Kind regards, Melissa

[jcmk1281]

The use of contrast will make it clearer to see if there are any lesions present, it works to make the difference in the tissue types as clear as possible.

You do need to have a spinal tap to check for the things that DrAbhejeet mentioned, the oligoclonal band and the other stuff that he mentioned. In the beginning symptoms wax and wane so you may have less symptoms now but there still be a problem.

[Melissa072]

I had second lot of mri's done Dec 17 without contrast they were the same as the mri done in July 24 no change and no lesions.
I go to see the neuro in a couple weeks, he will only tell me no ms now.
The radiologist told me they don't need to use contrast as the first lot showed nothing,she told me they only use contrast if they find a lesion, I asked her as my referral said to use contrast.
Using contrast then no contrast does it show up different lesions or does it show the same lesions but shows which ones are active and which ones are old?
Melissa

[Melissa072]

The only tests I have had is mri of brain and whole spine without contrast.
Nerve conduction test only showed carpel tunnel in left hand.
No diabetes, thyroid fine, all other bloods tested for rare diseases etc neg.
Second neuro made me walk, he tapped my legs, made me hold arm out then touch nose, he put a metal thing on me and yes I could feel the vibration and that it was cold.
Both neuro's looked into my eyes so I guess they were looking for optic neuritis if they were my eyes were also fine. If its not ms could these symptons be due to post viral, stress?
What should I do if the next mri's also come back clear? Should I ask for further testing as my symptons are not as strong but definately there still. Also with tingling in ms my feet tingle the same and in the same spot on both sides, if I stretch both feet out it lessens, when I point my feet like a ballerina it worsens, this is on both sides, absolutely everything is bilateral, on my feet the tingling is always in the smallest 3 toes and on the edge outer side of my foot, (both sides), when I had the tingling in hands it was the 3 smallest fingers on both hands and down the outer side of hand. Is this normal with patients with ms or is anything possible with it, also when my face pain started in June I had a rotton cold, and I mean rotton, it took me a couple weeks to get rid of it then I had it again a few weeks later, I have also read an attack can be set of by a virus etc, but I'm not sure. Melissa

[Melissa072]

I sleep with the air conditioner on and it's very cool in my room in the mornings and when I wake up there is not really any tingling in my feet, when I drive and walk around throughout the day it's there, yes when I have a hot shower it brings on the tingling in my feet and makes the numbness around the bottoms near my ankles more noticable. Is a CSF a spinal tap or similar? Years ago I recall going to a G.P due to feeling off balance, also, as I have been feeling off balance for the last few months, but it seems to be getting better. I am having another mri Monday, only 5 months after the first so I hope it's not too soon. I am very concerned about MS as all the symptons fit, my first neuro told me I don't have MS due to the clear mri and the 2nd told me MS is very unlikely, if my next mri's are also clear he will probably be like the first and tell me it's not MS, could it be anything else? The second neuro told me it's probably a sensory neuropathy that will resolve by itself. Melissa

[Abhijeet Deshmukh, MD]

Hello Melissa,

Apart from the symptoms you have described, do you have worsening with heat ? And do you get tired easily ? And a CSF test shows Oligoclonal Bands and an elevated IgG Index. And as you know, MS is a demyelinating disease. A raised quantity of Myelin Basic Proteine in the CSF suggests demyelination. All these symptoms which come and go, suggest demyelination and remyelination.

These are usually common indicators of MS. Please check if you have done at least these, to rest assured that you don't have MS. Do not worry about other diagnoses at this point. Focus on ruling out MS first.

Regards