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Is it possible to have both a pinched nerve and MS?
Is it possible to have both ms and a pinched nerve? I have a pinched nerve between L4and 5 but I also have more than 10 lesions on my brain highly indicative of MS and symptoms such as shocking feeling in my head that makes my lips tingle and go numb as well as extreme fatigue, and my right hand and leg twitch out of the blue, I also have leg weakness in both legs and trouble with the heat and cognitive issues as well. Any help is greatly appreciated.
COMMUNITY LEADER
Well i definitely didn't see that dx coming, Radio Isolated syndrome (RIS) is in a lot of ways as controversial as Benign MS so it's not surprising you've found the information to be conflicting and your dx confusing...
Technically the term radiologically isolated syndrome (RIS) was created in 2009 and in the last couple of years the dx of RIS is becoming more common, it is used to define a rare subgroup of patients who have demyelinating lesions highly suggestive of multiple sclerosis (MS) but they have 'no' clinical symptoms or signs suggestive of a demyelinating disorder.
RIS is still not considered a distinct type of MS, approx one third convert to MS within 5 years of being dx-ed, typically clinical conversions are males younger than 35 and have spinal cord lesions.
"....the main causes of overdiagnosis are (1) applying DIS radiological criteria for a patient who has a suspected clinical event suggestive of MS even when atypical based on the history; (2) an abnormal neurological examination; (3) inappropriate application of RIS diagnostic criteria, which have been validated using Barkhof and Tintore MRI criteria10 and not the newest so-called Swanton criteria used for MS; (4) over-reliance on the presence of MRI abnormalities meeting Barkhof and Tintore dissemination in space (DIS) criteria; and (5) mis-determination of lesion count, periventricular or juxtacortical lesion location.
Surveys on treatment practices have been done in the United States and in Europe. Neurologists are inclined to treat RIS patients if their follow-up MRI shows dissemination in time characterized with new gadolinium-enhancing lesions (for US neurologists12) or spinal cord lesions (for European neurologists13).
Neither approach has been demonstrated or prospectively validated with a proper phase III study, even if we know that early disease-modifying treatment (DMT) introduction positively impacts the natural history of CIS patients. With these published surveys, the number of off-labeled treated RIS patients is increasing worldwide and current treatment patterns outside clinical studies are risky......We do not know how many mis-identified cases of RIS are receiving DMT, but no doubt the number will increase in the next few years, with an important undocumented repercussion on our health care systems. Worldwide collaboration is needed to improve characterization of RIS, with development of risk algorithms."
http://journals.sagepub.com/doi/full/10.1177/1352458517727149
RIS criteria: http://www.ajnr.org/content/ajnr/suppl/2016/02/04/ajnr.A4660.DC1/15-01107.pdf
To be continued.....
Technically the term radiologically isolated syndrome (RIS) was created in 2009 and in the last couple of years the dx of RIS is becoming more common, it is used to define a rare subgroup of patients who have demyelinating lesions highly suggestive of multiple sclerosis (MS) but they have 'no' clinical symptoms or signs suggestive of a demyelinating disorder.
RIS is still not considered a distinct type of MS, approx one third convert to MS within 5 years of being dx-ed, typically clinical conversions are males younger than 35 and have spinal cord lesions.
"....the main causes of overdiagnosis are (1) applying DIS radiological criteria for a patient who has a suspected clinical event suggestive of MS even when atypical based on the history; (2) an abnormal neurological examination; (3) inappropriate application of RIS diagnostic criteria, which have been validated using Barkhof and Tintore MRI criteria10 and not the newest so-called Swanton criteria used for MS; (4) over-reliance on the presence of MRI abnormalities meeting Barkhof and Tintore dissemination in space (DIS) criteria; and (5) mis-determination of lesion count, periventricular or juxtacortical lesion location.
Surveys on treatment practices have been done in the United States and in Europe. Neurologists are inclined to treat RIS patients if their follow-up MRI shows dissemination in time characterized with new gadolinium-enhancing lesions (for US neurologists12) or spinal cord lesions (for European neurologists13).
Neither approach has been demonstrated or prospectively validated with a proper phase III study, even if we know that early disease-modifying treatment (DMT) introduction positively impacts the natural history of CIS patients. With these published surveys, the number of off-labeled treated RIS patients is increasing worldwide and current treatment patterns outside clinical studies are risky......We do not know how many mis-identified cases of RIS are receiving DMT, but no doubt the number will increase in the next few years, with an important undocumented repercussion on our health care systems. Worldwide collaboration is needed to improve characterization of RIS, with development of risk algorithms."
http://journals.sagepub.com/doi/full/10.1177/1352458517727149
RIS criteria: http://www.ajnr.org/content/ajnr/suppl/2016/02/04/ajnr.A4660.DC1/15-01107.pdf
To be continued.....
5 Comments
Sorry it's taken me so long to get back to you, i'm currently not doing so good so i'll cut it short and send a shorter continuation.....
https://www.youtube.com/watch?v=r2Rh9bxw6-8
In a basic nut shell, RIS is typically diagnosed when there has been incidental MRI findings from when a patient has had an MRI for something totally unrelated to a neurological condition like MS (eg migraines, back injury or pain etc) and clinically patients are neurologically normal without a history of any objective neurological events. Whilst their brain and spinal cord MRI's are highly suggestive of MS, physically RIS patients are expected to be perfectly normal. Technically RIS is seen to be before clinically isolated syndrome (CIS) which is a first clinical attack which is not as yet clinically defined MS.
It sounds like the diagnosing neurologist is saying the symptoms you are experiencing haven't caused any clinically abnormal neurological signs 'and or' your anxiety-depression is currently significant enough to be making it too difficult to determine you clinically. Anxiety honestly can cause and mimic a lot of similar-same physical symptoms as neurological conditions like MS but without causing the corroborating neurological abnormalities.
Also anxiety and depression will absolutely make anything feel a heck of a lot worse than when your not additionally dealing feeling anxious and depressed, so with that thought in mind i would HIGHLY recommend you make your mental health a priority, not only to determine your psychological health but if it's necessary, it will provide you with additional support and mental health treatment options, getting your mental health back on track will most likely make your clinical signs more clear too if that has been part of the problem.
I definitely would recommend getting a second opinion with another MS specialising neurologist, preferably someone completely independent to the one who's diagnosed you with RIS so you get a completely new perspective. I personally would get the mental health situation worked out asap, it will definitely help you in many ways....i would also see if you can find any documented medical records in the last few years where you have sought medical assistance of recurring episodes of unexplained visual issues, fatigue, cognitive issues etc that may be used as evidence of a prior MS attack.
I hope that helps.....JJ
PS i have hunted high and low and can't find anything at all about any association of black holes and RIS, so that in my not neurologists perspective might be a bit of a red flag, and something you might want to ask about..
https://www.youtube.com/watch?v=r2Rh9bxw6-8
In a basic nut shell, RIS is typically diagnosed when there has been incidental MRI findings from when a patient has had an MRI for something totally unrelated to a neurological condition like MS (eg migraines, back injury or pain etc) and clinically patients are neurologically normal without a history of any objective neurological events. Whilst their brain and spinal cord MRI's are highly suggestive of MS, physically RIS patients are expected to be perfectly normal. Technically RIS is seen to be before clinically isolated syndrome (CIS) which is a first clinical attack which is not as yet clinically defined MS.
It sounds like the diagnosing neurologist is saying the symptoms you are experiencing haven't caused any clinically abnormal neurological signs 'and or' your anxiety-depression is currently significant enough to be making it too difficult to determine you clinically. Anxiety honestly can cause and mimic a lot of similar-same physical symptoms as neurological conditions like MS but without causing the corroborating neurological abnormalities.
Also anxiety and depression will absolutely make anything feel a heck of a lot worse than when your not additionally dealing feeling anxious and depressed, so with that thought in mind i would HIGHLY recommend you make your mental health a priority, not only to determine your psychological health but if it's necessary, it will provide you with additional support and mental health treatment options, getting your mental health back on track will most likely make your clinical signs more clear too if that has been part of the problem.
I definitely would recommend getting a second opinion with another MS specialising neurologist, preferably someone completely independent to the one who's diagnosed you with RIS so you get a completely new perspective. I personally would get the mental health situation worked out asap, it will definitely help you in many ways....i would also see if you can find any documented medical records in the last few years where you have sought medical assistance of recurring episodes of unexplained visual issues, fatigue, cognitive issues etc that may be used as evidence of a prior MS attack.
I hope that helps.....JJ
PS i have hunted high and low and can't find anything at all about any association of black holes and RIS, so that in my not neurologists perspective might be a bit of a red flag, and something you might want to ask about..
Thank you so much for the info. I have been receiving treatment for my mental health for about two years now by way of cognitive therapy and depression and anxiety medicine as well. This is just all very confusing. I am considering getting a second opinion from a different MS specialist but would like to see the neurophthalmologist first to see what they have to say seeing as I was previously thought to have retinitis pigmentosa and now they believe it may have been optic neuritis all along. That is my next step as of right now. The doctor did say it is very hard to separate the ms symptoms from the depression and anxiety symptoms but plans on trying to see if we can do that. He also said however that my sciatica pain is not related to ms at all even though is was extremely debilitating when I had the two attacks of it. No one else I have talked to seemed to of had it as severe as I did. But apparently ms has nothing to do with that. I am determined to get this all figured out . I am 34 years old and feel like I'm 80 lol... so to me it is important to get this figured out so I can get a handle on it now and hopefully have a long active life . I thank u again so much for helping me and giving me all this information. I greatly appreciate it.
Hope you are doing better JJ. Just wanted to make sure you were doing okay as well.
Thanks for asking......it's heating up over my side of the world which hasn't helped but lol a bigger part is self inflicted, we're currently renovating and whilst it might take me forever to get a project done, it feels really good to know i can still do my thing :D though my painting now is slightly wonkier than i'd like ROFL hopefully no one will notice :D
Thank you so much for the info. I have been receiving treatment for my mental health for about two years now by way of cognitive therapy and depression and anxiety medicine as well. This is just all very confusing. I am considering getting a second opinion from a different MS specialist but would like to see the neurophthalmologist first to see what they have to say seeing as I was previously thought to have retinitis pigmentosa and now they believe it may have been optic neuritis all along. That is my next step as of right now. The doctor did say it is very hard to separate the ms symptoms from the depression and anxiety symptoms but plans on trying to see if we can do that. He also said however that my sciatica pain is not related to ms at all even though is was extremely debilitating when I had the two attacks of it. No one else I have talked to seemed to of had it as severe as I did. But apparently ms has nothing to do with that. I am determined to get this all figured out . I am 34 years old and feel like I'm 80 lol... so to me it is important to get this figured out so I can get a handle on it now and hopefully have a long active life . I thank u again so much for helping me and giving me all this information. I greatly appreciate it.
COMMUNITY LEADER
Hey Mandi, just checking in to see how you are doing.....JJ
1 Comments
Thanks for checking in! So they diagnosed me with Radiologically isolated syndrome. Do you know anything about this? they tell me because i have depression and anxiety its hard to tell if my symptoms are from that or are ms related. I am so confused. does this mean i am in the beginning stages of ms? The doctor tells me we have to monitor me closely as i have a higher chance of having a clinical attack. I'm kinda shocked that depression and anxiety can cause such severe pain but I guess anything is possible. He wants me to see a neurophthalmologist to check my eyes due to vision problems only my regular Medicare doesn't cover that so I am looking into an advantage plan that will help with that. I honestly don't really know that having ris means as the articles I've read are somewhat conflicting.
COMMUNITY LEADER
Unfortunately your brain MRI results significantly limit the types of conditions that can cause the different types of findings your MRI is showing, conditions like MS will be very high on your list because some of your results are more commonly associated with MS...
"Multiple sclerosis (MS) is a chronic central nervous system (CNS) disease that affects at least 2.5 million people world-wide. Longitudinal MRI studies show that MS is a dynamic disease in which lesions appear and disappear.
About 80% of the newly formed T2-hyperintense lesions appear hypointense on T1-weighted images. About 40% of these lesions remain hypointense over many months to years and are generally referred to as persistent black holes that represent severe, irreversible tissue damage.1
The correlation between the persistent T1-hypointense lesion volume and EDSS is not always consistent.2 It is not known why certain T2-lesions or portions of T2-lesions convert to persistent T1-hypointense lesions."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844029/
I typically advice anyone not diagnosed with this type of MRI evidence to make an appointment with an MS specialising neurologist because they are more up to date with all things relating to MS and it's mimics but your already doing that next week......don't be surprised if your MS neuro sends you for a lot more tests (eg more brain and spinal MRI's, Visual evoked potential (VEP), Lumber puncture (LP) etc etc) before you get a more concrete idea of what it is that your dealing with.
Going through the diagnostic process can be scary and very confusing, it's always better if you have someone with you to support you and pay attention to what the neurologist is saying because it can be a lot to take in.....breath, try to stay calm and take one step at a time!
Ask any question and i'll do my best to give you a straight answer.....JJ
"Multiple sclerosis (MS) is a chronic central nervous system (CNS) disease that affects at least 2.5 million people world-wide. Longitudinal MRI studies show that MS is a dynamic disease in which lesions appear and disappear.
About 80% of the newly formed T2-hyperintense lesions appear hypointense on T1-weighted images. About 40% of these lesions remain hypointense over many months to years and are generally referred to as persistent black holes that represent severe, irreversible tissue damage.1
The correlation between the persistent T1-hypointense lesion volume and EDSS is not always consistent.2 It is not known why certain T2-lesions or portions of T2-lesions convert to persistent T1-hypointense lesions."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844029/
I typically advice anyone not diagnosed with this type of MRI evidence to make an appointment with an MS specialising neurologist because they are more up to date with all things relating to MS and it's mimics but your already doing that next week......don't be surprised if your MS neuro sends you for a lot more tests (eg more brain and spinal MRI's, Visual evoked potential (VEP), Lumber puncture (LP) etc etc) before you get a more concrete idea of what it is that your dealing with.
Going through the diagnostic process can be scary and very confusing, it's always better if you have someone with you to support you and pay attention to what the neurologist is saying because it can be a lot to take in.....breath, try to stay calm and take one step at a time!
Ask any question and i'll do my best to give you a straight answer.....JJ
1 Comments
Thank you so much you have been so helpful. I do a have a great support system and loving family so for that I am truly blessed. While this is scary and a bit overwhelming , I am finally getting some answers as to why these symptoms are happening. I appreciate you taking the time to answer my questions. I now have a better understanding of what I am up against. God bless
COMMUNITY LEADER
Hi and welcome,
You asked if it is possible to have both MS and a pinched nerve and the answer would have to be yes, simply because MS doesn't prevent anyone from having additional medical issues or diseases.
I'm going to assume your question has something to do with you not having been diagnosed with MS even though your brain MRI showed you have "more than 10 lesions on my brain highly indicative of MS" and having been diagnosed with a pinched Lumber nerve because your spinal MRI showed you have some structural spinal issues ( herniated disc, a bulging disc, spinal stenosis etc) with L4-L5 nerve entrapment.
Your L4-L5 nerve entrapment wouldn't account for all your mentioned symptoms, a pinched nerve at the L5 level of the spine is almost always associated with symptoms known as sciatica, the sciatic nerve becomes vulnerable to compression and can produce unilateral or bilateral symptoms in the lower body eg pain, shooting pain, tingling, numbness or muscle weakness so unless you have additional structural disc issues higher up your cervical spine too, a peripheral nerve related condition wouldn't be able to account for all the symptoms you've experienced....
BUT MS still can't be taken off your potential causes list if you unquestionably have MRI lesions suggestive-consistent with a neurological conditions like MS. exactly what specific evidence you have that would make the brain lesions "highly indicative of MS" is significant to whether or not an alternative condition is more or less likely than MS eg if any lite up with contrast, shape ie ovaloid, Dawson's fingers, size, specific locations ie juxtacortical, perventricular, infratentorial, spinal cord etc
I hope that helps......JJ
You asked if it is possible to have both MS and a pinched nerve and the answer would have to be yes, simply because MS doesn't prevent anyone from having additional medical issues or diseases.
I'm going to assume your question has something to do with you not having been diagnosed with MS even though your brain MRI showed you have "more than 10 lesions on my brain highly indicative of MS" and having been diagnosed with a pinched Lumber nerve because your spinal MRI showed you have some structural spinal issues ( herniated disc, a bulging disc, spinal stenosis etc) with L4-L5 nerve entrapment.
Your L4-L5 nerve entrapment wouldn't account for all your mentioned symptoms, a pinched nerve at the L5 level of the spine is almost always associated with symptoms known as sciatica, the sciatic nerve becomes vulnerable to compression and can produce unilateral or bilateral symptoms in the lower body eg pain, shooting pain, tingling, numbness or muscle weakness so unless you have additional structural disc issues higher up your cervical spine too, a peripheral nerve related condition wouldn't be able to account for all the symptoms you've experienced....
BUT MS still can't be taken off your potential causes list if you unquestionably have MRI lesions suggestive-consistent with a neurological conditions like MS. exactly what specific evidence you have that would make the brain lesions "highly indicative of MS" is significant to whether or not an alternative condition is more or less likely than MS eg if any lite up with contrast, shape ie ovaloid, Dawson's fingers, size, specific locations ie juxtacortical, perventricular, infratentorial, spinal cord etc
I hope that helps......JJ
1 Comments
Thank you so much for your help. My Mri reads as follows: There are multiple punctuate white matter nonspecific T2 hyperintensities in the frontoparietal periventrivular regions bilaterally as well as in the right temporal periventrivular and juxtacortical regions which has perpendicular orientation with the lateral ventricular wall. There is also involvement of the callososeptal junction. The brain stem and cerebellum are preserved. There is no associated diffusion restriction or enhancement in most of the lesions. The number of these small lesions is more than 10. The appearance is highly compatible with demylinating disease. Clinical correlation with multiple sclerosis is recommended. A few of these lesions demonstrates T1 hypointensity. There is no evidence at this time of active enhancing demylinating lesion. So I'm not exactly sure what the heck all that means but I see an MS specialist recommended by my neurologist this coming Tuesday so we will see.
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