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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5401
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Neurologist said I have spots on brain MRI. But not MS even

Customer Question

Neurologist said I have white spots on brain MRI. But not MS even though have many MS symptoms. I been seen by many doctors over last 3 years...what could this be?
MS symptoms....
Blurred or double vision - YES
Thinking problems (slow, poor attention, fuzzy memory) - YES
Clumsiness or a lack of coordination -YES
Loss of balance - YES
Numbness - YES
Tingling - YES
Weakness in an arm or leg - YES all
Pins & Needles Sensations - YES
Itching/Buring/Stabbing/Tearing Pains - YES
Bladder Problems - YES
BM Problems - YES
Fatigue - YES
Dizziness/Lightheaded - YES
Muscle Spasms - YES
Lower Sex Drive - YES
Speech Problems (long pause, slurred) - YES
Tremors - NO
Breathing Problems (rare) - YES
Seizures (rare) - NO
Submitted: 1 year ago.
Category: Neurology
Customer: replied 1 year ago.
MRI images attached
Expert:  Dr. Bob replied 1 year ago.

What did your lumbar puncture show?

Expert:  Randy Davis replied 1 year ago.

what is your age? Are you also having problems with widespread body pains?

Expert:  Dr. Bob replied 1 year ago.

Your post indicates you are 40. Are you currently taking any medications?

Customer: replied 1 year ago.
LP results:
IgG Serum 1110 mg/dL
Access complete set of age- and/or gender-specific reference intervals for this test in the ARUP Laboratory Test  Directory (
IgG, CSF 2.5 mg/dL
Albumin 4380 mg/dL
Testing Performed: ARUP,***** Salt Lake City, UT 84108
Albumin, CSF 20 mg/dL
Albumin Index 4.6 ratio
IgG Index, CSF 0.49 ratio
CSF IgG/Alb Ratio 0.12 ratio
Oligoclonal Bands CSF NEGATIVE
Reference range: NEGATIVE
MS/Oligoclonal Interp See Note
Isoelectric focusing/immunofixation reveals no oligoclonal bands in either the CSF or the serum.  This is considered  to be a negative result for oligoclonal bands.  Approximately 5 percent of patients
with clinically definitive multiple sclerosis will have a negative result.
CSF IgG Synthesis Rate <0.0 mg/d
Reference range: <=8.0
Num of Oligo Bands 0
Platelet Count 323
Glucose, Random 94 mg/dL
VDRL Quant, CSF Non Reactive
Protein, CSF 28 mg/dL
Glucose, CSF 61 mg/dL
Acetylcholine Receptor Binding Antibody <0.30 nmol/L = Negative
Acetylcholine Receptor Antibody Blocking <15%
Acetylcholine Rcpt Modulat Ab <1%
Pathologist Review - CSF N/A
RBC Count CSF 0 uL
Crenated Cells 0%
Volume, CSF 8.0 mL
Appearance, CSF Clear
Color, CSF Colrless
Xanthochromia Absent
Polys CSF, Lymphs CSF, Monocytes CSF N/A
B.burgdorferi Ab (Lyme), CSF 0.22 LIV = Neagtive
Customer: replied 1 year ago.
having widespread body pains. Yes am 40 yrs old. No medications and haven't been on any for over a year now.
Expert:  Dr. Bob replied 1 year ago.

Have you had your CRP and ESR tested?

Expert:  Dr. Bob replied 1 year ago.

Have you had any evoked potential studies done?

Expert:  Dr. Bob replied 1 year ago.

The most commonly used evoked potentials in patients with MS are Visual Evoked Responses (VER), Brain stem Auditory Evoked Responses (BAER), and Somatosensory Evoked Responses (SSER). Approximately 75% of MS patients exhibit abnormal VER regardless of whether or not they have a history of optic neuritis.

Customer: replied 1 year ago.
CRP is .5, Sed Rate has been 34 but last test was 21
Customer: replied 1 year ago.
Don't think I have had any evoked tests done.
Customer: replied 1 year ago.
I did have a 3 hour cognitive test done for like memory and things, would the evoked tests be included in that? If so I can look for my results.
Customer: replied 1 year ago.
I just read what VEP, BAEP and SEP are and I seem to recall all of those. For the VEP is that when you watch a screen and click a button when you see a flashing square? And the BAEP raise hand (or click button can't remember which) when hear noise in ear? And with SEP they zap you with what looks like a stun gun on wrists, elbows, ankles and so forth? If so they came back normal.
Expert:  Dr. Bob replied 1 year ago.

So your work up for MS did not substantiate the diagnosis, it would appear. Is the going theory that your symptoms and hyperintensities are from a migraine syndrome. This would seem reasonable given the above. If so, migraine prevention therapy might be in order. Have you discussed this with your doctors? Ask them about a trial of topamax or depakote.

Customer: replied 1 year ago.
I do not get migraines.
Customer: replied 1 year ago.
Oh btw the cognitive test was not all 'normal'.
Expert:  Dr. Bob replied 1 year ago.

Migraine syndromes do not always include headaches. In fact, they can mimic TIAs or strokes. They can also cause aphasia in rare instances. Atypical seizures can also cause aphasia, so you should get an EEG if you have not had one already.

Customer: replied 1 year ago.
I have not had an EEG yet will ask doctor about that. Thank you.
Expert:  Dr. Bob replied 1 year ago.

You're very welcome. Hope all works out for the best for you.