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Im 61, had symptoms for at least 2+ years and was referred…

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Hi Im 61, had...

Hi Im 61, had symptoms for at least 2+ years and was referred by 2 GP's accidentally to 2 Neurologists. One looked at my history of symptoms plus MRI with FLAIR and said I had a partial Transverse Myelitis + RR MS and the other just looked at my MRI with FLAIR and said because I didnt have any frontal lobe lesions I didnt have MS, fairly much dismissed my symptoms and couldnt offer any diagnosis. Because I am 61 I understand that diagnosis ands presentation of persons with MS is different and difficult. Not sure where to go now

Doctor's Assistant: Have you seen a doctor about this yet? What medications are you taking?

If you read my post you will see I have been to 2 GP's one of which ordered immediate MRI based on my symptoms and from that confirmed MS but referred me to a neurologist. Re medications I self changed diet and commenced on high dose Vitamin D3 initially 10,000 units daily for 6 months then have tapered it back to 5,000unit weekly. Plus also take Vit B12, 9 and 6

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I am an RN by the way and very self aware having had a Brain Injury over 10 years ago and did much of my own rehab

Doctor's Assistant: Do you keep personal medical records to help track this?

ABI 2007, JAK 2 Pos, Hepatosplenomegaly, and a few others but not significant. Born in bvery south ;latttude, caucasian, female, 61

Submitted: 4 months ago.Category: Neurology
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Customer reply replied 4 months ago
Hi typing in MRI report 16 December 2016
Clinical History
Lefdt sided parathesia, progressing, extreme lethargy decreased reflexes on the left fundoscopy normal
Multiplanal and Multisequence MR imaging performed
FINDINGS
No tonsillar descent. Pituitary gland appears normal. The gray white matter interface is preserved. No focal intra or extra axial mass lesion. No mASS EFFECT OR MIDLINE SHIFT OE EVIDENCE OF RAISED PRESSURE
tHERE ARE EXTENSIVE AREAS OF WHITE MATTER HYPERINTENSITY ON t2 ANDand FLAIR in the deep and subcortical white matter. The largest of these areas on the right is in the peritrigonal area approximately 11mm in size and on the left in the frontal region approximately 11 mm in AP diameter.
No restricted diffusion identified. Bones, orbits and paranasal sinuses are within normal limits. No evidence of Haemorrhage. No abnormal enhancement on post contrast imaging.
Assessment
1. Extensive whiter matter hyperintense foci on T2 and FLAIR, some of which are coalescing.
2. These features are not typical for age related white matter ischaemic chaNGES. i Cannot rule out demyelination and neurology review is required. Given the symptoms I cannot exclude Multiple Sclerosis.
MRI CERVICAL SPINE
Saggital T1 T2 STIR Axial T2 and saggittal post Gadoluinium
FINDINGS
Subtle reversal of normal cervical lordosis. Prevertebral soft tissues are normal. Small haemangiomata at C7 and T2.
No vertabral body compression fracture seen.
Subtle high signal lesion identified within the cerebral spinal cord at C2/C3 level 8mm in size. Subtle high signal within the T1 level of the cord 8mm in length. The rmeaining cord signal is normal. Atrlantodens interval is preserved. AXIAL IMAGING
C3/C4 Mild disc bulging. Exiting and descending nerve roots are free. Facet joint are end located.
C4/C5 Posterior disc osteophytes which narrow the neural foramina and touch the exiting C5 nerve roots, left more than right. Central canal is patent
C5/C6 posterior disc osteophytes which efface the CSF anterior to the cord and cause indentation of the exiting C6 nerve roots more right than left. Facet arthrpathy.
C6/C7 Normal disc space.Assessment
1. Disc degenerative disease at multiple levels with small foraminal oseophytes which narrow the neural foramina
2. Two subtle areas of cord high signal on T2 at the C2 and T1 levels possibly reflecting cord demyelination. No abnormal enhancement
Answered in 5 hours by:
12/25/2017
Neurologist: Dr Subbanna MD, Neurologist (MD) replied 4 months ago
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,192
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi Ann, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I am sorry to hear about your health in the form of the symptoms as you have described above, and also the mri scan showing findings as described in the report you have posted above. As a Neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

Yes I can fully understand the major confusion you are facing because you have received two diagnoses of contrasting nature.

One neurologist thought of demyelinating issues such as MS and Partial transverse myelitis, and the other one disregarded this possibility

I have carefully studied the symptoms you have described above as well as the mri scan report of the brain and the spinal cord you have posted above.

Please see, sorry to tell, but it does appear ms

In fact ms can explain the spinal cord findings too, so there is no need for separate diagnosis such as transverse myelitis etc to explain the spinal cord findings

Both the brain and spinal cord findings can be explained by a single condition such as ms

The radiological features of the lesions seen in these scans are more consistent with a diagnosis of ms, rather than any other diseases or health conditions

While around 60+ ms is very rate but it can happen, and as you have put it very correctly around this age diagnosis and presentation of persons with MS can be different & difficult too.

And also when someone has lesions in both brain scan and spinal cord scans then the suspicion for ms is very high, and putting together your symptoms + the type of lesions that are present in these scans + the presence of lesions (demyelinating type) in both the brain and spinal cord the most likely diagnosis is ms, rather than any other

Now regarding how to proceed further;

First of all please try to see a neurologist at some famous university medical centers, and they see rare cases too, so this can help in clarifying the diagnosis. And preferably try to see an MS specialist

And also there are couple of very helpful additional investigations that can help with exploring the possibility of ms;

If not already done then a Spinal tap (also called as LP or Lumbar puncture) for spinal fluid analysis, and another test by name Evoked potential studies can provide us with additional clues towards the diagnosis of MS.

The spinal fluid shows findings such as abnormally increase Oligoclonal bands, IgG levels, IgG index, Myelin basic protein etc in majority of MS patients and the presence of these findings are highly suggestive of MS.

The evoked potential studies may reveal abnormal conduction of electrical signals (nerve signals) along the visual, auditory (hearing) and ascending sensory pathways of the central nervous system (brain & spinal cord) and all these findings further support MS diagnosis.

So if these investigations were not done yet then these needs to be accomplished now.

And if MS is confirmed then you need to start one of the MS preventive agents like immuno modulator disease modifying agents such as Interferon or Glatiramer acetate or oral agents such as Fingolimod, or Demethyl Fumorate, or Teriflunomide etc to prevent future MS clinical attacks as well as to prevent new MS lesions developing in the brain.

For this current & progressive symptoms a course of steroids can help and it can help with preventing further progression as well as help with recovery too. If steroids are not sufficiently helping then a course of immunoglobulins can help.

To summarize once again;

1) Once again I am sorry to tell, but the mri findings along with the clinical symptoms you have been having are suspicious for ms more than any other possibilities

2) Seeing a neurologist in a university medical center, preferably an MS specialist can help in finalizing the diagnosis

3) Also undergoing the additional above mentioned neurological investigations such as spinal tap/CSF analsyis and Evoked potential study etc can help further in exploring the possibility of ms

4) In the meantime to continue with the diet & supplements etc you have been using including the vitamin d too which is very helpful in ms, and also a course of steroids which can help you with resolving the symptoms you have been having.

5) If steroid is not sufficiently helping then a course of immunoglobulin can help

6) And also very importantly, please see ms can be treated very well with latest developments in our understanding of its pathogenesis as well as with the availability of several very effective treatments, so please not to be scared or not to lose hopes, an early diagnosis & treatment gives the best prognosis, so please try to see a Neurologist in an university medical center, especially an MS specialist asap and also try to undergo the above mentioned ms related investigations asap and this will help with the best outcome & best results.

Wishing you a quick & complete recovery! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. If you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Neurologist: Dr Subbanna MD, Neurologist (MD) replied 4 months ago

Hi Ann, have you received the answer I have posted above? And have you had a chance to go through the above answer?

Do you have any additional health questions? Do you want to discuss further the health concerns you have mentioned above, or any other health related concerns?

Please let me know and I am available here.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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