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Once again I have this burning sensation in a patch on the…

Dear Subbanna,Once again I have...
Dear Subbanna,Once again I have this burning sensation in a patch on the side of my left arm, which I described to you before. It has not been there since february, but yesterday it was suddenly there. Today the sensation comes and goes with minutes between. Just like an internal rush of heat in just the same spot. Why does it show up like this?
Kind regards
Kathrine
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Customer reply replied 25 days ago
It's not warm to touch but an internal warm sensations that feels like you put a warm cup of coffee against a patch of skin for a second or two and then it goes away.
Customer reply replied 25 days ago
Around this area - The same as last time
Answered in 22 minutes by:
3/25/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,120
Experience: American Board Certified Neurologist, Internal Medicine
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Hello, if you are once again concerned whether this could be secondary to ms, please see this is once again not due to ms.

First of all ms presents with certain very distinct or obvious symptoms such as the following;

Numbness

Loss of sensation

Motor weakness/paralysis

Gait ataxia

Speech difficulties

Swallowing difficulties etc

But the symptom you have described is an internal warm sensation or internal rush of heat and such a symptom is not typical for ms

Then comes the symptom-pattern, which I had discussed with you previously too;

It is the pattern of the symptom rather than the symptom itself which provides crucial or vital clues regarding what is causing a particular symptom

The pattern of the symptom you have been having including the one this time too is not at all raising any suspicion for ms

For example, it is unlikely ms symptoms can resolve so fast

The diagnostic criteria of ms requires a symptom to constantly present for at least 24 hours

But in your case the above symptom lasts only for seconds or minutes

This is not how ms symptom presents; they last for more than 24 hours at the least

And the other point that is against this being ms is the location of this symptom, ms is unlikely to involve such as small area, rather ms symptoms involve larger areas such as whole arm, or whole hand, or forearm etc, but not such small areas as it has been happening in your case

As you see you are neither having ms symptoms, nor having the pattern of the symptoms that is raising any suspicion for ms

Once again, there is absolutely no suspicion for ms in you - for the various reasons mentioned above. The type of symptom and the pattern of the symptom you have been having are consistent with a psychological issue such as severe health anxiety and fear of serious illnesses etc rather than ms, and there is not even an iota of suspicion for ms in you.

regards,

Dr Subbanna MD

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,120
Experience: American Board Certified Neurologist, Internal Medicine
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Customer reply replied 25 days ago
Thank you. I understand this explanation. It is just the fact that the symptoms last for days (over 24 hours) that makes me worried. But if you mean that the sensorydisturbance should be CONSTANTLY present (Not in a wave-like pattern) for this time-range, then I'm not so worried.
Is that what you mean?
And thank you again! (I know you answered me almost the same question before, I just need to be sure)
KIND regards
Customer reply replied 25 days ago
It is just everywhere on the internet it says that altered sensation (like burning) is very common for ms. IF this sensation was caused by ms, in which part of the brain would the nervedamage be positoned? It would help me a lot if you could tell me, please.

No problems. Yes, precisely, each symptom of ms means one ms attack or one ms flare-up, and when ms attack occurs - the inflammation it causes in the brain or spinal cord cannot resolve that quickly. The inflammation in fact lasts for many days or even more. But for definition purpose the symptom should last constantly for at the least 24 hours, and this is exactly what happens with ms, ms being a type of inflammatory disease (more precisely – an autoimmune inflammatory disease) – causes inflammation of certain region or regions of the central nervous system structures such as brain or spinal cord etc, and there is no way this inflammation can resolve within 24 hours. Even with IV steroid treatments it lasts for days or sometimes weeks or months too and it is impossible for ms inflammation to resolve within seconds or minutes. For symptom such as the one you have described above to resolve within few seconds or minutes the inflammation too has to resolve so fast (in a jiffy) but it is not possible to body to heal the inflammation so fast. Which means the symptom also cannot resolve so fast. And it is not the total duration of the same type of symptom, I understand in your case the same symptom lasts for total more than 24 hours, but it is the constancy of the symptom that matters, the same symptom without any resolution or interruption should present at least for 24 hours constantly, for example the warm feeling that you have been having should stay on the same region of the skin for at least 24 hours non-stop, then only one can start suspecting ms, of course if symptom lasts non-stop for more than 24 hours it does not automatically imply ms, we need to look for other features too, but the symptom should non-stop stay in the same region for at the least 24 hours then only we can start suspecting ms, but in your case this is not the case, so this is definitely not ms, and also for other reasons too, such as symptom restricted to such small region on the body and the symptoms are kind of vague rather than being obvious or definite etc – so everything is against this being ms, and absolutely no suspicion for ms in you.

regards,

Dr Subbanna MD

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That was the reply to your previous question, I am typing now, I will follow up soon.

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Yes, burning sensation can be a symptom of ms, but what you have described is an internal warm or rush of heat feeling, but if it were ms then the burning sensation must be felt on the body or on the skin, and it should not be just an internal feeling, rather it should be an external feeling, right on the skin of the region where you should be experiencing your symptom, but not internally. So while burning sensation is certainly a symptom of ms but not the way it is manifesting in you. And as far as the location of the lesion in the CNS, this location on the arm corresponds to the right side of the brain since the right side of brain controls the left side and vice versa. So the lesion should be in the right sensory regions such as parietal cortex, or subcortical white matter, thalamus or internal capsule or brain stem etc, rarely even spinal cord lesion too can cause arm symptoms, which is usually on the same side, but rarely the opposite side too – because the sensory fibres cross in the spinal cord to the opposite side.

But even the tiniest lesion of ms in the above mentioned regions of the CNS will present with symptoms over a large area of the limb such as whole arm or whole upper limb or whole forearm or whole hand etc – and this type of few inches involvement is not something that can occur in ms. This is because even a tiny sensory control region of the CNS contains nerve fibers subserving a large areas of the body – as mentioned earlier above – so this type of vague symptom that too involving such small area of the limb can never be due to ms, period.

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Customer reply replied 25 days ago
Thank you for this thorough explanation. I don't know if it is just an internal heat - I also described it like feeling a hot cup of coffee against the skin - just for seconds, but you say it connot be nervedamage in the above mentioned regions then the burning is not constantly present, right? I was just wondering if it had something to do with the findings on my brainscan.

No problems. Even if it is an external burning feeling too, still this cannot be secondary to ms for the various other reasons mentioned earlier above. For example such external burning sensation must be present for at the least 24 hours non-stop, without absolutely any time gap or interruption during this period - then only it can be suspected to be a symptom of ms, not otherwise. What your mri scan showed is some very tiny punctate spots and such tiny punctate spots are not caused by any diseases including ms etc, and also such very tiny spots do not cause any symptoms in the body, so you are definitely not a case of ms for sure. And once again, even if this is an external burning sensation but this still cannot be due to ms for sure.

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Customer reply replied 25 days ago
Thank you so much. I will try and relax now. The very last question: Why do you think I experienced this feeling in february - and then now again? For a couple of days ago I was very stressed regarding a problem with my sister (in wheelchair) Could that really be the cause for this? Some kind of reaction?

No problem. Yes, stress can certainly explain why this happened again this time. In fact identifiable stress like this is the culprit most often for these types of psychological symptoms. Sometimes there may not be even any obvious externally noticeable stress - because it can occur at subconscious level too - but in this instance it appears you have an identifiable obvious external stress which certainly appears to have precipitated this non-ms symptom this time once again.

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Customer reply replied 25 days ago
I see, thank you! And it is normal for this kind of anxiety/stress-related symptoms to appear in a pattern like this for days?

No problems. Yes, stress and health anxiety related symptoms can present in any pattern, and the pattern of the various symptoms you have been having so far including this time all can definitely be explained just based on anxiety and stress etc alone. In fact the pattern of the symptoms you have been having including the one currently occurring is diagnostic for psychological issues such as anxiety/stress etc.

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