Multiple Sclerosis?

Could this be multiple sclerosis?

*CURRENT SYMPTOMS*

Feeling of lump-in-the-throat, or throat spasms. Able to swallow food, but feel like there is something in the throat moving around and/or squeezing. Dizziness and disorientation. Feeling of being off-balance. Feeling of “brain fog,” i.e., difficulty with certain cognitive functions, such as slight memory loss, confusion, inability to concentrate, and “reaching” for words that I should know. Feeling of fullness in the forehead, especially above and behind the eyes; head feels heavy. No headaches, but occasional slight shooting pain from over my right eye to the back of the neck. Intermittent feeling of pressure or tightness in the forehead, face and cheekbones, and behind the eyes. The above symptoms vary in intensity from day-to-day, and during the day, but have not improved. Symptoms get worse as the day progresses, and are typically the worst at night. About February 6, 2006, I began to experience altered vision in my left eye. Not blurry per se, but a feeling that something was not quite right with that eye. The vision in my left eye felt dull rather than blurry. At times, it felt as though there was something in my eye (especially at the outer corner), although I couldn’t see anything there when I look in the mirror. This altered vision was alleviated somewhat—but not entirely—when I put on my glasses. This symptom improved significantly after about a week. Tests at the optometrist and neuro-ophthalmologist were all normal. Dizziness, imbalance, and altered vision appeared to improve somewhat (but not completely) when I put on my contact lenses about a week ago. When I took the contact lenses off in the evening before bed, the symptoms returned worse than ever, along with a slight headache. (Headache went away after a few hours and a couple of Advil). A about 10 days ago, I experienced altered sensation/feeling in my left ring and little fingers, and along a part of my left forearm. The area felt slightly “tingly,” but not necessarily numb. Just like mild pins-and-needles. This went away after two days. However, on February 22, 2006, this symptom returned, and now I also experience the slight tingling in my left kneecap. The tingling sensation is now milder than before. In recent days, when the symptoms are at their worst, it is difficult for me to read or type on my computer without stopping to clear my head. This varies throughout the day and from day-to-day.
Symptoms do not worsen when I am driving or being driven. In fact, at, times, they seem to improve when I am behind the wheel. I am not experiencing any constant headaches, seizures, sinusitis, or nasal congestion. Intermittent feeling of chest pressure. Feels like there is something pressing down on my breastbone. Does not increase when I breathe in deeply. Sometimes pain spreads to my underarm area.

Brain MRI (with and without contrast) normal; optometrist and opthalmologist say my vision is normal; no sinusitis; EEG, trans-cranial doplar, and nerve-conduction tests normal; bloodwork and chest x-ray normal. I have heard that a negative brain MRI does not definitively rule out multiple sclerosis, and little else seems to account for all of the above symptoms simultaneously. Should I request an MRI of my spine, or am I barking up the wrong tree with this? Any feedback would be much appreciated. Thanks a million.

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Dr. Joshua’s Answer:

The most important information here is that brain MRI was normal, and none of the other examinations have revealed anything that would indicate a serious illness. I’m happy about that.?

Your symptoms are not specific for multiple sclerosis, or indeed any other illness. Dizziness, tingling and numbness are common complaints, and the average neurologist-on-call deals with several patients per shift complaining about these symptoms. In the majority of cases, no underlying disease can be found, and the symptoms usually subside with time. The other symptoms you describe are also not specific for any illness, and can be followed.

In my opinion, you describe no symptoms of spinal cord multiple sclerosis, and I feel that spinal MRI is unnecessary.

The only examination that has not been done is cerebro-spinal fluid (CSF - spinal tap). When multiple sclerosis is suspected, CSF is examined for IgG index, also numerous other tests are usually done to rule out a large number of possible central nervous system pathology. However, I am not convinced that you need this.

While it is true that multiple sclerosis can present with a wide variety of non-specific symptoms, most cases that need expeditious treatment will present with clear neurologic deficits, such as cranial nerve palsies or motor weakness in limbs, or optic neuritis.

Of course, I cannot make a diagnosis over the internet. Talk to your neurologist about your concerns.

I’ll give my opinion though. Without the benefit of clinical examination, and based on your symptoms diary (I edited most of it out to save space, but I read it all), and the results of the examinations - based on that information alone, I do not feel that further examinations are necessary at this point, and your symptoms can be followed.

An important thing to consider is that fear of multiple sclerosis can cause the body to mimick multiple sclerosis symptoms.

Good luck!

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