Dr. Shubadeep Debabrata Sinha
Infectious Diseases
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am 44 years old. My symptoms are stiffness, heaviness, and hard to move. I feel like I am wearing a concrete suit when I am having issues. It is awful, and I have to use a walker, and sometimes that is not even enough. I feel extreme fatigue while walking, and it looked like I am drunk. I lose balance and feel dizzy (caused by the heat). It happens when I get too warm. I fell down the stairs a couple of times, tripping at times, my big toe dragging at times when I get too warm.
I get muscle spasms and twitching mostly in my legs, but they happen all over my body. This is a newer symptom that started a year and a half ago. I have lesions on my brain and severe heat intolerance. If the shower is too warm, my legs begin to shake and get weak. I get tingling and numbness. I have cold intolerance just started in the last couple of years. The doctor has said I have Raynaud’s disease. I have been diagnosed with pots and lots of bladder issues and incontinence at times with constipation issues.
My biggest struggles are going upstairs. My legs will shake, feel extremely heavy, stiff, and weak. Sometimes I have to crawl, and sometimes I have to go slow. It depends if I am in a flare or not. I have severe upper back and neck pain randomly. I feel like my back is breaking into pieces. I think this is from osteoarthritis in my T spine). I also have neck pain almost whenever I sit with trouble writing and stiff hands. I have trouble with fine motor skills that come and go depending on stiffness and strength. My weak hands will freeze in the claw position, and I will have to take the other hand and bend my fingers open.
Sometimes I cannot walk at all from leg weakness and heaviness even on normal ground. I have random small swelling in joints that comes with swallowing problems, but they do not often happen. Cognitive problems have become bad at times and much more noticeable. I cannot remember words and feel disorientated, cannot think straight, and very forgetful. I get tingling in my legs and feet, along with some numbness in arms, hands, and fingers at feet. Recently I started getting migraines behind the eye pain and pressure that has been happening for years. I have a lot of pain with eye movement like the muscles are being stretched in my eyes. I have trouble seeing at night while driving. Do I have MS?
Hi,
Welcome to icliniq.com.
First of all, I will be responding based on the described symptoms and your MRI report (with no other details) (attachment removed to protect patient identity).
The first impression is that the described symptoms are not very clearly suggestive of multiple sclerosis (MS), although there is apparent demyleination (loss of nerve layer) on MRI, possibly suggestive of nervous system (possibly brain) disorder and might have led to neural losses. The important symptoms you do not seem to have (as per clinical history provided) are visual loss (which is the first to appear in the disease affecting brain), progressive worsening of symptoms like intractable pain, major sensory or motor losses or any other symptoms clearly suggestive of MS as per clinical diagnostic criteria. The other symptoms are also not clearly suggestive of the diagnosis or similar other diagnosis. The latter may require MRIs of other regions such as spinal cord, cervical and other levels.
Also, MRI images for MS diagnoses need to be taken at three months or 6 to 12 months periodicity (depending on neurologist's clinical judgement) to observe specific changes.
Also, it is recommded to get ruled out of other diseases like the diseases of thyroid (hyperthyroidism), hypertension, Vitamin B12 or Vitamin D deficiency, both for ruling out other diseases and also possible presence concomitantly.
Hence other diagnostic tests like
1. Serum T3, T4, TSH.
2. Vitamin B12 and Vitamin D3 levels in blood are otherwise recommended.
The medications that you are using are for possible acidity or gastroesophageal reflux diseases (Pantolac 40) and anxiety (Ativan), both also sometimes prescribed during neurological diseases for control of associated symptoms, but are not primary medications.
For further diagnosis, an MRI cervical, lumbar, and sacral spine are also recommended. Also, you may need to rule out possible infection with human polyoma virus, often causing similar signs and symptoms when it affects brain. I would request access to all other reports of diagnostic tests done earlier and the full report of MRI and its image, in order to provide further advise.
Please let know of previous or current family history of neurological diseases including but not limited to MS, ALS, GBS etc. I would also strongly recommend a local neurologist consultation as the disease that you want to rule out and also other similar differential diagnoses are primarily neurological diseases.
The Probable causes
Investigations to be done
Differential diagnosis
Treatment plan
Preventive measures
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