Hi, first time posting
I hadn't been diagnosed with MS (haven't met the McDonalds criteria) but I also haven't been "diagnosed" with anything else.
Sorry about all the info, don't know what to / not include.
I went to the neurologist because of numerous (sudden onset) migraines (with aura) followed days later by numbness on my face and arm (which only lasted maybe as much as 30 minutes).
EXAMINATION: Disc hyperaemia and swelling of disc margins left > right. Impression of preserved venous pulsation right. No RAPD. No evidence of nystagmus or ophthalmoplegia. Motor examination including testing of tone, power and reflexes normal. No pathological reflexes. Normal sensory examination. No evidence of cerebellar dysfunction. Normal coordination and gait. Normal vital parameters, normal HGT and urinary dipstix.
Visually evoked potentials showed no supportive evidence for diagnosis of optic neuritis
MRI found: 10 mm T2/FLAIR hyperintense nodule seen in the peripheral medial left cerebellar cortex. No restricted diffusion. Intense homogeneous enhancement after contrast administration. No evidence of meningitis, no evidence of abnormal cortical enhancement or hydrocephalus.
CSF clear. 12 red blood cells. 14 lymphocytes (elevated). Protein 0.27 (normal). Glucose 3.91. CSF albumin 111 (not elevated). CSF IGG 42.7 (elevated). IGG index 1.57 (indicative of locally produced IGG). Oligoclonal bands present.
LABORATORY INVESTIGATIONS: RPR, TPHA, ANF, ANCA negative. TSH 1.82, T4 11.4.
Conflicting evidence whether intracranial pressure was elevated. Pressure measurement was 28 cm H2O (elevated), there was however venous pulsation visible in the right eye, double pathology in absence of other clinical evidence of meningitis appearing unusual.
OPHTHALMOLOGICAL EXAMINATION: Normal left visual field. Increased right nasal scotoma.
Received a three-day course of intravenous Solu-Medrol.
Received a diagnosis of:
DIAGNOSIS: Optic neuritis left
Raised intracranial pressure
Enhancing nodule in the left cerebellar cortex
DD: Enhancing demyelinating plaque
DD: Small vascular malformation
After the treatment, I felt better than I had in years. Things that I didn't go to the neuro for had disappeared (like balance problems, inability to sweat, palinopsia etc.) The thing that I didn't go to the neuro for was my eyes and yet I had relief to a certain extent, but not ever complete recovery.
In the last years or so I have started having recurrence of things like walking into walls etc and I have now been having double vision in addition.
Was sent to neuro the other day and these were the findings.
Examination: Disc margins left not as well demarcated as right, however no optic atrophy. Pulsation of the central retinal veins seen in the right eye. Reflexes lively, impression of slightly increased reflexes in the right arm. No pathological reflexes or pathological increase of tone. They evidence of cerebellar dysfunction. Normal walking and turning.
Special investigations: Cranial MRI: The previously enhancing left cerebellar nodule no longer demonstrates contrast enhancement. It is T2 hyperintense and suppresses on FLAIR. No restricted diffusion. It has near CSF signal characteristics.
There is a new focal area of T2 and FLAIR hyperintensity within the periventricular white matter of the posterior right temporal lobe. This does not demonstrate any enhancement.
Intracranial flow voids all appear normal. No abnormal hemosiderin deposition.
Midline anatomic structures appear normal on the T1 sagittal sequence. Dural venous sinuses opacify normally.
There is incidental mucosal thickening within the right maxillary sinus. No additional abnormal findings.
Midline anatomic structures appear normal on the T1 sagittal sequence. Dural venous sinuses opacify normally.
There is incidental mucosal thickening within the right maxillary sinus. No additional abnormal findings.
COMMENT: The left lesion within the left cerebellar hemisphere no longer enhances and has near CSF signal characteristics. Appearances suggest inactivity. New non-enhancing T2 and FLAIR hyperintense lesion within the white matter of the posterior right temporal lobe, non-specific. The topography would be atypical for demyelination of the multiple sclerosis type. MRI could be performed for a follow-up if required. No other lesions identified.
So here I sit, totally clueless, neuro simply said, everything looks fine (I had to get copy of the letter to find there had been changes). My GP is referring me to another neuro.
Any insights would be greatly appreciated.
Regards,
Sally