What Kinds of Symptoms Don't Sound Like MS?

[Quixotic1]

I seem to have thoroughly confused everyone when I talk about patterns of symptoms that are not typical of MS.  I probably sound like those dreaded, dufus neuro's we roast on Friday nights.  A couple things come up all the time.  these two are when I talk about "symmetrical" symptoms and when I talk about "all over" symptoms.

DEFINITIONS:

Bilateral - on both sides (anywhere on either side)

Symmetrical - appearing the same on both sides

Mirror-Image - Perfectly symmetrical on both sides

Global - all over the body

Systemic - acting throughout the body and not localized to the central nervous system

ORGANIZATION OF THE BRAIN AND SPINAL CORD

I don't know how many of you know in general how the nerves are organized in the brain and spinal cord.  This is something that is fairly important to have a vague idea about.  In the brain, the functions of sensation and movement are very symmetrical.  This means that the nerve that moves the right great toe is in exactly the same place on one side of the brain as the nerve that moves the left great toe.  However, these two spots may be quite a distance from one another.  They will also be quite a distance from the spots on each side that move the thumbs.

In the spinal cord the nerves move in "tracts" that extend all the way from the bottom to the top of the cord.  The sensory nerves are in two symmetrical tracts and the motor nerves are in two others.  These tracts are close to each other on each side, but separated by a little distance from the other side's sensory and motor tracts.

THE RANDOM NATURE OF MS ATTACKS

I would like to start with some ideas about how MS does its attacking.  Remember that the common, early symptoms of MS are the inflammatory lesions of demyelination.  The disease attacks randomly, here and there as seen by the appearance of the visible lesions on MRI.  It can hit both sides of the Central Nervous System, but it does so one distinct lesion at a time.  Many distinct lesions can appear at one time.  When I say that the disease doesn't usually present with symmetrical symptoms, I mean that the attacks on the nerves don't usually hit EXACTLY the same spot on each side of the brain or spinal cord.

Think of MS as attacking like guerrilla warfare.  It may have a mulit-front attack, but each band of fighters chooses its own target.  The fighters have preferences for certain areas, but while one might choose the edge of a village, another might choose the center, and another a place where people gather.  The bands aren't necessarily too bright and many choose targets that won't accomplish anything - vacant fields, big rocks and forest meadows.  These less than brilliant bands don't cause any symptoms.

Over time MS tends to cause lesions in the same "general areas."  Now this gets tricky to describe.  When we say general areas we mean certain areas of the brain like the periventricular region, the corpus callosum, the cerebellum, part of the brainstem, and certain tracts within the spinal cord.  Over time, the lesions may take on something of a symmetrical appearance, but it will NEVER be a mirror-image, that is, one side perfectly reflecting the other.


WHAT MS DOES ACT LIKE

With the exception of Tranverse Myelitis, MS attacks and we have a batch of symptoms as our first attact.  Attacks are often "bilateral," meaning we have some symptoms on both sides.  But it would be very unusual to have the same EXACT symptoms on one side of the body as on the other.  Another way of saying this is that lesions don't appear symmetrically - they don't appear in the same spot on each side at the same time.  For example, we may have a numb hand on both sides, but on the right it may be mostly in the fingers, and on the left side it may be a glove-like numbness reaching up to the wrist.  Over time both hands may become "numb," but still the person may notice differences like the right hand feels more tingly.

The same with weakness or spasticity.  Almost everyone notices that there are differences between the extent of weakness between the two sides.  Clearly the lesions are a little different side to side in the Central Nervous System.  So you get descriptions of symptoms like, "my right arm and hand became weak, I had right foot drop, and a cold patch on the left thigh.  The left side of my face hurts when I chew and the right cheek is tingly.

It is important to understand that over time we get more and more lesions.  This increase in lesions - on both sides - may lead to some symptoms becoming pretty symmetrical.  The difference is that they didn't "show up" in a symmetrical pattern.  Another example is trying to do a huge painting by standing in one place and throwing the paint out of a paper cup.  Try as you might the splatters (lesions) will not be symmetrical.  The more paint you throw (attacks you have), the more the two sides might come to look like each other, but that is through the process of accumulating lots of paint (lesions).

The big difference in this is the condition of Transverse Myelitis.  Literally the words mean "across the spinal cord."  If a lesion does cross all or most of the way across the cord, then you can get symmetrical symptoms.  In fact, MOST of the symptoms in TM are symmetrical and THAT is the tipoff.  Also, a neurologist, who knows exactly how the nervous system is oriented, can tell where the lesion is by the level of weakness and sensation loss on exam.  In cases of partial TM this gets much harder to call.

SO WHAT DOESN'T MS ACT LIKE?

When people have the sudden onset of numbness and tingling in "their hands and arms and legs and feet and both sides of their face,"  and they don't feel a difference between the two, that is a clue that this is unlikely to be MS.  A spinal lesion would have to be very large (and obvious on the MRI) for this to be MS.  They would have to have a different set of lesions on their brainstem for the facial numbness - again in the "exact" same spots on each side.  We hear people with this type of complaint frequently.

What this type of pattern suggests is something "systemic."  The nerves throughout the body are affected and irritated.  Things that could cause this kind of all over symptoms would be infections (like Lyme Disease) or metabolic problems (like B12 deficiency or thryoid disease)  Systemic problems circulate through the body and can affect everything at once.  This is in contrast to MS where the damage is here and there in isolated lesions.

Well, my brain is pooped and I'm not sure I am making sense.  My inner voice is expecting a call from Nintendo, so I will sign off and await the likely deluge of questions.

Quix

[Janette2836]

Thanks Quix!  You have a way of making things clear.  Something tells me you were a fantastic peds doctor - you talk human talk not doctors lingo  :)
Thanks for sharing this.
Janette
Limbolander

[BobbyRay51]

Thank you for the detailed post.  What about burning sensations on different areas of the body that come for a few seconds to minutes, and dissapear and keep reappearing throughout the day?  I feel them in my legs, stomach,back, feet, and sometimes my arms.

[Quixotic1]

that will be ny next section of this discussion.  Hopefully tomorrow.

[skarey]

Thanks for that very helpful post.  So, since my sx are body wide, it is less likely to be MS?  This is confusing for me cause a lot of my sx are a little of each (bilateral, symmetrical, and one sided).  I feel like my range of symptoms do make MS less unlikely just cause I have SO many in all parts of my body.  For example... My foot is numb just on my left side.  However both legs feel weak.  Both my arms and hands hurt in the same places, but left arm is usually worse.  I feel I get burning on both legs as well but worse on left side.  What about sx such as brain fog, dizziness,heaviness, adn fatigue?  Cause you can't feel these sx on either side... it's just there.   My brain fog is REALLY bad.  Do MS sx seem to come and go from hour to hour or day to day?  That is very much how my sx are.  It seems everyday brings a new group of sx.    Like yesterday my brain fog was bad, but didn't notice much else.  Today my inner thighs (both sides) are burning and my arms hurt.  These patterns don't really go with MS.  Does it?     I'm still a bit confused, being that my symptoms are everywhere..... Would this definatley point to something Systemic???  
  Thanks for the help.
  skarey

[Quixotic1]

In the next section I'm going to talk more about the "body-wide" or global symptoms and the fleeting, ever-changing symptoms.

Quix

[skarey]

I look forward to it!  Did you get my message??
  Thanks for devoting your time to this forum and helping everyone.  Thanks!!

[sllowe]

Makes perfect sense! YOU are so GOOD to us!

I think I'm an example to one of your points w/the tingling and numbness in both hands and wrists (though I had no clue at the time an attack would follow).  My largest lesion was seen and is within my spinal cord.

Thank you so much  Doc Q.  We have so much to learn in advance of actually understanding MS and this is yet another important educational piece for us to learn from so we understand better.

-Shell

[Lulu54]

Wow! I have to say I understand  this a bit more thanks to your thoroughness in explaining this lesson to all of us.  Now if only I can remember it! LOL

As always,
Lulu

[Lulu54]

And you will copy this and put it into a HP for easy reference, right?

[goofysmom1]

Another great explanation, Quix!  I agree with Lulu - this would make a great HP.

Thanks so much for all you do!

Chrisy

[truelove47]

hi
I want to tell you another story

I woke up one morning and I lost the use of both my hands.  I was so surprized and scared because i did not know ms hit your upper body,   duh!!!l  My husband called my
neuro and he put me in hospital for a course of steroids. This happened about 1990
My neuro explained there was nothing wrong with my hands, but it was the signal coming from my brain to my hands and that some lesions were activating.
That is when I learned that what ever part of the brain that has a lesion that controls a  that part of our body acts up it causes a problem.  Hope this makes sense

end result+ took a good 6 months of hard work PT  and I got the use of my hands back.

A very scarey situation                                             Linda

[samandsprout]

Just wanted to say thank you for yet another informative post!  As a newbie here and a limbolander, all of the information I am finding here is like a godsend.  I just want to learn as much as I can, because I feel like my neuro really doesn't have the right idea about MS.  I think all neuros should have to read forums like these to see the reality of what patients out there experience.

[LATW]

Thank you! That was very helpful. My right side is my goofy side!

LA

[jensequitur]

I loved your metaphor about the paint splatters!  That was perfect.

[Sarahsmom46]

I see a new HP brewing here.  The explanation was very easy to understand and follow.  I can't wait for your second installment.  

You are such a good teacher.  Thanks.

Julie

[Quixotic1]

I just read this and I am not happy with it.  I gave the impression that one could never have symmetrical symptoms and that is not true.  Like Shell said, she had symmetrical numbness in her hands due to a large spinal cord lesion.

I also mispoke when I talked about people with tingling in hands and arms and legs and feet.  that could happen in Transverse myelitis.  What would be near to impossible is paresthesias in both hands and feet starting at the same time.  That would require 4 separate, mirror-image lesions and would be quite improbable.

So, this is not at all ready for prime time.

I still think the discussion is good, but I don't have it yet.

But, I am going to continue with discussions about fleeting and dancing around sensations - those that come and go and change all day, like Karey and BobbyRay complain of.

In the meantime I welcome the critical comments of those with a diagnosis.  How many of you feel that your symptoms came on in a very symmetrical pattern, such that there isn't a great deal of difference between them?

It could be that I am making distinctions where none are appropriate.

Quix

[jensequitur]

Hmmm...  I think what you said about symmetrical symptoms is very true.  I often have symptoms on both sides, but they're different - I tend toward spasticity on the left, and weakness on the right.

However, I do have some symmetrical stuff.  Mostly in the middle of my back, where it tingles and buzzes right down my spine.  I also get a rhythmic clenching of my stomach muscles, that sometimes feels like a twitch, and sometimes more like a spasm.  I can't tell whether it's one side or the other, but it feels like all of them at once.

[keddy1221]

Very informative Quix, thank you very much for taking the time to explain all of this.  I look forward to your next post about global and fleeting symptoms.

Kelly

[CheeserNurse]

As a nursing student, who has taken several anatomy and physiology courses, I have to say your explanations here are wonderful!!! Great information here!!!  I am also seeing a chiropractor who specializes in neurology and he has helped me with my symptoms tremendously. I would suggest some of you look into it. It's amazing!

Thank you,

~Aleah

[sunshine8]

Great explanation. It has really helped me to understand why I am finally dx and what the doctors were saying when they narrowed down the differential lists based on types of symptoms and lesion appearence.

I have what I call extremity symtoms and systemic ones. Extremity symptoms would be my hyper reflexes, which are primarily in my right lower leg, but also appear mildly in my left lower leg. I have had hot patchs appear on the back ofmy thigh off and on for 5 months now, but only in the left thigh. I have shooting electrical pulses in the right foot and a left hand tremor. I also have decreased sensation in my left foot, but it is much worse in my right foot. In the right it stretches up above the ankle. I also have dcreased sensation in my right hand, not my left is fine.

Systemic symptoms are my balance issues, dizziness and fatigue. I call them systemic because they don't affect one side, but my whole body.

Apparently the fact that the majority of my systemic symptoms are one-sided helped rule out mimics and lend evidince to the MS dx. It was one of the things that the multiple Neuro's ratled off that I caught.

Thanks for the helpful information and I can't wait for the second part.

-Amy
dx RRMS Oct 2008

[sunshine8]

Sorry, that ending part should say exterminity symptoms and not systemic. It must be my brain fog rolling in. :)

Amy

[Eyesnlegs]

Thank you so much for this it will be of tremendous help at my next neuro appointment and explains perfectly some of my sx too.

You are a star!
Pat
x

[PastorDan]

Another outstanding explanation, dear lady.  As another respondent noted, there are some symptoms that we really can't define as having a side, such as brain fog, vertigo, etc.  However, when I think about the other odd sensory things I've experienced, I think they're all one sided, at least at any particular time.  Tremors in head seem balanced, though, and I have them in both hands, but not always at the same time or under the same conditions.

The exception I've yet to understand is my eyes.  My visual disturbance (a haze, or decrease in intensity, usually) has been consistently in the upper right of my field of view, except for the one day I later had what I knew was migraine aura.  On that day, it was center left, but the migraine "image" showed up in the right eye, dead center of that eye's field.

Then there's the eye pain, and this is where there's both one-sidedness and symmetry.  Nearly every day I have pain behind the eye for at least part of the day, pain that feels like bruising on the back side of the eyeball.  Some days it's left, some days it's right, but recently there have been episodes when the pain is behind both eyes.  However, in those instances, the pain usually is less severe.  Usually.  It seems like there's only a certain amount of pain to spread around back there, and sometimes they are forced to share.  Scripture tells us that we are "fearfully and wonderfully made."

[essdipity]

I've always been a bit of an odd duck, and guess I still am, MS-wise.

My very first symptoms of something or other neurological was a chapped, sore feeling on the insides of both knees. That came and went for a long time. Since then I've gone through stabbing pains in both feet. The longest-lived thing I've had constantly for almost 2 years, burning on the skin of my legs and feet. For this one, the right side has consistently been worse. That's about all of the reasonably symmetric stuff.

A past neuro suspected cerebellar degeneration, though I've never known how this correlated, if it did, with MRI images. Also don't know to what extent this could affect both sides.

Current neuro insists I have small fiber neuropathy in legs and feet, in addition to more central things. I think he's fixated on that, so he comments that I experience dfferent things on touch tests than what I really feel. However, he did order nerve conduction tests (and does an EMG automatically go with this?). That was last summer. Somehow I don't have the reports from these tests, but was told they were normal. Therefore, I don't see how I could have peripheral stuff in legs and feet.

I've had 3 bouts of vertigo (including now). Have had severe pain across low  spine. Butt numbness. Have had left-sided mouth, tongue and face symptoms. Not all these at once, though! Strength tests show weakness on both sides, not symmetrical. Tinnitus on left. Floppy bladder. Esophageal problems in testing phase. VNG test coming Monday.

Brain MRIs, 6 or 8 of them, consistently significantly abnormal and worsening, but not typical of MS, though within differential. Have had 2 cervical and 1 thoracic MRI (this last in '06). All have been normal. I don't know whether recent symptoms will cause neuro to order more when I go this next July.

Sorry to rehash all this, but I don't know how to interpret the things that are or have been relatively symmetrical, based on what you've written.

ess