Hi, I usually give people nicknames and I am considering Frownie. It is interesting that your face has change in expression. Has this been completely symmetrical? that is possible, but some measure of asymmetry would be more common in MS. My neuro noted that I have a muscular asymmetry to my face, something I had never noticed.
I have read all of your posts. Mostly they made me mad. You have really seen some dunderheads in the neurology field. You have the honor of being totally new and adding a new "lie" to our growing list - Lies My Neuro Told Me. You will likely enjoy reading this though it has grown enormously long. I had never heard the choice idiocy that people with MS can't stand on one leg. Too bad no one told the woman with MS that climbs mountains. Alas...
http://www.medhelp.org/posts/Multiple-Sclerosis/Lies-My-Neuro-Told-Me-or-Common-MS-Myths/show/1074879
Your symptoms are certainly MSish. The asymmetrical onset of numbness and foot drop is classic. The fatigue of MS can be bone-crushing. While it is classic in MS, it is certainly not exclusive to MS. Many disorders have similar complaints of severe fatigue. In MS fatigue is the number one cause of people leaving the workplace.
You remark that the symptoms have come and gone, but it would be nice to hear a couple examples of episodes - like what symptoms appeared and how long they lasted coupled with how much improvement you got. My gut is that they will conform to the relapsing remitting pattern in MS well.
It is also interesting that your attacks responded to Medrol dose packs. That surprises me a little, with respect to MS. Those contain a very low dose of steroid compared to what the routinely use in MS. The highest day of the DosePak has 24mg of methylprednisolone. In MS they use 1000mg each day for 3 to 5 days. However, a few people have commented that low doses offered some relief.
Sequential MRIs show an increasing lesion burden. Can anyone spell MS??? The distribution on the 2nd MRI of subcortical lesions often throws the more mediocre doctors off, but purely subcortical lesions are totally "consistent with" MS, even if they are not classical. The third MRI listed lesions as being also in the periventricular location. Now we are talking a classic distribution that should have had a thinking doctor falling all over himself to rule out (or in - depending on how you view it) MS.
So, who was the mental giant who looked at all of this and diagnosed Chronic Fatigue?? CFIDS does not cause increasing brain lesions, neuropathies, paresthesias and jerky vision. This is just so stupic that I am embarrassed for my profession. A moment of silence for my grief......okay, that's over. I'm getting used to it. I can't stay silent too long or I'd never be able to speak, we have so many instances of dufus neuros thinking idiotic things. Sorry you were taken down that road.
The second radiological opinion you had of the MRIs was very thoughtful and well-done. Yes, demyelinating diseases (of which MS is by far the most common) is clearly at the top of your "differential diagnosis". The DDx is the list of possible suspects that could possibly fit a person's history, physical exam findings, and test results.
Do you think you have had a really thorough head to toe neurologic exam?? A good one takes in excess of 30 minutes and does many dozens of tests. If there are enough abnormalities on neuro exam you have met the first two requirements for a diagnosis of MS. I didn't note. Do you have a neurologist who takes you seriously and is committed to finding out the answer to your problems?
But, before any firm diagnosis of MS can be done a THOROUGH rule out must be done of those diseases like autoimmune diseases, infections like Lyme Disease, syphillis, and HIV, vitamin deficiency, and a few others must be undertaken and must be negative. This ruleout process is accomplished by noting certain things in the very thorough history and physical and by a whole slew of blood tests.
At this point, it can be possible to diagnose MS, even without seeing an MRI. However, the MRI holds a pretty important role in most neurologists eyes. But, not much abnormality is needed. Even just two or three MRI abnormalities is enough to raise the likelihood of MS to greater than 90% (enough to make a diagnosis) if there is a history of at least two attacks and there are two abnormalities on the neuro exam that indicate separated lesions in the brain or spinal cord.
So, you seem to just need a good MS neurologist. The picture looks pretty clear to me - except that I would like to hear a description of your attack pattern and of the results of the neuro exam. Plus, of course, the ruling out of MS mimics.
BTW - I'm still laughing at the idiot that thinks that no one with MS can stand on one leg and mad at the imbecile who thought that CFIDS was the best answer to your problems.
Now, despite my gut feeling (which is right more often than not) NOTHING can be diagnosed online. But, in the context of MS, my suspicions for you have MS as the first, second and third possibilities - given that the rule out is negative.
For completeness you should have an MRI of the cervical and thoracic spinal cord. I definitely agree with that. Depending on the results of the neuro exam I'm not even sure that a spinal tap would be necessary. Some MS neuros always do them, though in Europe they are being done less and less.
I would recommend that you read some of the Health Pages to get a feel for what MS looks like during the work up. Ones that might be useful would include
Spinal cord lesions
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Spinal-Cord-Lesions/show/764?cid=36
http://www.medhelp.org/health_pages/Multiple-Sclerosis/History-of-the-Diagnosis-of-MS/show/158?cid=36
http://www.medhelp.org/health_pages/Multiple-Sclerosis/Diagnosing-MS---The-McDonald-Criteria-revised-2005/show/370?cid=36
And here is a list of some of the more popular ones in an Index
http://www.medhelp.org/health_pages/Multiple-Sclerosis/MS-Information-and-Resources-Index/show/22?cid=36
I hope some of this helps clarify what needs to be done to find your diagnosis - whatever it may be.
Quix