peripheral nerve examination

[jek33]

Hello,

I posted this morning, but now I have a more specific question that I am hoping you can help me with.

If the neurological physical exam that was done quickly by my PCP and then more extensively done by my neurologist was to test the peripheral nerves, how does that determine if there is something affecting the CNS?

Today on the phone, the neurologist said that through the exam she did in her office (no MRI or anything else...just testing reflexes, strength, sight, etc) was perfect, than she can rule out a brain tumor, MS, etc. But, if I am having these symptoms, does it mean that if it was MS something would definitely be affected in that exam she did?

Thanks in advance,

jek33

[jek33]

The doctor has ruled out an MRI for the next six weeks or so. She wants me to come back and meet with them again. I just want to get one done to see if there are any lesions or anything else. I am going to see if I can find another neuro today...one that specializes in MS or other autoimmune diseases.

My symptoms have gone through the gamut in one just week. So, before last Wednesday, I had felt off-balance and dizzy at times, nauseous and sometimes slurred over words (although no one else noticed but me).

In the last week, I have had severe (although not painful) tingling and numbness in my hands and feet. Yes, it has been in both, both primarily on my right side. Today, I feel "tight spots" on my right calf and left forearm. Also, for two days, I have these waves of tightness and somewhat numbness in my head and face.

All of this has only happened over the course of the week and has never happened before. I am a very healthy 33 year old woman who works full-time in a somewhat stressful atmosphere. At first, I thought this was stress-related, but I really cannot imagine that my body can produce these physical symptoms from just anxiety or stress.

Thanks for your thoughts,

jek33

[COBOB]

Asymmetric symptoms are very MS like.  Both arms or both legs are possible with spinal lesions  but much rarer in MS.    Have they done an MRI yet?   Since you have upper and lower extremity sensory symptoms on alternate sides, it makes a spinal issue less likely.  It also makes a tumor less likely.  Tumors displace tissue (mass effect) and tend to displace that tissue on one side of the brain (initially) not both.

If your doctor has not talked about an MRI, I guess I'd be more interested in hearing your symptoms.  What you have said so far makes me think an MRI would be in the plan.

Bob

[jek33]

Thank you, Bob. Of course, this makes sense. And, I totally understand it.

I guess I am frustrated that this neurologist told me that she could "rule out a brain tumor and MS" based on my neurological examination in her office. I am having so many symptoms and I cannot imagine that they can be a result of anything else but my brain doing something that it is not supposed to do.

Tonight, I have numbness in my right calf and my left forearm. How is this even possible? I also am in a cloud -- lightheaded and a bit of tightness in my head that comes in waves.

How can she be so certain to "rule out" those things???

jek33

[COBOB]

Welcome to the forum.

Testing reflexes, sight, sensation, etc is not really a "peripheral nerve exam."  Reflexes are CNS mediated responses.  Sight is all CNS.  Strength and Sensation (touch) is a mixture of CNS and PNS.  Loss of strength and or sensation may lead to an EMG/NCS or SSEP so the doctor can then decide if this damage is in the CNS or PNS.

MS is a diagnosis of exclusion.  Once the have excluded everything else: brain tumors, Lyme's disease, B-12 deficiency, and a bunch of other things -and- you have Dissemination in Space  (by history ot MRI) and Dissemination in Time (by history or MRI) they can diagnose MS.  There is no "Test for MS."  History and physical exam provides some of the data.  MRI helps.  CSF testing helps.  Evoked Potential tests can help.  None of them are diagnostic for MS on their own.

Many neurological conditions take a while to sort out.  MS is one of them.

Bob