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Fear of MS

Hello,

In February of last year, I fell ill with the flu. Shortly afterwards, a slight hemiparesis (paralysis) of the right side of my body, unclear speech, slight swallowing difficulties, and later my eyelid drooped and I saw double vision (due to an eye muscle paralysis). I was examined at the City Hospital Offenbach am Main during the acute episodes. Two MRIs of the head were done, one of the cervical spine, CT scan, EP, cerebrospinal fluid examination, Simpson test. Everything was negative except for the right leg, which was slightly delayed in the SEP. Reflexes were somewhat weakened, but there was no Babinski reflex or similar. I was then discharged with the diagnosis of unclear brainstem symptoms, ruling out inflammatory CNS processes. I then saw a neurologist who suspected Bickerstaff encephalitis (para-infectious brainstem symptoms), which was not confirmed by a test and was considered unlikely by the professor who treated me at the hospital. For six months, I had no symptoms until October 2009 when tingling and nerve pain in the extremities started, which is still present to this day. I underwent another neurological examination and a head MRI, with the diagnosis being no evidence of CNS disease, no inflammatory lesions are detectable. The same at the end of 2009, another head MRI was done with no findings, at the request of a second neurologist. Now, I am very worried due to the tingling and nerve pain, as I still do not know the cause of the tingling and the severe symptoms in February. What can I do?

It is often said that MS can be difficult to diagnose at first and lesions can only be in the thoracic spine, which was not investigated in my case by MRI. Nevertheless, neurologists should know what to investigate, especially since the symptoms were acute and seemed to originate from the brainstem. The course of events can be summarized as follows:

My flu presented in the normal way, with headaches, fever, sore throat, swollen lymph nodes, and a runny nose. I was ill for a week, then I may have overexerted myself while partying and drinking, so I was sick again for a week. Unfortunately, I partied wildly again, thinking I was healthy again. Shortly after, the symptoms got worse, first difficulty walking, then slurred speech, and finally drooping eyelid and crossed pupil (double vision). Something definitely attacked my central nervous system. After being in the hospital for a week, I practically only stayed in bed for about a month because I could barely walk, saw double, and reacted strongly to stimuli (could hardly watch TV or be on the computer and couldn't tolerate light well). After over a month, the eyelid lifted again and the pupil slowly returned to its place, and the double vision disappeared, indicating nerve regeneration. Apart from the nerve pain,

Dr. med. Olaf Stephan

Dear Inquirer,

Unfortunately, despite your detailed description of the symptoms and course of the illness, I cannot provide a definitive diagnosis. The complex neurological picture and the brainstem symptoms you described already suggest, among other things, multiple sclerosis as a differential diagnosis. However, a comprehensive diagnostic process has been conducted in the clinic. In your case, a variety of neurological diseases have been ruled out, and the presence of MS appears to be very unlikely. MRI scans, evoked potentials, and cerebrospinal fluid analysis are crucial in diagnosing MS and are very specific in this regard. Usually, when the disease becomes symptomatic, changes can be seen in the MRI. Your MRI has been performed multiple times, including of the brainstem. You are correct in assuming that there can be manifestations of MS in the spinal cord, which can be seen on MRI, but these do not correspond to the symptoms you described. Additionally, your condition seems to have spontaneously improved without specific therapy, indicating that the course does not support a diagnosis of multiple sclerosis. It is more likely that you are experiencing a post-infectious neurological event, and the remaining nerve pain you have may persist for a while. Overall, the presence of MS in your case appears to be very unlikely. However, since medicine rarely provides definitive certainty, regular neurological check-ups are recommended. If symptoms reappear, a thorough diagnostic process using MRI (which does not expose you to radiation) and evoked potentials may need to be conducted again.

Sincerely,
O. Stephan

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Experte für Neurology

Dr. med. Olaf Stephan

Dr. med. Olaf Stephan

Berlin

Ärztliche Tätigkeit seit ca. 17 Jahren, durchweg im stationären Bereich, neben den o.g. Fachrichtungen Erfahrungen in der Intensivmedizin, Angiologie, Kardiologie und gastroenterologischen Endoskopie vorhanden.

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