Tough Diagnosis

[willint]

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My wife suffered from severe numbness in her hands and feet over a period of 4 months (from November '02 through the end of February '03), which completely disappeared when she became pregnant with our second child, a boy born a couple of weeks ago. The numbness has now returned.

Before the pregnancy, she saw a neurologist who performed a battery of blood tests (Thyroid, B12 def, etc)--all normal/negative--as well as an MRI, which was also normal. The neurologist also performed a nerve conduction velocity test, which detected severe carpal tunnel syndrome in her hands, but the neurologist had "no comment" concerning the numbness in her feet. She then saw an endocrinologist, who offered very little in the way of helpful advice and said that there weren't any tests that he could run.

She had acupuncture done last week, but the symptoms haven't improved.

She is a little discouraged at this point and fears that she may have early-onset MS. Are there any med students, residents/fellows or full-fledged Docs out there who could offer some helpful advice?

 

[USIMGgrad]

Hi,

I'm sorry about your wifes condition. First of all, if your wifes neurologist thinks that its early symptoms of MS then she should see a MS specialist. I know that there has been recent trial with Statins (Atrovastatin, Lipitor) usually 80mg daily and it has been shown to slow or even reverse MS lesions in the brain. I think you should ask your neurologist about this. I think this is worth looking into.

 

[tofurious]

If the MRI was completely normal, there is just insufficient evidence for clinical diagnosis of MS. However, even if it was positive, unless there was supportive evidence (two+ lesions, CSF findings), she wouldn't have been started on any meds.
(There are quite a few good meds to reduce frequency of MS flare-ups, and statins are not the standard of care right now). Interestingly, women who suffer from MS do experience some protective effects during pregnancy.

Since EMG is negative, I am in favor of a vasculitis type of small vessel disease. Not sure if the carpel tunnle syndrome finding is a red herring. Depending on how strong your/her physician's index of suspicion is, you can do a few or a large number of blood tests (ESR, RF, ANA, anca) and even consult rhematology to r/o Raynaud's and other phenomena.

 

[El Duderino]

"Numbness in hands and feet" is a very good description for a layperson, but a neurologist can't really use it. 🙂 What you should do is map the numbness more specifically (its relation to dermatomes etc). Also, try pricking her hands and feet with a needle, and check if her sense of vibration is lost etc. I'm sure the neurologist did this already, but the results would definitely help us close in on the diagnosis.

 

[sacrament]

It doesn't sound like her neurologist is worried, and with a normal MRI, what I can only assume was a normal neuro exam, and no symptoms other than paresthesia, with neither a progressive nor a clearly relapsing/progressive course, I'm not sure he should be that worried about MS at this point. Of course, I'm just a 2nd year. 🙂

Anybody know what the status is on Antegren? I've heard lots of promising stuff. Shouldn't it be nearing approval soon?

There is a lot in the pipeline for MS right now. What do you guys think? "Cure" (or at least complete stabilization?) in our lifetime?

 

[willint]

Thank you all for your ideas and advice--and time. I'll keep checking back periodically to see if there are any additional suggestions.