Brain MRI Question

[Caltana]

Hi everyone,
I'm new to this group and I'm currently undiagnosed. I will quickly explain my situation and hopefully someone will be able to answer my question.
Back on the12th Jan 2015 I started getting numbness and tingling in my right leg and then it moved to my right arm and then lip. The symptoms continued so on the 13th I decided to go and see my Dr. The Dr thought I was having a stroke and sent me to the hospital. Since in hospital they did blood tests and a ct scan, both came back clear. They ruled out a stroke but sent me for a brain mri as they were concerned about something neurological happening. The brain mri has come back clear yet my symptoms have increased. I now have numbness, tingling in both arms and both legs plus electric feelings in both legs, heaviness in arms and legs. I have major fatigue, brain fog, slurred speech and having trouble finding my words. My symptoms can change from day to day and sometimes hour to hour. My question is, if this is MS, is it common for the brain mri to come back clear?? I see my neurologist for the 1st time this coming week and just want to know what's going on. I do have some other symptoms but this is just a brief run down of what's been going on. Any advice would be greatly appreciated.

Many Thanks

[NHE]

Back on the12th Jan 2015 I started getting numbness and tingling in my right leg and then it moved to my right arm and then lip. The symptoms continued so on the 13th I decided to go and see my Dr. The Dr thought I was having a stroke and sent me to the hospital. Since in hospital they did blood tests and a ct scan, both came back clear. They ruled out a stroke but sent me for a brain mri as they were concerned about something neurological happening. The brain mri has come back clear yet my symptoms have increased. I now have numbness, tingling in both arms and both legs plus electric feelings in both legs, heaviness in arms and legs. I have major fatigue, brain fog, slurred speech and having trouble finding my words. My symptoms can change from day to day and sometimes hour to hour. My question is, if this is MS, is it common for the brain mri to come back clear?? I see my neurologist for the 1st time this coming week and just want to know what's going on. I do have some other symptoms but this is just a brief run down of what's been going on. Any advice would be greatly appreciated.

Welcome to ThisIsMS. An MS MRI usually includes imaging of the cervical spine. Sometimes, people have lesions on their spine, but don't have any visible in their brain. Was your spine also imaged?

In addition, an MS diagnosis is usually a process of elimination as there are several other conditions which can mimic MS symptoms. One of these which is fairly common is vitamin B12 deficiency. If you've been tested for B12, you should know that the lower limit for the standard range used by many laboratories is usually set far too low. Typically, it runs from 200-800 pg/mL. However, it's possible to have neurological symptoms and still be "within the range." The book "Could It Be B12?" by Sally Pacholok states that B12 levels need to be 500 pg/mL or higher. Therefore, it's best to know your actual test results rather than just being told that your results are "normal." Sometimes, normal isn't enough.

[ElliotB]

"if this is MS, is it common for the brain mri to come back clear?"


It is not common, but about 10% of those with MS have clear MRIs. Be patient and let your doctor's do their job. Hopefully it won't take too long for them to figure out what is going on.

[Caltana]

They only did the brain mri so I'm hoping the neurologist will request a spine mri. The B12 bloods came back normal too.

[jimmylegs]

b12 bloods usually come back 'normal' unless there's a serious problem (which i did have - my levels were undetectable but mine was an unusual case)
the way b12 deficiency is defined is problematic. did you happen to get a copy of your lab results by any chance?

(just as an fyi i'm not personally a b12 pusher, but it is a good enough place to start - i was pretty fixated on it in 2006 but at the end of the day that deficiency was a tiny piece of a biiiig complex picture)

[Caltana]

My results say: vitamin B12: 187 PMO1/L (138-800)
Then on the next page it says:
Active B12 59 PMO1/L (>35)
I have no idea what any of that means. I am in Australia so not sure if this is done differently to other countries.

[NHE]

My results say: vitamin B12: 187 PMO1/L (138-800)
Then on the next page it says:
Active B12 59 PMO1/L (>35)
I have no idea what any of that means. I am in Australia so not sure if this is done differently to other countries.

For B12, the 138-800 pmol/L range converts to 187-1084 pg/mL. As you can see, it's a pretty broad range. The testing laboratory has likely taken the population mean and defined some area underneath the bell curve as normal (probably + or - 2 standard deviations from the mean, otherwise known as a 95% confidence interval). The lower end of this range is much too low and probably includes some unhealthy people.

Your result of 187 pmol/L converts to 253 pg/mL. This puts you in the gray area of deficiency and it's too low considering that you have neurological symptoms. Last Spring my B12 was 247 pg/mL. The nurse said "well you're still within the range." However, I knew better than to listen to her. My suspicions were confirmed when my doctor said "247! You're definitely deficient." and immediately ordered a B12 shot for me. Since then, I've been taking a sublingual methylcobalamin form of B12 and have experienced an improvement in my energy levels and a lessening of my cognitive fog. I've discovered that not all brands are of B12 are created equally. I had been taking the Superior Source brand at 1000 µg of methylcobalamin, but ran out. I tried taking the same amount using the Jarrow brand of methylcobalamin, but within 5 days I could tell that it wasn't working and went back to using Superior Source's methylcobalamin. Costo's brand also seemed to work all right, but it comes in 5000 µg sublingual tablets and tastes like cherry flavored cough syrup.

Regarding active vs. inactive B12, B12 is carried on two proteins in the blood, holotranscobalamin and haptocorrin. Active B12 is B12 bound to holotranscobalamin and it's this form that can be taken up and used by cells. Active B12 is usually around 20% of the total of circulating B12 and the other 80% is inactive and bound to haptocorrin. Your value of 59 pmol/L is 30% of your total.

You can find some discussion and several research articles on B12 in the following thread.
http://www.thisisms.com/forum/natural-a ... 24857.html

By the way, it might be a good idea to follow up on your B12 results with some additional tests. These usually include homocysteine and methylmalonic acid. Both of these molecules can build up to toxic levels if B12 is low. It's a pretty good way to double check your B12 status. My homocysteine was at 16.1 µmol/L and the range is 4-12 µmol/L (in addition, one of my local medical groups really wants to see their patients below 9 µmol/L since homocysteine is cardiotoxic). Note that high homocysteine can also be due to low folate levels. However, B12 and folate work together and are like the two wheels of a bicycle in that you're not going to get very far with only one or the other.

[Caltana]

My folate was low and I have since started taking folate tablets. My folate level was 11.

[jimmylegs]

hi again caltana, excellent to see those results.

personally i usually aim for serum cobalamin ~ 500 pmol/L even though recommendations are often more in the 500 pg/mL zone, which is only 370 pmol/L if memory serves. it's a very typical problem with lab ranges. low normal is NOT where you want to be, for quite a few essential nutrients.

may i ask how often you consume any of the foods from this list of healthy b12 food sources?
http://www.whfoods.com/genpage.php?tnam ... #foodchart
(source: world's healthiest foods - a great info resource and the top ones on the list come with a lot more benefits than a tablet)

just as a side note, there was a time when i took b complex with 1g folate and i had a sort of unscratchable itch as a side effect. at the time i had a blood test done and folate was way through the roof. later, after sorting out nutritional status broadly, i realized i had again been taking a similarly folate-loaded b complex product with no reaction. i think my body was missing a bunch of cofactors needed to deal with it appropriately.

i know it can be time consuming to do a big food overhaul but for the short term i am wondering if you take any kind of a multivitamin, as a base for adding isolated folate?