Lumbar MRI - yes or no

[Titleist76]

Hi there. I am new to this forum and this if my first post (here and to any forum for that matter). I'm a 39 year old male, in general good health, but experiencing some symptoms that are starting to become quite concerning. I have had 2 neurological "episodes" in the past; one 10 years ago left leg weakness (feeling of fatigue, leg never gave out), and one 2 years ago left leg weakness again, along with a lot of facial, mouth and tongue, and scalp tingling. A cervical and c-spine MRI was ordered by my family doctor for each episode, both clean, and symptoms subsided both times. So in my mind this was great news - no MS. Fast forward to today, where the leg is again experiencing weakness and fatigue, along with an intermittent cold sensation below the knee, and new this time - popping clicking and pain in the hip. I have also had back pain and buttock pain on the left side. My urinary habits have also changed - what I would call mild urge incontinence. I think my family doctor is a little tired of me expressing my concerns about MS, as she feels it has been quite confidently proven that I do not have MS. I've been in physiotherapy for 5 months trying to correct things with very little improvement. My fear is that something has been missed on a lumbar MRI which would explain the leg symptoms and urinary symptoms. Am I correct to worry, and should I pursue the lumbar MRI?

Thanks,
Titleist76

[lyndacarol]

I'm a 39 year old male, in general good health, but experiencing some symptoms that are starting to become quite concerning. I have had 2 neurological "episodes" in the past; one 10 years ago left leg weakness (feeling of fatigue, leg never gave out), and one 2 years ago left leg weakness again, along with a lot of facial, mouth and tongue, and scalp tingling. A cervical and c-spine MRI was ordered by my family doctor for each episode, both clean, and symptoms subsided both times. So in my mind this was great news - no MS. Fast forward to today, where the leg is again experiencing weakness and fatigue, along with an intermittent cold sensation below the knee, and new this time - popping clicking and pain in the hip. I have also had back pain and buttock pain on the left side. My urinary habits have also changed - what I would call mild urge incontinence. I think my family doctor is a little tired of me expressing my concerns about MS, as she feels it has been quite confidently proven that I do not have MS. I've been in physiotherapy for 5 months trying to correct things with very little improvement. My fear is that something has been missed on a lumbar MRI which would explain the leg symptoms and urinary symptoms. Am I correct to worry, and should I pursue the lumbar MRI?

Welcome to ThisIsMS, Titleist76.

In my opinion, it is logical to search for the cause of your symptoms, which are common to many conditions. You seem to be fixated on the possibility of MS; however, MS is a diagnosis of exclusion, made only after other more likely possibilities have been ruled out. There is no definitive test for MS. Is there any event that could possibly explain "clicking and pain in the hip" or the back pain – any accident or injury?

For example, fatigue, weakness, tingling, pain, urinary problems, and abnormal sensations may be caused by a vitamin B12 deficiency. Has your GP ordered the thorough initial testing necessary to rule out a B12 deficiency? This would include 4 tests: (1) a serum B12 test – or the newer, more reliable HoloTc test, (2) RBC folate test, (3) a serum homocysteine test, and (4) a methylmalonic acid test. (The "serum B12" alone is not enough to uncover a deficiency.)

Have you had blood tests for thyroid, liver, kidney functions? Have you had an evaluation for vasculitis? Oral glucose tolerance test? Celiac disease? Lyme disease? And several more.

I encourage you to work with your GP, gather some basic information and test results (By the way, request your own copy of any test results.), and try not to worry. (Worrying won't change the outcome.)

MRIs are expensive, most of the initial testing to rule out other conditions is not. The choice of a lumbar MRI is up to you, your doctor, and possibly your insurance company. If you have a good relationship with your family doctor, she is your best source of advice.

[DrGeoff]

Look at it like this:
If your car will not start, and the mechanic checks the tire pressures and tells you everything is OK, does this explain why the engine will not start?
Like Lynda says, a proper set of B12 tests is really where you have to start.
Next, if you have leg problems, the place to look is the Thoracic section of the spine - a competent neurologist should be able to pinpoint the area within a hour by physical examination alone to enable the MRI to look in the right place.
Maybe, if you stopped worrying about MS, and let your family doctor get on with finding out what is really wrong with you, she might get somewhere. She might want you to see a neurologist - who in turn may figure that you do not have MS.
But remember that you do not tell the experts what is wrong with you - you ask them.
Geoff

[Titleist76]

Thank you both very much for your replies. I should have relayed that I've had two neuro exams (by a neurologist) at the same time the MRIs were performed. He stated both times that he was fairly confident I did not have MS, and that my symptoms were likely caused by a pinched nerve...and off I went. I've now invested a small fortune in physio to try and resolve a potential pinched nerve (in the back and/or buttock) - minimal results. I've had a nerve conduction study on my left leg with normal results. Two years ago, my family doctor performed extensive blood tests, but I know that the B12 was just the basic one.

I am aware of B12 deficiency, but because my issues are only in one limb, I find it hard to believe I could be suffering from a deficiency. Am I wrong?

I haven't had a significant injury that would explain the back pain. I have had periods when I've experienced a "bad back" following heavy lifting.

I am back to see my GP next week, and will try to get things started again.

Thanks.

[Scott1]

Hi,

I doubt a physio will do much for you. If you have a bad back then you probably have weak or very weak core muscles and need to strengthen them. My preference is Pilates but some would say Yoga. Going to the gym will not make a difference. After many years of Pilates I find my jaw hits the floor when I see what people do in the name of fitness (or vanity) in a gym. It looks like blind people playing in traffic to me. Try a good small pilates class.

Regards,

[Froggie]

I have actually found physical therapy to be quite efficacious. During a recent relapse, I presented with excruciating lower back pain, heaviness in my thighs and difficulties walking. While in the hospital, I had cranial, C-spine and thoracic MRI's done. All revealed nothing. The attending neurologist ordered a lumbar MRI to make sure there was nothing mechanical going on. I'm glad he did as it revealed a herniated disc! A good physical therapist will have you doing exercises at home that will help with weakness and strengthening your core. As part of my treatment, I was also doing traction. That was the proverbial bomb! You may have to do said exercises in perpetuity, but you'll feel a lot better.