Cervical spine lesion... possible MS?

[Toadstool]

Hello ,

I'm a 20 year old female who has been diagnosed with Ankylosing Spondylitis in November of 2016, but I've been having a lot of problems that I'm not sure relate to that. For instance, I had an MRI done of my cervical spine in July of 2016 (ordered by my neurologist) that said,

"There is a nonexpansile T2 hyperintense enhancing lesion within the left posterior elements and articular facet at C4. This may be an atypical hemangioma or other benign lesion."

I haven't been able to get a good response on what this means from my neurologist, and he hasn't been very helpful as far as exploring the idea of possible MS... I've had two brain MRIs in the past (both without contrast) and they haven't shown anything. My symptoms that may or may not relate to this subject are horrible back pain (although this could be due to my ankylosing spondylitis), leg weakness/heavyness, neck pain, numbness and tingling in my hands and feet that come and go, blurred vision/double vision at times, floater spots, electric shock sensation in my neck when I move it at times, constipation, frequent urination/urge to urinate, frequent nighttime urination (gosh its annoying), terrible fatigue. I think that covers it but geez I've been feeling especially horrible in the past 2 weeks with all these symptoms really getting to me. These symptoms were what caused me to get that cervical MRI back in July, and they subsided a bit later in 2016, but now they're back and I'm not sure why. I can barely concentrate on my college school work, and its definitely affecting my quality of life.

Could the lesion(s?) be due to MS or should I be thinking of something else? Thank you very much for reading, I appreciate any advice I can get.

[jimmylegs]

hi and welcome
i'm not one to argue with docs' dx, except when it comes to my own which i know tons about, naturally.
i can't imagine anyone here being able to suggest no your docs are wrong, ie that is so definitely MS, and not AS. i could be wrong, we could have a lurking as pro in our midst.
my suggestion is always to ensure nutritional status is optimized to ensure least likelihood of conforming to an ms profile. so not the best person to commiserate with if gunning for an ms dx.
at least there's a heap of science on the nutritional aspects of ms, vs not as much so far for as. i had to resort to a 20+ yr old book which i remembered had an entry on as, just bc at the time the name of it made an impression. it says it's an inflammatory illness, 'bamboo spine', with pain in spine pelvis and sometimes rib cage. bone fusion.
recommendations given: cut sugars, minimize simple carbs and boost complex carbs like various peas lentils and beans. also says if on painkillers, increase intake of vits a and c.
also says long term use of painkillers can cause iron loss due to bleeding in the stomach, and that docs may prescribe anti-inflammatory drugs, steroids etc.

so, we're probably looking for developments over the last couple decades re vit d3, so sure enough there it is from 2013, albeit out of africa, and using resources from my ms clinic's institution no less woot. now that is interesting. is there an ethnic component to as? bc the only person i know personally who has been dxd with AS is african american.

Seasonal disease activity and serum vitamin D levels in rheumatoid arthritis, ankylosing spondylitis and osteoarthritis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645084/
"The mean Bath Ankylosing Spondylitis Disease Activity Index score was significantly higher in winter than in summer "

if there is an ethnic connection there, it seems like it could be related to the fact that darker skin, and even more so darker + covered skin, is susceptible to reduced cutaneous vit d3 synthesis. otherwise, just some lifestyle factors leading to low d3 levels. either way, that's a pretty straight line to bone pain. would be exacerbated by any low dietary magnesium and other d3 cofactors. low mag and d3 are also seen in ms, so there would be potential symptom overlap regardless of the ultimate dx either way.
similarly, lhermitte's sign (the shock feeling) is not unique to ms. https://www.hindawi.com/journals/crinm/2015/707362/

some of your other symptoms also suggest potential mineral issues. can you describe any nutritional testing that's been done in your case?

there are excellent newer resources out there to help balance diet to the anti-inflammatory side of things. the IF rating web site provides a limited food search tool. when working on inflammatory illness, you want to balance out healthy food sources while aiming for a +100 overall score each day.

also this from 2014:
"We reviewed the literature for studies assessing vitamin D level as a marker of AS disease activity and those examining vitamin D levels in AS in comparison to healthy controls. Four of 7 studies found a significant negative correlation between vitamin D levels and Bath Ankylosing Spondylitis Index (BASDAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In a review of 8 case-control studies, the mean level of 25-hydroxyvitamin D3 was 22.8 ± 14.1 ng/mL in 555 AS patients versus 26.6 ± 12.5 ng/mL in 557 healthy controls."
those serum d3 levels are all bad, but the AS patients worse off on average. 40 ng/ml is a better level, and should be worked on using cofactors not d3 alone. basically allows your body to create anti-inflammatory steroid hormone treatment for itself.

1,25(OH)2-vitamin D3, a steroid hormone that produces biologic effects via both genomic and nongenomic pathways
https://www.ncbi.nlm.nih.gov/pubmed/1314073

The Anti-Cancer and Anti-Inflammatory Actions of 1,25(OH)2D3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164534/

Vitamin D or hormone D deficiency in autoimmune rheumatic diseases, including undifferentiated connective tissue disease
https://arthritis-research.biomedcentra ... 186/ar2552

[lyndacarol]

Welcome to ThisIsMS, Toadstool.

"Vitamin D deficiency in patients with SpA is prevalent, may be related to disease activity" August 20, 2015 Ankylosing Spondylitis
http://www.healio.com/rheumatology/spon ... e-activity

The researchers concluded that vitamin D deficiency in patients with SpA occurs with frequency and that deficiency may be associated with disease activity and severity.

25-Hydroxyvitamin D Levels and Vitamin D Deficiency in Children with Rheumatologic Disorders and Controls
Christina F Pelajo, Jorge M Lopez-Benitez, and Laurie C Miller
http://www.jrheum.org/content/38/9/2000.abstract

Conclusion. Twenty percent of patients attending a pediatric rheumatology clinic were vitamin D deficient. Patients with autoimmune disorders were more likely to be vitamin D deficient than patients with nonautoimmune conditions. Screening of serum 25(OH)D levels should be performed for patients with autoimmune disorders.


In view of these articles, it is my opinion that you should see your GP and request the vitamin D blood test called "25-hydroxy D" – if you have not already this test recently. (And request your own copy of the test results so that you have the actual number.)

In my opinion, your various different symptoms may have different causes.

[jimmylegs]

an oldie but a goodie:

Serum copper and caeruloplasmin in ankylosing spondylitis, systemic sclerosis, and morphea (1976)
http://ard.bmj.com/content/35/5/443.full.pdf
"Studies of serum copper and caeruloplasmin were performed in patients with ankylosing spondylitis, systemic sclerosis, and morphea. Mean levels of both were raised significantly in ankylosing spondylitis, with the greatest increases in the worst cases. ...

Table II Correlation of raised serum copper with severity of ankylosing spondylitis
Serum Copper in Ankylosing spondylitis
umol/l (ug/100ml)...Mild...Moderate...Severe
< 30 (191)..............13........6............7
> 30 (191)...............1........6............5"

30 is very high to my knowledge, making it a weird place to break up serum copper for analysis to my mind.. i would have thought a healthier level would be closer to 20 umol/L or less. too bad they did not also run serum zinc, to see how the ratio factors in.

speaking of which, this one looks at the cu zn ratio specifically. not for AS though, but still interesting:
Serum Levels of Copper and Zinc in Patients with Rheumatoid Arthritis: a Meta-analysis (2015)
http://link.springer.com/article/10.100 ... 015-0325-4
This meta-analysis suggests that increased serum level of Cu and decreased serum level of Zn are generally present in RA patients.

if it were me, i'd be checking that ratio out and ensuring it was optimal.

[Scott1]

Hi,

It doesn't sound like you have been given much of a picture about yourself. Apart from the MRI what other test results do you have? Was Uric acid done with the blood tests?
I do think you should look at each symptom you have described as a problem to be dealt with with on its own. They seem to break into three main groups; muscle tightness (back legs etc), constipation/urination and fatigue.
They all could certainly be related to spinal trauma. The muscle tightness will relate to skeletal muscles and the constipation etc to smooth muscle action. As an adjunct to any final solution I would add magnesium (JL can suggest) as a muscle relaxant.
I would also start megadosing with Coenzyme Q10 to improve how your electron transport chain functions so you can make sufficient ATP to drive your metabolism efficiently. It relates to fatigue as well. (Here is an explanation I wrote recently for another site about fatigue - http://www.mstranslate.com.au/ms-many-s ... e-fatigue/)
You need to find a doctor who will explore for subtle underlying infections. There could be many such as mycoplasma, rickettsia, chlamydias etc. Infections cause inflammation and that causes significant release of free radicals. If your condition is chronic those free radicals start impacting on healthy tissue.
What I've suggested are adjuncts not final answers but they should help.

Regards,

[logancraig]

Wow, are you me?

I was diagnosed with AS after I woke up one day and literally couldn’t move from my bed. My lower back was so tight that I had to log roll out of bed—pretty scary for someone who is used to jumping right out of bed like they do in the movies.

Almost every symptom you’ve listed I’ve had or currently have. This is 10 years in the making. AS could definitely be the culprit for many of them and if you couple all of this with intense anxiety, you’re in for a bad time.

I know this is an old post, but I’d be interested to know if you found any answers.