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Back pain, migraine. Multiple sclerosis or B12?

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Practicing since : 2001
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MS or B12?
I am a 36 year old female with no family history of MS. In XXXXXXX 2011 I was diagnosed with B12 deficiency after I become off balanced & inner ear was ruled out. My numbers were 163. My last blood test was in November & came back as 505. I believe I have been deficient for 6 years, this is as far back as I can remember having symptoms that doctors could not explain. I have off & on numbness, tingling, burning, vibrations, etc Everywhere from my legs, feet, hands, back.In Sept, our of nowhere, I had numbness from the rib cage to the hip, right side only that wrapped from the middle of my abdomen to my spine. The numbness went away but I developed horrible back pain that has not gone away.

My neuro did am EMG and lumbar MRI that were normal. Cervical showed possible lesion at the T2. So I underwent MRI for brain, cervical & thoracic spine. Brain showed some lesions that the neuro said looked like those from migraines which I have had since a child. Spinal showed "small T2 hyperintense focus posteriorly toward the right in the cord." and "level of T4-T5 there is a lesion which extends for the craniocaudal length of 5mm. There is also slight thinning of the cord at this level. There is no evidence of cord compression." The T4-5 is where I experience the most pain & a feeling of pressure.

My doctor sounds like he has made up his mind it's MS, he wants a spinal tap but says even if they don't find anything, it doesn't mean anything. I told him that I have researched B12 deficiency & that it can mimic MS because it causes demyelination. He did not want to consider this. I would like your opinion on this matter. I am also thinking of getting a 2nd opinion. I'd also like to know, if this is from the lack of B12, as my numbers are restored, is it possible the lesion in the spine could go away & hopefully the pain with it? I know sometimes if you are deficient too long it can lead to permanent damage.

Thank you very much!
Posted Mon, 30 Apr 2012 in Multiple Sclerosis
Answered by Dr. Shiva Kumar R 18 hours later

Diagnosis of MS is based on clinical symptoms, MRI findings and exclusion of other disease which mimic MS. One such among the list is Vit B12 deficiency. Usually B12 deficiency presentes with symptoms of peripheral neuropathy and sensory ataxia. Rarely can present with memory problems and as psychiatric disorders. Evidence like low levels of B12 and reversal of symptoms after correction would favor Vit B12 deficiency. Odd is normal EMG in Vit B12 deficiency.

One should always consider the possibility of MS when MRI shows features of multifocal demyelination in the spinal cord and brain. If the follow up MRI shows new lesions with contrast enhancement you do qualify for the diagnosis of MS.

So I personally feel if follow up MRI shows new and contrast enhancing T2 hyperintense lesions you have to undergo evaluation for MS and if proved positive should get started on prophylaxis. If not close observation and follow up by Neurologist is required for excluding the diagnosis of MS.

I thank you again for the query. I hope you found my response to be helpful and informative. I you have any additional concerns I would be happy to address them.

Wish you good XXXXXXX


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
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