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Broke pelvis and experiencing tingling and numbness in hands. What do you recommend?

DOCTOR OF THE MONTH - May 2014
May 2014
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Radiologist
Practicing since : 2002
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Question
my daughter is active duty coast guard last april broke her pelvis since initial injury has had dizziness sick shakes episodes of tingling and numbness in both hands and both feet loss of balance below avg on vit D and iron loss of more eyesite-775 in one eye They did a 1.5 T mri but it was normal she is in constant pain and has detoriated she is 20 now on crutches and still having issues...they put her on 80 mg of steroids and it went away -they lowered her dose and the tingling and loss of limbs began again and also has notice "brain farts" lol of memory. Does MS hide without showing placques in MRI from 1.5T.
Posted Tue, 10 Dec 2013 in Brain and Spine
 
 
Answered by Dr. Vivek Chail 4 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX, Thanks for writing in to us. I have read through your query in detail. You have raised in a valid query in asking the possibility of MS in your daughter who has a normal brain MRI. Research has been done in making a diagnosis of Multiple sclerosis and doctors from Oxford, UK have made the following conclusions as given below: 1. MS is a clinical diagnosis 2. Brain MRI is abnormal in the majority of patients with MS 3. Patients with a monophasic presentation can be diagnosed with MS using interval gadolinium enhancing or T2 weighted longitudinal MRI 4. VEPs (visual evoked potentials), OCBs (oligoclonal bands), and spinal cord MRI are useful if the MRI brain is negative and in patients with a progressive presentation 5. An abnormal MRI following a clinically isolated episode carries a > 80% risk of clinically definite MS after 10 years 6. A normal MRI following a clinically isolated episode carries a 11% risk of clinically definite MS over 10 years 7. A follow up counseling session to discuss MS is useful for patient and relatives Therefore it can be seen that Multiple sclerosis cannot be completely ruled out in a patient with normal brain MRI. MRI brain findings in Multiple sclerosis are based on the appearance of lesions in space and time on repeat scans also. There is MRI diagnostic (McDonald's) criteria which is being updated regularly and followed when making a diagnosis. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
Above answer was peer-reviewed by
 
Follow-up: Broke pelvis and experiencing tingling and numbness in hands. What do you recommend? 6 hours later
does the lesions show on a 1.5? or is it better to show on a 3.0? What types of auto-immune possibilities are going on with her symptoms? They are sending her to XXXXXXX XXXXXXX for neuro consult....I want to be sure they are doing the right tests, she is too young to have these complications and I don't want to miss something....not saying that would happen just want to be ready and ensure before they discharge her and her dreams are ended, that all avenues have been checked.
 
 
Answered by Dr. Vivek Chail 15 hours later
Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXX, Thanks for writing in with an update' Lesions show up non 1.5 T MRI machine but will surely be much better seen in 3.0 T MRI. The main differential diagnosis of Multiple sclerosis includes, but are not limited to, the following: Spinal cord neoplasms (eg, astrocytomas, ependymomas) Acute disseminated encephalomyelitis (ADEM) Schilder disease Baló concentric sclerosis Sarcoidosis Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) Vasculitis Progressive multifocal leukoencephalitis Subacute combined degeneration of the spinal cord (vitamin B12 deficiency) Small-vessel ischemic disease (affecting the brain primarily, and caused by diseases with vascular risk factors, such as diabetes, hypertension, hyperlipidemia, old age) Some of the above conditions are autoimmune in origin. I am sure the doctors at XXXXXXX XXXXXXX will be careful and get the necessary tests before making a final diagnosis. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek
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