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Mild Tremors, Fatigue, General Malaise And Numbness In Toe Since Months. MRI Clean. Does Normal MRI Rule Out Late Onset Of MS?

Posted on Tue, 11 Jun 2013

Question: I have been experiencing minor tremors, fatigue, general malaise and numbness in toe for several months. I have a history of CFS and little else. Neuro doc did EMG test as well as physical. That plus 1 year old brain MRI led him to discount ALS, Parkinsons and MS. My symptoms seem to mimic MS, but MRI was clean. Does a normal MRI rule out late onset MS? I am 68 years old and glucose intolerant (113 fasting and 5.6 A1c). Diabetes neuropathy has also been discounted. Vitamin B-12 level was fine in last blood test 1 month ago. Cholesterol was ok, Triglcyerides were a little elevated. Neuro did blood tests that ruled out Sjorgens, etc. He does not know what is causing my symptoms as of now. Any ideas? thanks

Answered by Dr. Gopal Krishna Dash (4 hours later)

Hello,

Thanks for the query

I understand your concern

Yes, a normal MRI rules out late onset MS. I am yet to see a patient of MS without MRI changes.

The numbness in toes can be related to low calcium or even small fibre neuropathy which may not be detected by the routine ENMG test. You need to check your thyroid function, electrolyte to see any abnormality as these can cause fatigue.
Please stay relaxed, you do not have any of the MS, ALS, Parkinson's disease
Please get back if you need any additional information
Best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gopal Krishna Dash (39 hours later)

thanks Doc. A further question. My labs all read ok and a neck MRI this week was also ok. But I still have the fatigue, "spacyness," numb left toe, tingling in my left sole, some ghosting in my vision, and tremors only when I do something like lift a weight, not resting. Sometimes I also get bilateral arm ache. I did some lifting about 5 months ago and wonder if that could have injured something, although the MRI indicates not. This is really getting exasperating after numerous tests and doctors with no resolution. In fact, it seems to be getting worse. Any ideas on what to do next? thanks

Answered by Dr. Gopal Krishna Dash (37 hours later)

Check the serum electrolytes, blood glucose and get back to me

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gopal Krishna Dash (39 hours later)

My serum electrolytes are all within range; A1c was 5.5 on 14 May. Fasting Glucose was 113. So far all tests including CBCs, head and neck MRI, EMG, neuro blood panels are ok. However my symptoms of fatigue, numb left toe, tingling in left foot, numb or tingly tongue ( especially after eating or drinking) and slightly numb fingers continue. I may be looking for a new Neuro doc since my current one has no idea what is wrong. I'd certainly appreciate any advice you could give me.

Answered by Dr. Gopal Krishna Dash (3 hours later)

Hello,
Thanks for the feed back,
I understand your concern
If all the investigations are negative, I feel that it is a good news to you in the sense that nothing serious neurologically in your case as of now. These symptoms may be related to stress or fibromyalgia. I suggest you to try medications like Gabapentine, pregabaline, amitryptiline etc under the guidance of a local neurologist. Please do not worry and stay relaxed as there is no evidence to suggest a neurological disease in your case based upon the investigation data that you have posted
Best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar