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Having pain in left eye ball. No vision loss. MRI showed 3 lesions. Have consistent tingling. Developed burning feet. Suggestions?

Answered by
Dr.
Dr. Sandhya Manorenj

Neurologist

Practicing since :1998

Answered : 479 Questions

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Posted on Fri, 9 Aug 2013 in Brain and Spine
Question: 2 months ago, I had left eyeball pain with no vision loss. Doctors were concerned and did an MRI and found 3 small lesions. I was referred to a MS specialist and he said that the lesions are not typical of MS and wants to do more testing. Since that time, I have had consistent tingling and prickling in my left arm, hand and left leg. My left arm, hand and leg also feel weak. I also developed burning feet. My feet feel like they are hot and prickly although they are not hot to the touch. In the past 2 weeks, I have noticed that I am starting to develop MILD and very MILD tremors when I write and use both of my hands. These tremors seems to come and go. I have a lumbar puncture scheduled. I am wondering if these symptoms lean towards MS or other problems?
doctor
Answered by Dr. Sandhya Manorenj 21 minutes later
Hi,

Thank you for writing in.

Based on the details you have L) hemiparesis, burning feet syndrome,and tremors of both hands with eye pain without visual loss

L) sided weakness indicates R) cerebral hemisphere lesion.Burning feet syndrome indicates either peripheral neuropathy or it can also be produced by spinal cord and brain lesion.There are many causes of tremor of both hands at your age, it can be anxiety, essential tremor, weakness related tremor, dystonic tremor, tremor due to peripheral neuropathy.

One can pin point exactly based on neurological assessment whether it is brain, spinal cord or peripheral nerves involved.

We can help you better if you upload the MRI brain report.You may require MRI cervical spine, Visual evoked potential ( for eye pain),nerve conduction study, vitamin B12 level, in addition to lumbar puncture to know exactly the cause whether it is MS or something else.

I hope this helps you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sandhya Manorenj 1 hour later
I uploaded a few MRI images. I just noticed on the front shot, labeled "front lesion" that i see a white spot that the radiologist didn't catch. What do you think of this spot specifically. What do you think of the other spots?
doctor
Answered by Dr. Sandhya Manorenj 6 hours later
Hi,

Viewed the images.First image reveal left frontal lesion juxtacortical lesion ( near to cortex /near grey matter).Second image reveal R) frontal contrast enhancing subcortical white matter.Third image ,fourth, fifth image reveal L) frontal lesion mainly white matter and also grey matter.

Hence based on MRI details you have bilateral frontal lesion, R) side is white matter and left sided is in the grey and white matter region.Your MRI is not typical of Multiple sclerosis pictures because Grey matter is not involved in MS.MS plaque will be located specifically along the periventricular region, which is not there in your case.

I want to know that did you have any head injury /trauma ?due to the lesion at left frontal region.Also one need to rule out lacunar infarcts brain and you may require angiogram also. Blood sugar, lipids also to be checked to know the risk factors for infarcts

Do you smoke or drink alcohol?

Tremor of both hands is due to bilateral frontal lesion .You may require anti epileptics as it can be type of fits without loss of consciousness( frontal lesion prone for fits).Meantime antiplatelets, statins ,citicholine to be started after discussion with treating physician

You need not worry, number and size of lesion is less hence recovery would be complete.

Hope this would help you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sandhya Manorenj 1 hour later
I am 36 years old male. I weigh 172 pounds. I am very healthy. My tremors are intermittent and very faint. idnt it strange that the tingling in left arm and face all started when i had left eyeball pain (but no vision loss). They saud it probably wasnt optic neuritis because there was no vision loss snd the optic nerve wasnt inflamed in the MRI. Do you think I could have a blood clot in my brain? Why would I have these lesions? I have had no head trauma. My symptoms are most in my left side. My neurologist is an ms specialist and he's not recommending any of these things except a lumbar puncture. I am concerned about a blood clot in my brain. Wouldn't that show in the MRI? Is a blood clot a real possibility? Is this something that needs attention or can I just forget about it?
doctor
Answered by Dr. Sandhya Manorenj 7 hours later
Hi,

Yes blood clot also can produce similar clinical finding and MRI brain.Anyhow with single episode and MRI findings not typical of MS with absence of optic neuritis, multiple sclerosis is ruled out.

If blood clot has produce such changes means it indicates lacunar infarct and you should be back to normal by another one month.You may require neuralgic drugs like pregabalin /gabapentin to relieve your sensory symptoms along with physiotherapy.

You need not be concerned about blood clot as it is already completed 2 months Need to check risk factors like deranged lipids, blood sugar,and blood pressure monitoring to prevent stroke recurrence.



Hope this will help you

Regards


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