For my post yesterday, I used the link http://www.medicinenet.com/multiple_sclerosis_pictures_slideshow/article.htm. Rather than just posting the link, I wanted to display all of the information that it contained. So, I put together a presentation based on the site. Today I want to use the different points and then explain how multiple sclerosis has affected me.
Who Can Get Multiple Sclerosis?
I was diagnosed with multiple sclerosis in 2002, just around the time that I turned 28. I started to lose feeling in my right foot. By the next day, the tingling had moved up to about my mid-thigh. On the third day, the numbness had reached my right cheek. At that point, Jamie got pretty concerned. The symptoms that I was having were starting to sound like those of a stroke. I made an appointment through my doctors office with a nurse practitioner. She examined me and told me that it definitely was not MS because she had worked with MS patients before and that . I was told that if the feeling didn't go away that I should make another appointment. Needless to say, it didn't and I started to have trouble walking. I saw my Primary Care Provider and he gave me neurological exam. An appointment was made for me to see a neurologist in about a month. I was told that, in the meantime, if my vision got worse that I should go to the emergency room. A couple of days later, Jamie and I found ourselves spending a day in the ER. After about 6 hours and some tests, I was admitted to the hospital being told that it was either a brain tumor, a series of small strokes, or multiple sclerosis. Guess which one I was hoping for?
How is Multiple Sclerosis Diagnosed?
Having gotten settled in my room, Jamie and I were told that I had an MRI scheduled for aroung midnight that night. The next day, there were more tests to be done. Blood was taken. I was catheterized to obtain a urine sample. I had a spinal tap. At that point, the doctors need to review the tests so I was sent home. As is standard treatment for an MS relapse, I was prescribed Solumedrol, a liquid steroid to be given intravenously. Before I left the hospital, an IV line was put in my arm. A case manager had arranged for the VNA (visiting nurses association) to come to my hous to adminster the medication for the next 5 days at which point I would have a step-down of oral steroids.
What Are the Types of Multiple Sclerosis?
The following week I had an appointment with the neurologist to review the results. My doctor performed a neurolgical exam on me. What is a neurological exam?
There are many different neurological tests and the ones your neurologist chooses to perform will depend, in part on the symptoms that you present with. Here are some of the more common ones.
Romberg's sign: This is a test for ataxia (incoordination or clumsiness of movement that is not the result of muscular weakness) and involves standing with your feet together with your eyes closed. Ataxics have great problems standing still under these conditions.
Gait and coordination: The neurologist evaluates ataxia in various parts of the body by observing the patient walking normally, walking heel-to-toe and finger-to-nose tests The neurologist will also be looking for intention tremor (shaking when performing small motor movements) as well as ataxia in this last test.
Heel/Shin test: This is a test for ataxia and cerebellar dysfunction. You have to bring the ball of your heel onto the knee of your other leg and then move it down the shin.
L'Hermittes sign: This is a test for lesions on the spinal cord in the neck. The neurologist will ask you to lower your head towards your chest. A positive L'Hermittes will generate buzzing, tingling or electrical shock sensations in one or more parts of the body.
Optic Neuritis: This is a condition of the eye caused by inflammation and demyelinaton of the Optic Nerve and is perhaps the most commonly presenting symptom in MS. The tests involve the ubiquitous reading of letters from a board and a test for color vision using an "Ishihara" color chart. An examination with an opthalmoscope will reveal pallor of the optic nerve in old optic neurites.
Hearing Loss: This is done by lightly clicking the fingers next to each ear and asking the patient which ear the click was done next to.
Muscle Strength: This involves resisting the neurologist with various muscle groups. Differences in strength between left and right sides are easier to evaluate than symmetrical loss unless the weakness is severe.
Reflexes: This is done with both ends of the hammer. The reflexes can be normal, brisk, i.e. too easily evoked or non-existent.
Babinski's sign: A test for signs of disease process in the motor neurons of the pyramidal tract. The test involves drawing a semi-sharp object along the bottom of the foot. The normal response in adults and children is for the toes to reflex downwards (flexor response). In babies and people with neurological problems of the corticospinal tract, the big toe moves upwards (extensor response).
Chaddock's Sign: Similar to Babinsky's but testing for lesions inthe corticospinal tract. The neurologist touches the skin at the outside of the ankle. A positive response in upwards fanning of the big toed just like in Babinski's test.
Hoffman's sign: This is also similar to Babinski's but involves the hands rather than the feet. Again it tests for problems in the corticospinal tract. The test involves tapping the nail on the third or fourth finger. A positive response is seen in flexion of terminal phalanx of thumb.
Doll's Eye Sign: The neurologist is looking for dissociation between movement of the eyes and of the head. A postive response is when the eyes move up and head moves down.
Sensory: This is done with tuning forks and pins and tests the level of sensory perception in certain parts of your body.
At this point, there wasn't a definitive diagnosis, but the theory was that I had MS. At this point, though, a diagnosis couldn't be made until a second episode.
(to be continued)
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