February 04th, 2022

Here is My Question:
I developed foot numbness in 2019 and it went into my hands. Although they felt numb, I could still feel everything. I could still feel pain, cold, hot, etc. It’s 2022 and everything has cleared up except my fingertips which still have a dry feeling. I was diagnosed with MS by just MRI findings of brain and cervical. I later reviewed my own MRI of my cervical to find out I have cervical spondylosis, herniated disc and cervical kyphosis. I’m so confused because I thought spinal disorders must be ruled out before diagnosis. Cervical issues can cause the same symptoms and at times affect the brain as well.

I also had scoliosis surgery in 2006 ( hardware) and suffer from menstrual migraines. My doctor did not give me a spinal tap because of my hardware but my orthopedic suggested I get one.

Otherwise I feel normal and nothing has changed. I’m just wondering if I should get another work up or take the diagnosis? What do you suggest?

Answer:
Thanks for a wonderful question that gets right at the heart of MS diagnostic criteria. You are correct in your feeling that the rush to diagnosis is often inappropriate. Although I cannot say that about your case without seeing you in person and reviewing your case, I can make some useful comments that may help you.

A diagnosis of MS really requires several criteria to be met and that doesn't seem to be the case with you.

1. First, an individual must experience symptoms consistent with MS. That is a possibility in your case based on your description but certainly not definite. This is where a detailed history and expert examination is helpful
2. Second, you must have clinical findings of a multifocal process consistent with MS or an MRI scan meeting certain specificity criterion. This is called, "dissemination in space." Again, it is hard to make comments on your case without reviewing the scans. This MRI review should be done by someone with expert experience, either a neuroradiologist/neuroimager or an MS expert proficient in MR imaging.
3. Third, you must satisfy a concept referred to as, "dissemination in time". This can be satisfied in 3 ways: first, you can experience another problem or symptom affecting a different part of your central nervous system at a different point in time; second, your MRI must show both new and old MS appearing lesions involving different parts of the nervous symptoms. This criterion can be meet on your initial MRI scan if one or more lesion is enhancing or if a definite new lesion develops on a subsequent MRI scan; third, an examination of your spinal fluid showing the presence of oligoclonal bands allows you to satisfy the "dissemination in time" criterion. 
4. Fourth, other possible causes of your syndrome and findings must be excluded.  These other problems could include findings like cervical spondylosis with compression of the spinal cord.

I hope this helps you find the answers you need.

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego​