Is This MS or Pulsatile Tinnitus?

Here is My Question:
I'm 49 and an English teacher. For months I have had trouble finding the right words to use, and several times I have arisen from my classroom chair to find no feeling in my right leg. I have pain behind my right eye and the sensation that there is a hand pressing on the right side of my scalp. It seems like my right eye doesn't open all the way. I have horrible fatigue. There is a sharp pain that I feel in my neck sometimes that I hate most of all. I can also hear my pulse in my right ear.

My children also say that I start sentences and don't finish them.  I am so afraid. I have an MRI MRA of my head and neck in three weeks. Am I wrong in thinking this is classic MS?

Answer:
It would be difficult for me or any neurologist to be certain of any particular diagnosis given the facts provided. However, I do have certain concerns after reading your description.

Pulsatile tinnitus (hearing one’s pulse in the ear) often has a specific vascular cause. This can include narrowing of carotid artery in the neck by atherosclerosis, traumatic dissection or fibromuscular dysplasia. A carotid dissection is an emergency and may be accompanied by neck pain (in your case on the right side) with drooping of the eyelid on the same side and unequal pupils (the right pupil being smaller than the left in your case). A carotid dissection under the correct circumstances does not require significant trauma. Other causes of pulsatile tinnitus may be serious as well, but less urgent.

If you have right sided neck pain, right sided pulsatile tinnitus and drooping of the right eyelid, I would suggest a more urgent evaluation than waiting three weeks. It is possible your doctor already thought of this diagnosis and obtained a  CT scan and CT angiogram. If this is the case then you can probably proceed with the evaluation as currently planned.

These are my thoughts given the little information provided; many of your other symptoms such as fatigue and word finding difficulty are non specific in nature and do no raise any immediate concerns. Similarly, the right leg falling asleep may have many causes. As doctors it is most important that we exclude any potential urgent and serious medical problems first and then proceed with less urgent evaluations . Please contact your physician with the concerns listed in this response. I would not be surprised if he or she has already thought of these possibilities and is proceeding with an appropriate evaluation, but it would not hurt to ask for further reassurance.

Revere (Rip) Kinkel MD
Director of the UCSD Multiple Sclerosis Center