Some things to consider when making a clinical diagnosis of MS

Here is My Question:
Does a clinical diagnosis for MS have to include dominant motor, as in a partial or complete paralyzed arm or leg? 

The reason I'm asking is my first attack 12 years ago left my legs feeling like walking on stilts from the knees down and my right hand weak with no sensation from hot coffee spilling on it; as well as dominant sensory and autonomic dysfunction.Yet all motor emg/ncs at that time were normal except for no reflexes from knees down. Recent 11 day stay in hospital, nothing fits of text book symptoms on cardio and internal medicine. Lumbar puncture noted 4 ocb in csf and not in serum, high levels of igg in csf and serum. low igg syn rate and low total protein.

MRI-small density lesion in the basal ganglia (radiologist noted possible existing tia) and mild nonspecific white matter disease in the setting of borderline volume loss with T2 scattered prolongation involving the periventricular and subcortical white matter of bilateral cerebral hemispheres; as well as tiny focus of subtle diffusion restriction in the left parasagittal ventral pontine belly. (radiologist noted possible small vessel in fact and chronic small vessel ischemia slightly advanced for age). Neurologist says it is unlikely MS due to not having partial arm or leg numbness. Positive snf, p.o.t.s, orthostatic intolerance and ocb. One treatment of ivig at hospital improved all symptoms and stopped cycling episodes of near syncope. 


Answer:
I am not sure if I completely understand your question but let me make some comments on your question. By the way, it is always useful for us to know your age but I will assume you are under 50 or relatively young based on the radiologists comments:

1. MS can cause all types of neurological symptoms including partial or complete paralysis of a limb or limbs. Of course it is far more common for MS to cause partial paralysis (weakness) of a limb than complete paralysis. I suspect the main concern is that your initial symptoms were severe and seemed to involve the central spinal cord (asymmetrically) above the level of T1. If nothing else happened until recently your neurologist probably feels that you experienced Transverse myelitis (longitudinally extensive or not) 12 years ago, not MS. It is impossible to know without the details of your evaluation 12 years ago.

2. EMG and Nerve conduction studies are almost always normal with spinal cord disease unless there is significant involvement of the anterior horn cells or ventral roots. This shouldn’t mean anything. Lack of reflexes can be caused by spinal shock  , also uncommon with MS and far more common with Transverse myelitis or a vascular problem in the spinal cord.

3. Oligoclonal bands in the CSF that are not in the serum is consistent with many things, not just MS. At the Mayo Clinic, they do not even call it abnormal unless you have more than 4 oligoclonal bands in the CSF.

4. The description of your MRI is of no use. Restricted diffusion can be seen with ischemia (stroke) or MS. The mere presence of restricted diffusion does not mean you have had a stroke or TIA. Only neurologists can make this diagnosis based on symptoms and examination in combination with MRI findings.

I hope this helps you.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Director of Hillcrest Neurology
Professor of Clinical Neurosciences
University of California San Diego