Symptoms: Is It Multiple Sclerosis or Spinal Issues?

Possible Multiple Sclerosis

Hello, doctor.
I am a patient with ulcerative colitis, which is currently under control, and my colonoscopy showed that the mucosa has healed.
I unexpectedly discovered a mild positive result in my cryoglobulin test after being diagnosed with COVID-19.
My main issue over the past couple of months has been pain and discomfort in my left shoulder, neck, and arm, sometimes accompanied by weakness.
Occasionally, my left thumb shakes, but it sometimes resolves on its own.
The symptoms are primarily on the left side, with only two instances occurring on the right side, which usually improve by the next day.
Additionally, I experience occasional lower back pain, and my left thigh, calf, and foot also have similar discomfort, predominantly on the left side.

Previously, I underwent an MRI of the cervical spine and X-rays of the lumbar spine, which indicated disc compression at C3-4-5-6 in the neck and at L3-4-5 in the lumbar region, with slight compression at S1 as well.
I am currently undergoing rehabilitation, and while my symptoms occasionally improve significantly, they sometimes return.
I would like to know if my symptoms are still related to cervical and lumbar spine issues, or if I should be concerned about the possibility of multiple sclerosis.

Zhe, 40~49 year old female. Ask Date: 2023/09/09

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
I believe there is a higher likelihood of cervical spine compression.
If you are concerned about multiple sclerosis, it would be advisable to have an evaluation by a neurologist.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is here to support you.

Reply Date: 2023/09/09

More Info

Understanding the symptoms you are experiencing is crucial, especially given your medical history of ulcerative colitis and the recent findings from your tests. Your symptoms, including left-sided shoulder, neck, and arm pain, occasional weakness, and tremors in your left thumb, alongside lower back and leg discomfort, can indeed be perplexing.
Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, leading to demyelination and a variety of neurological symptoms. Common symptoms of MS include fatigue, difficulty walking, numbness or tingling in the limbs, muscle weakness, and visual disturbances. The symptoms can vary widely among individuals and can sometimes mimic other conditions, making diagnosis challenging.

Given your history of cervical spine issues, including disc compression at the C3-4-5-6 levels, it is essential to consider whether your symptoms might be related to these spinal problems rather than MS. The cervical spine issues can lead to radiculopathy, where nerve roots are compressed, causing pain, weakness, or numbness in the arms and hands. The fact that your symptoms predominantly affect the left side of your body could suggest a specific nerve root involvement or a localized issue in the cervical spine.

The presence of mild cold agglutinin positivity in your blood tests could indicate an autoimmune component, but it does not definitively point to MS. Cold agglutinins can be associated with various conditions, including infections and other autoimmune disorders, but they are not specific to MS.

Your ongoing rehabilitation is a positive step, as physical therapy can help alleviate some of the discomfort associated with spinal issues. It is not uncommon for symptoms to fluctuate, with periods of improvement followed by exacerbations, especially in conditions involving nerve compression.

To determine whether your symptoms are primarily due to cervical and lumbar spine issues or if there is a possibility of MS, further evaluation is warranted. An MRI of the brain and cervical spine can help identify any demyelinating lesions characteristic of MS. Additionally, a thorough neurological examination by a specialist can provide more insights into your symptoms and help differentiate between MS and spinal-related issues.

In summary, while your symptoms could potentially be related to multiple sclerosis, they are more likely to be associated with your existing cervical and lumbar spine conditions, particularly given the findings from your previous imaging studies. It is essential to continue working closely with your healthcare providers, including neurologists and rehabilitation specialists, to monitor your symptoms and adjust your treatment plan as necessary. If you have concerns about MS, discussing these with your doctor and possibly pursuing further imaging or testing would be prudent.

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