Pernicious Anemia (PA) or MS? Posted: 09-20-06 11:37am
Am I experiencing symptoms of Pernicious
Anemia or could this be MS?
My first visit to a Neurologist was in
1998 when I awoke with tingling, numbness
and couldn’t support my right side.
Several test were ran including an MRI
which showed several lesions. They
didn’t tell me the exact location of the
lesions but the diagnosis from the tests
was “Possible MS”. However, when the
spinal tap showed up negative, they said
there was nothing more they could do for
me.
Through years I have experienced episodes
similar to the one of 1998 in which I
would see a doctor and they would say it
was my nerves and simply leave it at that.
Until 2001 one when a Gastroenterologist
noticed my B-12 was staying in a
low-normal range, never increasing and
sometimes dropping to the lowest level.
He ran a Schillings Test and found I was
missing the Intrinsic Factor. I was then
diagnosed with Pernicious Anemia and
started B-12 injections.
Since 2001 I have continued to have
episodes of weakness, tingling, numbness,
stinging, burning, in my right side and
recently noticed it in my left side. Also
within the last year I have noticed
additional symptoms that are getting
worse. They are:
I experience a Tingling, Burning,
sensation shooting down my back when my
head is bent down.
My R-leg is cramping severely at night.
This causes my leg to draw up and I
can’t straighten it out for quite a
while. Afterwards my leg continues to
cramp, is weak and makes it hard to walk.
Sometimes it is so weak my foot drags on
the floor. This has caused me to fall on
2 occasions. This does not happen every
night. I have had 3 episodes which ranged
in duration of 1 day to several weeks.
Several people including myself have
noticed that I now search for words while
talking. I can start a sentence and in
the middle I can’t think of the word to
say. Also, I am having trouble
remembering what I have done…especially
in the area of my medicines. This has
resulted in taking to many of one
medicine. This is especially scary.
I have finally be referred to another
Neurologist. Initially they wanted to
blow it off, however, after seeing I had
some of the symptoms once before they
scheduled me for another MRI. At this
time I do not have the results. I have
had 3 EMG tests with 2 indicating nerve
damage in my r-leg and r-arm. I have had
surgery on the ulnar nerve in my r-arm.
Cortisone injections in the r-side of my
neck, and r-ankle for inflamed nerves.
So with that said, am I experiencing
symptoms of Pernicious Anemia, or could
this be MS? If my symptoms point to MS,
should I push for another spinal tap?
According to your symptoms (tingling,
numbness, weakness, stinging, burning, leg
is cramping severely, hard to walk,
disturbed speaking and thinking…), the
MRI (indicating brain lesions), and
missing intrinsic factor…you may
experiencing both multiple sclerosis (MS)
and/or pernicious anemia (PA). Both
conditions can have similar neurological
symptoms because in both cases, the
myelins sheaths (covering) of the nerves
are damaged.
Multiple sclerosis is a neurological
autoimmune disease wherein the immune
system produces antibodies against the
myelin sheaths of the nerves. Anti-myelin
antibodies cause inflammation and damage
of the of the myelin sheaths - called
"demyelinization".
Pernicious anemia is also an autoimmune
disease. During this condition, the
immune system produces antibodies against
the intrinsic factor and parietal cells in
the stomach’s mucosa causing atrophic
gastritis. Intrinsic factor is very
important for absorption of the Vitamin
B12 in the intestines. Vitamin B12 has
very important role in the maturation of
the blood cells and the synthesis of
myelin sheaths. That’s why PA manifests
both neurological and anemic symptoms.
While MS has only neurological symptoms,
PA also includes symptoms of anemia
(weakness, tiredness) and gastrointestinal
symptoms (painful red tongue, nausea,
vomiting and diarrhea). Several
diagnostic procedures can be done to
exclude/confirm MS or PA:
1. MRI of the brain and spinal cord. In
both cases, demyelinization lesions can be
found in the brain and spinal cord;
2. EMG-shows conduction damage in the
peripheral nerves during PA;
3. Lumbar punition- anti-myelin antibodies
are found in the case of MS;
4. Blood work- In PA there is present:
low hemoglobin count, increased MCV,
reticulocytes are under 1%, large red
blood cell (macrocytes) in peripheral
blood, increased indirect bilirubin,
increased LDH, and increased serum iron
and increased feritin;
5. Bone marrow examination-
hyper-celularity with degenerative forms
of cells during PA;
6. Vitamin B12 level in blood – under
200ng/l in PA and normal in MS;
7. Folic acid level in blood – normal in
PA and MS but under 4ng/L in case of
megaloblastic anemia caused by lack of
folic acid;
8. Shilling-test- examines the absorption
of the Vitamin B12 in the intestines;
9. Detection of antibodies against
intrinsic factor in PA;
10. Stomach liquid examinations- pH=7 and
lack of intrinsic factor in PA, and
11. Gastric biopsy- atrophic gastritis
with intestinal metaplasion in PA.
You may consult a neurologist and a
hematologist for an expert opinion and to
make sure that all diagnostic procedures
are completed.
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