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What Causes Numbness In The Scalp And Lower Leg?
Question: Over the space of 3 years, I have had two separate attacks, the first where a large proportion of my scalp went numb and this lasted for approx 3 weeks. This time my lower right leg (but not foot or toes) is numb and has been for 2.5 weeks (and still is). My GP suspected MS and referred me to a neurologist, who, without meeting me stated that this was not indicative of MS and was the result of small cutaneous nerves that will resolve itself. I dont feel happy with this, as, as far as I can tell, I meet the first part of the McDonld criteria. My GP has referred me for a second opinion to a MS specialist. Is this enough evidence to warrant an MRI? And should I refuse to accept the first neurologists explanation (which came with no reasoned justification nor an explanation as to why he had apparantly not followed the NICE guidelines). He also described the numbness (3weeks) as "fleeting". Is this sufficient grounds on which to request an MRI and a consult with a MS specialist? Edited to add: my first attack was when I was 36, I am now 40year old. [female]
Brief Answer:
Neurological exam is necessary.
Detailed Answer:
Read your question carefully and I understand your concern.
Judging from the distribution of those symptoms it would seem not to be a characteristic distribution for a brain or spinal cord lesion, meaning doesn’t correspond to a specific area, neither the scalp numbness nor the leg sparing the foot and toes, usually the whole limb or half of the face and body are involved. Furthermore both episodes are with sensory symptoms. Such symptoms can be a part of MS, but are not the most common manifestation, usually symptoms such as double vision, vision loss, motor weakness of the limbs etc are the initial manifestation. So given that the likelihood of presenting with sensory symptoms is lower, the chances of that happening are even lower. For that reason I would not be that sure that those episodes constitute a relapse, I do not want you to over worry.
Now that being said I still do not agree with the approach of that neurologist. While I agree with him that symptoms are not typical for a relapse he should visit you and perform a neurological exam. At times on the exam there might be noticed new signs not seen by the patient which may indicate MS or some other neurological disorder. In MS because there are multiple lesions there are often found signs like increased reflexes, abnormal reflexes, coordination issues etc, symptoms which would prompt a MRI. Furthermore even if he thought it was a question of a peripheral nerve still that must be evaluated for the cause, and tests like nerve conduction studies or spine MRI may be necessary.
So I think you are justified in looking to be evaluated properly by a neurologist (not necessarily MS specialist), to check for neurological signs. If other signs are found then a MRI is certainly recommended.
I remain at your disposal for other questions.
Neurological exam is necessary.
Detailed Answer:
Read your question carefully and I understand your concern.
Judging from the distribution of those symptoms it would seem not to be a characteristic distribution for a brain or spinal cord lesion, meaning doesn’t correspond to a specific area, neither the scalp numbness nor the leg sparing the foot and toes, usually the whole limb or half of the face and body are involved. Furthermore both episodes are with sensory symptoms. Such symptoms can be a part of MS, but are not the most common manifestation, usually symptoms such as double vision, vision loss, motor weakness of the limbs etc are the initial manifestation. So given that the likelihood of presenting with sensory symptoms is lower, the chances of that happening are even lower. For that reason I would not be that sure that those episodes constitute a relapse, I do not want you to over worry.
Now that being said I still do not agree with the approach of that neurologist. While I agree with him that symptoms are not typical for a relapse he should visit you and perform a neurological exam. At times on the exam there might be noticed new signs not seen by the patient which may indicate MS or some other neurological disorder. In MS because there are multiple lesions there are often found signs like increased reflexes, abnormal reflexes, coordination issues etc, symptoms which would prompt a MRI. Furthermore even if he thought it was a question of a peripheral nerve still that must be evaluated for the cause, and tests like nerve conduction studies or spine MRI may be necessary.
So I think you are justified in looking to be evaluated properly by a neurologist (not necessarily MS specialist), to check for neurological signs. If other signs are found then a MRI is certainly recommended.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thankyou. What would you be advising as to the next steps. ie Which tests/consultations/assessment required now to move forward with firming up a diagnosis?
Brief Answer:
Read below
Detailed Answer:
Hello again!
My next step as I said would be to have a neurological consult, I mean a proper one with someone willing to perform a neurological exam.
It is based on history taking and physical exam that it is evaluated whether a central nervous system issue (like MS) which requires MRI is likely, or a peripheral nervous system issue which requires nerve conduction studies, blood tests, spine MRI is possible.
Or at times it may be concluded that there is no abnormal finding and given the lack of an anatomical correlation no test is needed at all, may be due to anxiety. But that should be said only after a complete exam.
Read below
Detailed Answer:
Hello again!
My next step as I said would be to have a neurological consult, I mean a proper one with someone willing to perform a neurological exam.
It is based on history taking and physical exam that it is evaluated whether a central nervous system issue (like MS) which requires MRI is likely, or a peripheral nervous system issue which requires nerve conduction studies, blood tests, spine MRI is possible.
Or at times it may be concluded that there is no abnormal finding and given the lack of an anatomical correlation no test is needed at all, may be due to anxiety. But that should be said only after a complete exam.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your very helpful answer.
I'd like to check whether the following have any bearing. I have Bipolar Disorder II and last year was diagnosed with Ehlers-Danlos type 3. I suffer with chronic fatigue which has been put down to the EDS.
Do either of these conditions have any relevance in the diagnosis/assessment/investigation of my current situation?
I'd like to check whether the following have any bearing. I have Bipolar Disorder II and last year was diagnosed with Ehlers-Danlos type 3. I suffer with chronic fatigue which has been put down to the EDS.
Do either of these conditions have any relevance in the diagnosis/assessment/investigation of my current situation?
Brief Answer:
Read below
Detailed Answer:
The Bipolar Disorder may explain why the neurologist was dismissive of your complaints, he must have attributed them to anxiety rather than a brain lesion. While having a diagnosis of bipolar disorder makes a psychological origin more likely he still should have conducted a neurological exam though as I said.
As for Ehlers-Danlos type 3, it is not related to MS. It does increase the likelihood of having joint issues which may in turn lead to nerve pinching. However it must correlate with the distribution of the numbness, whether it corresponds to a particular nerve root. Only if yes and there are symptoms like lowered reflexes should nerve conduction studies and imaging of the spine be conducted.
I hope to have been of help.
Read below
Detailed Answer:
The Bipolar Disorder may explain why the neurologist was dismissive of your complaints, he must have attributed them to anxiety rather than a brain lesion. While having a diagnosis of bipolar disorder makes a psychological origin more likely he still should have conducted a neurological exam though as I said.
As for Ehlers-Danlos type 3, it is not related to MS. It does increase the likelihood of having joint issues which may in turn lead to nerve pinching. However it must correlate with the distribution of the numbness, whether it corresponds to a particular nerve root. Only if yes and there are symptoms like lowered reflexes should nerve conduction studies and imaging of the spine be conducted.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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