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Conditions and Diseases > Multiple Sclerosis Forum > Pernicious Anemia (PA) or MS?
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Q: Pernicious Anemia (PA) or MS?
asked by: DoctorQuestion on September 20th, 2006
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?

Thank you for your time.


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Dr. Nikola Gjuzelov , MD
replied on October 5th, 2006
Multiple Sclerosis Answer A1553
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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