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.
DISCLAIMER:
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