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.
