Contusion, MS, tumour?? Help!

[Carol-S]

Hi everyone, sorry for the long post but I am having tons of anxiety and would love to hear from a SCI nurse or Dr Young.

I am 39F and in early august I tripped and fell, landing on my knees, didn’t break my fall and felt my head whip forward. Later that afternoon the tips of the last three fingers on my left hand went numb. Over the next several days the numbness travelled to include the whole finger (left hand, last three), half left palm, part of left outside lower arm, left low back, whole abdomen, left leg, tip of right ring finger and inner right thigh. I had abdominal banding and spasticity in my left thigh.

Went to ER and was scheduled for a MRI to look for demyelinating disease due to numbness. There was no mention of my fall or the symptoms starting immediately after.

First MRI radiologist report said “centrally in the cervical cord there is an expansile T2 hyper intense lesion located at C6-7. It is intramedullary.” The diagnosis was a neoplastic tumour. Was recalled for MRI with contrast. Second MRI report stated “lesion demonstrates heterogenous central enhancement involving mainly the left hemicord at C6”. Based on this MRI the differential diagnosis list included TM/MS, ADEM, NMO.

Met with a neuro a week later who thinks I likely have a contusion caused by falling. Had a follow up MRI in November that showed the lesion had shrunk a bit, wasn’t as enhancing or as expansile. Radiologist report now stated “previously documented cord lesion is smaller. Given the history of previous trauma, this could have represented a contusion that is healing. Differential diagnosis is resolving MS, TM, ADEM.”

As for my symptoms, the initial numbness slowly faded, it took longer for my left hand to become functional. I eventually developed tingling and internal buzzing that would get worse if I put my chin to my chest. Thankfully the buzzing has gone away and the tingling is almost gone but tends to get worse if I am tired, cold, etc. I am getting physically better, but mentally I am a mess because no one has been able to conclusively tell me this isn’t cancer. Any help or comments would very much be appreciated. Thanks

[Bonnette]

Carol, I've had MS for a long time with several lesions in my cervical cord, and I can tell you from experience that falls such as you had can cause exactly the symptoms and MRI results you describe. It has taken years of observation and repeated MRIs to tease out what is MS-related, and what is due to nerve damage from whiplash-type injuries from falls (coupled with "jamming" caused by trying to break falls with my hands). It takes a long, long time for cord contusions to heal, and not all symptoms resolve completely.

I am not a doctor, but given your history of being asymptomatic prior to the fall, it seems to me that cancer would be low on the list of possible causes for your symptoms. Cord lesions seen on MRI are not always characteristic of specific conditions, and furthermore, your second MRI showed that the lesion had diminished in size, which is not what one would expect to see with malignancy.

Demyelinating diseases are very hard to distinguish from one another, and it can take years to go through a diagnostic process whereby each one is ruled out. MRI of the brain and cord, plus lumbar puncture and blood tests to exclude Lyme disease and some other conditions, are usually recommended as the place to begin, especially when MS is suspected. If worry about this is making you a nervous wreck, do discuss these diagnostic procedures with your primary physician and/or a neurologist.

Your fall could have been the first sign of a neurological issue, followed by traumatic symptoms caused by the fall itself. But you would need more tests in order to get closer to specificity. Since the doctors who treated you and read your MRIs did not mention malignancy in their differential diagnoses, it is unlikely that this was one of their concerns. But in order to differentiate cord contusion from ADEM, TM, MS or NMO, more tests will be needed - along with the "tincture of time" and observation.

[Carol-S]

Hi Bonnette,

Thank you so much for your reply and reassuring words.

My primary neuro said the lesion is likely a contusion but would send me to a neurosurgeon to get his opinion. The neurosurgeon basically said “don’t know what this is - could be contusion, MS or tumour, just wait and see”. From there I saw a MS specialist who said the lesion is probably, most definitely not cancer, he was actually very upset that the radiologist wasn’t told of my fall and symptom on-set and said that cancer never should have been mentioned to me. He was an awesome doctor! He did say I could have experienced a first MS attack, but he felt it was most likely a contusion. He didn’t even want to do a lumbar puncture because my brain imaging was clear. His plan is to do a repeat MRI in September. I know a MS diagnosis takes time - sometimes years and I am ok with that.

What is driving me nuts is the wishy-washy answers I am getting from my primary neuro and the neurosurgeon about a cancerous tumour. When I step back and look at things objectively, I know that cancerous tumours don’t magically shrink, like my most recent MRI shows, but I am finding it hard to remember that fact, especially since I am not getting a yes or no from my neuro. Sorry for the stream of consciousness lol!

[Bonnette]

Carol, in your shoes I would trust the MS specialist. There is no reason to panic, and the C word should never have come up - I am pretty sure that the only reason it did, is that your primary care physician and the neurosurgeon wanted to cover themselves - hence their wishy-washiness. Also, doctors sometimes run generic mental checklists and think out loud, not realizing or even considering the horrific impact their words have on patients who are already scared to death.

You will almost never get a clear-cut "yes" or "no" from a neurologist. I actually had a neurologist tell me that some of my questions could only be answered at autopsy! Fortunately, I have a dry sense of humor.

Your MS specialist sounds realistic, practical, experienced and well grounded in facts. The big tip-off that he doesn't think you're in danger is the fact that he doesn't think you need a lumbar puncture at this point, and your brain imaging is clear. He knows that, much as you'd like answers, they won't come quickly. His treatment and evaluation plan sound eminently sensible to me.