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A question about neuro exam

I have been puzzling over this and cannot find any info anywhere. In the time between episodes is it possible to show normal reflexes in tests if it is MS. I’m just wondering because by the time I saw the neuro last week my latest episode had ended. If she had asked me to do the various things a couple of weeks earlier I would have had great difficulty? x

Yes, I did really well when I had reflex tests but I wasn’t relapsing then. Didn’t stop them diagnosing me with MS that same appointment!

I don’t think I’d do so well now, and at times this year it would have been quite a lot worse. MS varies so much.

I think that is a weakness with neuro exams, by the time we’ve waited months to be seen by a neuro the symptoms may have gone in to remission. But I can’t back that up with a reference. However, there is the Relapse - Remission mode of MS. Also there is neuroplasticity where CNS damage (brain mostly) is compensated for.

As to whether it is possible to show normal reflexes in tests. if it is MS: I was dx with MS based on Optic Neuritis (ON) and nystagmus (possibly other things too) but with normal reflexes.

The MRI signs of lesions do not fade quickly (at least usually - Karen might have covered this in her sticky post at the top of the forum). My symptoms were less by the time of my neurological exam and I had an MRI scan a month after that. Nevertheles, the scan did show lesions - though they might have been even older I guess.

Thanks both of you. My last episode lasted in total about 4 months. Basically the whole time I’d been waiting for my appt. It was just typical I seemed to have come out of it a couple of weeks ago! I was just curious as she was unable to give an explanation for falling sideways with my eyes closed , or rather, just dismissed it! When I saw my GP in May my knee reflex was brisk but she said it was normal when the she did it. I shall have to wait and see what my MRI shows when I have it xx

Hi if you have brisk knee reflexes then it is due to a problem on the spinal cord. I think once brisk they will always be brisk. Your GP might have thought them brisk but they are might not have been. I have seen too neuros and in my opinion reflexes were the same but one thought them to be brisk but the other didn’t.

Moyna xxx

Hi Moyna, I’m not sure how my neuro could say they were normal as my legs were nearly completely flat on the bed when she tested them. When the GP tested I almost got her as the leg flew up. Have never known my reflex to be like that. I think it surprised her and me :slight_smile: xx

And I had brisk knee reflexes at my neuro exam and told that was anxiety! You can’t win lol

No you definitely can’t. I’m so hoping you have better luck with the next neuro xx

Seems to me that the neuro exam is only sometimes significant - mine was normal (symptoms had mainly abated by the time of it) but was still referred for MRI bloods etc so I’m not sure you should worry too much about whether the basic neuro test shows anything much. HTH Cx

Me too Sharon not long to go x Have you had a date for anymore tests?

Thanks Clare, I’m not too worried. What will be will be. Like I say, I’m just curious.

Arwen, no I haven’t heard yet x

Tell them that’s flipping rubbish Arwen! Stress & anxiety can not cause brisk reflexes! My neurosurgeon laughed at me when I suggested it!! xxjenxxx

Really Jen? My optician report saying I had a nystagmus due to neuro cause got ignored too. Luckily got appt to see a different neuro soon

A x

They do like saying that you’re anxious. What do they expect when you’re sat in a hospital being examined? Are we all supposed to be so laid back we’re comatose! Sorry, forgot, then we would be told that our symptoms aren’t bothering us!! x

Gosh they do love this anxiety get out clause don’t they!? it seems that almost everyone who sees a neuro is initially told they are depressed or anxious or suffering from stress. I defy them to walk a day in our shoes and not become just a little bit anxious because we are not taken seriously. grrrrrrrrr

Eww! Yes - It really annoys me when they emphatically state that someone’s set of symptoms are down to anxiety or depression when they haven’t done all the tests to rule everything out!!!

Many many moons ago when I was a trainee nurse - we were taught that if someone complained of something then the serious possibles need to be ruled out first - e.g if someone complained of severe headaches - before diagnosing migraine they would do tests to rule out stroke/tumour etc or if someone complained of bowel problems like alternating constipation and diarrhoea they would rule out cancer etc before diagnosing IBS!!

In fact I’ve been so desperate to blame things on something ‘simple’ like anxiety, stress, depression or the menopause I’ve been pushing it with every doc I’ve seen!! It’s literally been ‘hi doc - look I’m stressed with work and I think it’s that??’ or ‘I’m menopausal I really think it’s that?!!’ lol - and in all fairness every one of them has replied ‘erm nope!!’

Brisk reflexes or hypereflexia is a clinical sign of something physically wrong - whether that’s in the spine or brain - ok if it’s not accompanied by other clinical signs or if it’s mild or if it’s both sides it’s less likely to be something serious - but nevertheless if it’s persistent then it still needs investigating!

And yes we all know that anxiety & stress can exacerbate neurological symptoms/signs but only to a certain extent!

Sharon re changes during remissions - with me over the months I was very ill all my neuro exams were very abnormal - every time my GPs did them , or the Endocrinologist I saw - or with the Orthospinal, Neurospinal, Neurosurgeon & Neurologist!

I had hypereflexia with myoclonus +++ on the right with upturning toes (Babinski) with totally absent reflexes on the left.

In between relapses eg I saw the neuro a couple of weeks ago they have been much less abnormal (except for the Babinski response - that was still there) I asked if the difference is because I’m much better now & he said yes - that can very well happen.

xxxjenxxx

It is certainly annoying to be told its anxiety as I wasn’t anxious until I started falling over, forgetting words, had burning pains, crawling sensation, urge incontinence and 2 episodes of bed wetting (embarrassing). And then I get told no point mri cos if it shows anything I’d just be more anxious! ! I think what maybe went against me is I have medical knowledge and neuro problems in the family on maternal and paternal side so they start asking what my concerns are that it may be and anything I said from then on meant iwas dwelling on it. Tbh I still hope its a vit prob as my first b12 level was low and repeat was only just in normal range A

I have hyper-reflexia in my legs because the lesions I have are on my spine, not my brain. All my other reflexes are normal. I was still diagnosed with MS though.