For patients with MS, symptoms of stroke can easily be mistaken
When Michael Burns, 52, suffered a stroke in December 2012, his multiple sclerosis had been in remission for about eight years. Thinking his stroke symptoms were an MS attack, Burns didn’t get immediate medical attention, a mistake he said he hopes to help other people with MS avoid.
It started with a stomach virus. After severe vomiting, Burns said the muscles in his neck got painfully tight. Feeling horrible, he went to bed. When he woke, his left side was numb.
“Picture an imaginary vertical line that splits your body into two pieces,” he said. “The left side from the middle of torso, head to toe, everything was numb.”
He was also extremely fatigued and had tight muscles. About a decade earlier, Burns said, he’d had an MS attack that felt the same. This time, it was a stroke.
“The symptoms were identical,” he said. “I knew this was probably an MS attack.”
Burns was diagnosed with MS in 1997 and had about three attacks annually until aggressive treatment around 2002 put the disease into remission.
MS is a nervous system disease that causes damage to the myelin insulation around the nerves in the brain and spine. Burns compared myelin to the plastic coating around a speaker wire. Once damaged, the signals traveling through the wire, or nerves, get messed up.
That’s why MS can cause numbness, tingling, weakness, balance and coordination problems as well as muscle spasms and cramps, blurred or double vision, red-green color distortion or blindness.
During an attack some patients respond to steroids, but Burns has diabetes and the steroids also affect his blood sugar. It was one of the reasons he opted to wait to see if his symptoms improved.
Three days later, when he still couldn’t walk, his wife insisted he go to the ER.
There, an MRI revealed he’d had an ischemic stroke after a clot formed from a tear in an artery in his neck, which doctors think happened during a bout of violent vomiting. That clot went to his brain.
“I’m sitting there in shock,” said Burns. “Had I been aware of the stroke potential and had I been aware that the early symptoms are almost identical to early symptoms of an MS attack, I would have gotten to ER and insisted on an MRI.”
According to Steven Pugh, a neurologist at Providence MS Center, an MS attack can have similar symptoms to stroke, though this isn’t common because not all MS patients have stroke risk factors.
“The overlap is there because the brain tissue involved with either disease is the same. If you have an MS flare because of a new plaque in the visual pathways, you can get the same phenomenon with stroke,” he said, noting the difference in symptoms can be subtle.
“MS patients don’t normally have a complete loss of vision with an MS flare. It usually gets cloudy or loses color saturation. Stroke patients, on the other hand, will often have a complete loss of vision or half of both eyes,” said Pugh.
Additionally, Pugh said an MS flare often evolves over a few days; strokes are sudden and severe, with symptoms happening within minutes.
Regardless, anyone suffering strokelike symptoms should call 911 and get to an emergency room where they will perform an MRI.
“We use MRIs to detect stroke. Typically a new stroke looks very different on an MRI than MS lesions,” said Pugh, noting there’s a three-hour window to use clot dissolving drugs in the event of an ischemic stroke, with some benefit to patients who get the medication within six hours.
According to the National Institute of Neurological Disorders and Stroke website, patients who receive clot dissolving medication within 60 minutes of symptoms may prevent disability, and a five-year NINDS study showed that some patients who are treated within three hours are at least 30 percent more likely to have little or no disability three months later.
Still, about 600,000 new strokes are reported annually in the U.S. and it’s the third leading cause of death, as well as a leading cause of disability.
Pugh said the same healthy lifestyle that can reduce stroke risk also has implications for people with MS.
“MS patients need to be reminded if they have vascular risk factors associated with stroke, they are at higher risk of the MS getting worse as well,” said Pugh, adding that smokers are two to three times more likely to get MS than nonsmokers. The Swank diet – created by Dr. Roy Swank in the 1940s and said to reduce or prevent MS symptoms – is low in saturated fats and heart-healthy.
“I push lifestyle modification. Patients that have risk factors for stroke and heart disease, the MS doesn’t do as well over the long run,” he said.
Following that advice, Burns said he’s moved an exercise bike into the living room, although exercise is difficult with the long-term damage caused by the stroke, which he said was considered mild.
A year later he uses a brace on his left leg, with ongoing left-side weakness and numbness as well as balance problems and fatigue he didn’t have before the stroke. His MS is still in remission.
“I’ve had tons of MS attacks but I always got better. With this it’s way different. I won’t walk the same. My balance won’t be what it was,” Burns said. “If I can save one person with MS from going through what I’ve gone through this last year, that would be such a blessing.”