Differential Diagnosis Without MRI?

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Gardenerforlife

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Hi everyone.

Thank you for being here. I’m hoping you may have some ideas.

I am a 56 year old woman and have always been active and in good shape. I have recently developed some troubling symptoms that could be from any number of things. Most notably, I have weakness in my left leg that has led to a few falls and a broken elbow. The weakness seems to be slowly getting worse so that stairs have become very difficult and I do not feel safe on them. Recently I’ve noticed some weakness in my right leg as well. The duration is about seven months since I first noticed.

I also have developed a tremor in my right hand. Things seem to feel heavier in that hand but I haven’t noticed anything I’d call weakness.

My doctor referred me to a neurologist. The neurologist did a pretty basic exam and noted slight foot drag on left foot, hyper reflexes in both legs, reduced strength in left leg, and reduced sensation in both lower legs. She diagnosed me with an essential tremor and peripheral neuropathy of unknown cause. She ordered a bunch of blood and urine tests and a cat scan with contrast, all of which came back as normal, and told me to come back in 4 months.

I know there are multiple things this could be, including MS, PD, ALS, spinal issues etc. My question is: how can I get to a diagnosis without an MRI? (I can’t have an MRI due to metal in my body in an old injury)? What tests should I push for when I see my neurologist again? Would an EMG be able to differentiate? Is a pet scan a reasonable alternative to an MRI?

Sorry this is so long. Thanks in advance for lending me your expertise.
 
An emg / ncs should be helpful yes. A PET scan might be helpful as well. CT can miss MS for example. You can ask for another opinion if you do not feel your current neurologist is addressing your needs
 
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