Pain and numbness

[Dagun]

I started to be numb in the right big toe July 2010, had been feeling more pain (than usualy) in my back, and the pain was going a little down the leg. Went to my doctor month later, feeling a litle pain here and there in my other leg also. She took a CT and said I have Spinal Stenosis, I went to learn some good exercises for the back, and got a little better. Then went on vacation for a weekend in october and walked alot. When I came home, I slowly got so much worse (after 1 week or so) at then I could not sit for a minute, this was just down the right leg. Then I was sent to a MRI and told that I had a Disc prolaps, so I think that this does maby not connect to the numbness. But at this time the numbness had been getting worse (more toes) and also on left foot. But this doctor said that I don't have a Spinal Stenosis! So then it took some time to be able to sit again (about 8-10weeks) without pain, so I did not want the surgery.
Since then I have been doing the exercises and on and of felt a litle pain here and there in my arms, at first I did not think of it. But 3 months ago I got this numbness in left hand fingers, first two of them and now it feels like all of them and the palm also. Then a litle later also in the right arm and also on and of pain here and there in both arms. One month ago I felt like I was starting to get this on the left side of my face also! And pain on the right side, first for nearly a day close to the eye, then a few days later close to the nose for few hours and then under my chin one day. Most of this pain is not sooo bad, but the numbness is maby more like "pins and needles" feeling when I touch it and most of the time I don't feel it sooo much, but it is always there. Month ago they took an MRI of my neck, and they saw nothing. Now I am waiting for an MRI of my head Jun 3. But is there anyone that regonizes this? Is there a nerves in my head that goes to the hands, legs and face?
Thank you so much for any advice!

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It is often difficult to diagnose herniated disc on CT. It is possible that the read was different between the two. A herniated disc can cause sensory changes as you describe in the leg to the toe. In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people ever require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muscle relaxants, and so on. These are best prescribed by an experienced physician, each has its own indications.

In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there is evidence that a nerve is being compressed on to the point that its function is impaired. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain.

One means of assessing whether or not the nerve being pressed on by your herniated disc is impaired is a test called an EMG/NCS which assesses how fast the nerve conducts electricity and how the muscle responds. This type of test is done by neurologists in most centers. It would be best for you to discuss surgical and non-surgical options with your physician.

The generalized numbness you are experiencing is difficult to comment on. Since it is migratory in nature (moving around) and including your head and hemi-body (left sided), I agree that an MRI of the brain would be useful. It is good that you have had an MRI of the cervical (i.e., neck) spine.

You should continue working with your physicians. If the MRI of the brain is within normal limits, you may have two processes occurring.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Dagun]

Thank you so much for taking the time to answer me :). I will then just try to wait calm after the MRI off my head to role out anything scary from there! I was also reading about Amyloid, and wondering if something like that could be doing something to my nerves?  

[Dagun]

I just want to add, that everything is still the same with my legs and toes, pain here and there, and the numbness in the toes are always there but sometimes better or worse. And now I often feel like it is all the way to the heel, from the toes. Please give me some ideas? Thank you!