Question for Dr. Deshmukh

[biowham]

Hi, Dr. Deshmukh:

I've got a lot of actual, identified things that don't seem to form any comprehensible clinical picture, and I was wondering about your opinion. I'm 39, employed academic (science), three children, generally healthy, healthy lifestyle. B12, Sed rate, ANA, CNS analysis, all normal (borderline IgG ratio in CNS).

1. Brain lesions (see my avatar), per MRI
2. Paresthesias/numbness, right foot, right hand, not stocking glove
3. Paresthesias, left foot, kind of stocking distribution
4. EMG/NCT shows 50% or greater reduction in CMAP and SNAP amplitudes in right hand vs. left hand, medial and radial, slight increase in right hand vs. left in ulnar (forearm). All else (latencies, etc.) normal. Right leg, all normal.
5. Have two thoracic disc herniations (T6 and T8), compressing cord somewhat. Per MRI/CT.
6. Have one apparent arachnoid cyst compressing dorsal cord at T8, also, per MRI/CT. CT myelogram normal.
7. Have shocks across mandibular portion of trigeminal nerve.
8. Hyperrflexia in right lower extremity (4+) and upper right (3+, greater than left)
9. + Rombergs
10. Reduced two-pt discrmination right upper and lower; reduced vibration and positional sense, lower right extremity.
11. Notable weakness on right side (up and down).

I'm really confounding my neurologist, who has referred me to a neurosurgeon for the t-spine things.
What do you think?

Thanks,
E

[Abhijeet Deshmukh, MD]

Hello.

I guess the disc herniation has to be promptly treated. You could probably benefit more from a spine surgeon. I see one more cord compression happening 2 discs downwards from the one which is marked by the arrow. (I guess you have mentioned both)

As far as the brain MRI is concerned, these are some periventricular and some subcortical white matter lesions. Not sure if they are MS.

Do you have any significant history of the symptoms being brought on after anything (fever, etc.)?

IgG index is not specific for MS. Your symptoms are varied, which makes one think of MS. But all the other possible causes have to be ruled out. The upper limb symptoms and the jaw symptoms are not explained by the cord problem. Specifically, the vibration sense and the joint position sense nerve fibers are carried to the brain through the posterior part of the spinal cord (The dorsal column). It is probably not originating in the T6 and T8 compression, which is anterior.

I would like you to keep an eye on your symptoms. Do you have hypertension? The small peripheral lesions in the brain could also be due to small vessel disease or small tiny bleeds.

Regards  

[biowham]

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[biowham]

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[biowham]

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