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Should I have a spinal tap?
Im a 46 yo female with a PMH of bilateral PTX secondary to congenital blebs with bilateral VATS (1999) and Right thoracotomy with RML bleb resection (2007), SA node ablation x2 (SVTs).
My primary MD recommended me to see a Neurologist and I do have an appointment tomorrow. She suggested that I will most likely have a lumbar puncture to obtain CSF for oligoclonal bands, EMG and evoked potential testing.
What led her to do this is because for the past year, I have had mononucleosis. It seemed that the symptoms disappeared at one point and then returned a few months later (my titers went up again), leaving me extremely fatigued, myalgia, night sweats, nausea (still have that on occasion and take Zofran for it), paresthesia left leg and bilateral feet, weird sensations such as hip feeling dislocated or knee caps being pulled, sensory altercations ie: goosebumps unilaterally on anterior aspect of thigh and back of calf although Im not cold, but the limb feels that way?, back pain, bone pain (sometimes), increased frequency of urination and rare incontinence.
I have had seen a neurologist in the past (3 years ago) for ataxia, memory problems and paresthesia. I thought it was from the postoperative narcotic use for thoracic pain sydrome that caused this. The PTPS dissipated and no longer on any narcotic. It took about 6 months for it to be manageable without any use of OTC or prescribed medications.
The MRI on Oct 2007:
Impression: Several small bilateral supratentorial white matter T2 hypersensitivities, varying in size 4-5mm. No mass effect or posterior fossa lesions are seen. Small lesions within the anterior aspect of the left centrum semiovale. Close clinical correlation is advised. Non specific finding in a patient this age, likely to inflammatory, traumatic or ischemic disease. Demyelination disease should be considered.
I had another MRI brain and spine done 8 months later with no change.
Recent MRI without contrast (Nov 8th)
Impression: Scattered punctate supratentorial white matter foci of abnormal signal. (It states there were scattered punctate foci of abnormal signal in the periventricular white matter (is this the same area?)
The only change is now I have new lesions in a different area that was not there on the previous MRIs.
I am asking if you feel that I should have the spinal tap or does this not really support ruling out MS? Would doing an EMG and/or evoked potential first be appropriate before spinal tap?
Can chronic fatigue syndrome cause this? Does EBV have any correlation with MS? Could it just still be EBV?
I forgot to mention that my cspine (anterior column marrow is heterogenous and cervical body signal is heterogenous) I have no idea what that means in radiology. A nonspecific finding or nothing at all? Or something?
C5-C6 tiny focal paracentral disc osteophyte complex
S2 - focus hypersensitivity significance unclear given the partial fat compression failure in this region, hemangioma is considered.
Mid thoracic vertebral body foci of hypersensitivity reflects hemangiomas.
Anyone with the time and patience to read this and respond would be greatly appreciated!
My primary MD recommended me to see a Neurologist and I do have an appointment tomorrow. She suggested that I will most likely have a lumbar puncture to obtain CSF for oligoclonal bands, EMG and evoked potential testing.
What led her to do this is because for the past year, I have had mononucleosis. It seemed that the symptoms disappeared at one point and then returned a few months later (my titers went up again), leaving me extremely fatigued, myalgia, night sweats, nausea (still have that on occasion and take Zofran for it), paresthesia left leg and bilateral feet, weird sensations such as hip feeling dislocated or knee caps being pulled, sensory altercations ie: goosebumps unilaterally on anterior aspect of thigh and back of calf although Im not cold, but the limb feels that way?, back pain, bone pain (sometimes), increased frequency of urination and rare incontinence.
I have had seen a neurologist in the past (3 years ago) for ataxia, memory problems and paresthesia. I thought it was from the postoperative narcotic use for thoracic pain sydrome that caused this. The PTPS dissipated and no longer on any narcotic. It took about 6 months for it to be manageable without any use of OTC or prescribed medications.
The MRI on Oct 2007:
Impression: Several small bilateral supratentorial white matter T2 hypersensitivities, varying in size 4-5mm. No mass effect or posterior fossa lesions are seen. Small lesions within the anterior aspect of the left centrum semiovale. Close clinical correlation is advised. Non specific finding in a patient this age, likely to inflammatory, traumatic or ischemic disease. Demyelination disease should be considered.
I had another MRI brain and spine done 8 months later with no change.
Recent MRI without contrast (Nov 8th)
Impression: Scattered punctate supratentorial white matter foci of abnormal signal. (It states there were scattered punctate foci of abnormal signal in the periventricular white matter (is this the same area?)
The only change is now I have new lesions in a different area that was not there on the previous MRIs.
I am asking if you feel that I should have the spinal tap or does this not really support ruling out MS? Would doing an EMG and/or evoked potential first be appropriate before spinal tap?
Can chronic fatigue syndrome cause this? Does EBV have any correlation with MS? Could it just still be EBV?
I forgot to mention that my cspine (anterior column marrow is heterogenous and cervical body signal is heterogenous) I have no idea what that means in radiology. A nonspecific finding or nothing at all? Or something?
C5-C6 tiny focal paracentral disc osteophyte complex
S2 - focus hypersensitivity significance unclear given the partial fat compression failure in this region, hemangioma is considered.
Mid thoracic vertebral body foci of hypersensitivity reflects hemangiomas.
Anyone with the time and patience to read this and respond would be greatly appreciated!
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