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tazechip
tazechip, Board Certified MD
Category: Neurology
Satisfied Customers: 26825
Experience:  Board certified in Critical Care Medicine
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Hello Dr, I have recently been having a huge range of symptoms

Customer Question

Hello Dr,

I have recently been having a huge range of symptoms which I won't go into just yet, because they are so varied, I decided to go for a Full MRI on Brain and Spine to put my mind at ease and received the following results, I haven't been able to discuss the results with a Dr yet because of the Christmas period, however the radiologist emailed over the report which I would like to be deciphered and explained to me please:

MRI Brain
No focal parenchymal lesion seen. There is no evidence of restricted diffusion.
No intra or extra axial haematoma seen.
There is no ventricular dilatation.
Normal signal void is seen in the major arteries and venous sinuses.
The midline structures are normal.
No abnormal meningeal thickening or enhancement seen.
Maxillary mucus retention cysts are seen.

MRI Whole Spine
There is moderate spondylotic change within the mid / lower cervical spine.
On the axial imaging, there is no cord impingement or exit foraminal narrowing.
Vertebral body height, MR signal and alignment is preserved throughout the cervical,
thoracic and lumbar spine.
A small vertebral body haemangioma is seen at L3. No cord lesion is seen.
At L5/S1, there is mild discal degeneration with mild left paracentral disc bulge with mild narrowing of the left lateral recess of the left S1 nerve root. Mild bilateral facet joints areseen at the same level.

Conclusion:
No intracranial abnormality.
Degenerative changes within the cervical spine and at L5/S1 with mild narrowing of the left lateral recess.

My Symptoms are (shortened version):
6 weeks ago noticed slight tingling in left foot and hand. Ignored it at the time.
Tingling gets worse when putting pressure in that area or for example raising my arm above my head brings on the tingling in my hand much quicker than would seem normal. That didn't cause me too much alarm, it's only when I look back I can remember how it started :)

After that I noticed my legs were throbbing, calf in particular, but also my hamstring area. I noticed my legs muscles in particular were twitching, seen more easily at rest! This was my first complaint! I noticed I felt a little weaker and felt when I got out of bed my legs felt extremely tight. I couldn't see any swelling! After a little walking the stiffness isn't so bad, but gradually through the day it gets a little worse. At night I notice when going down stairs my quads are trembling. This started about 6 weeks ago.

Fast forward to today, I can't see any noticeable muscle wasting in my legs which i'm relieved about, however I've lost maybe 3 or 4 lbs of weight which I can't afford to lose (not feeling as hungry). I'm only 10 stone 5 today, 5 foot 10. I have noticed arm trembling and reduced strength (in the same fashion as my legs), particularly when it comes to stamina. E.g holding my arm out on the gear stick in the car results in pain in my bicep. This used to be very comfortable for me, but now I can feel some slight pain. I've also noticed the day after a party, my right arm will be sore because I have been drinking and bringing the bottle/glass to my mouth to drink. I would compare it to rsi, that's probably the best way to describe it. The feel is similar to dead arm, as if there is no blood in the muscle, there is no loss of sensation or pins/needles when this happes.

My other symptoms of today (back to my legs), I still have pain in my calfs and back of legs, but I have learnt how to keep it to a minimum. By resting more than normal, not crossing my legs, not sitting on my legs helps greatly. However if I cross my legs or for example when lying on the sofa leaning on my left arm with my right leg on top of my left leg with my knees flexed inwards to the point where my heels are about 30cm from my back-side, this is a very normal and quite relaxing position to be in for me, as it is for many people I would suspect, however the more my calfs touch my upper-back leg area (hamstring area) the more pain I feel in those muscles and for the last 2 weeks or so the pain has gone up a level the the muscle behind my knee. From memory its called the popliteus muscle. This muscle behind my knee is been clicking slightly from push off, when you feel it, there doesn't feel anything obviously wrong which is annoying, the only way I can describe it is when my leg is fully extending it feels like a cord in my leg is rubbing and popping back and to, it doesn't happen in every stride! In fact after a few minutes of walking it stops. This is more in my left leg, but I suspect its a matter of time before I also get it in my right leg. I also suspect I've got it in my left leg first because it's my weaker leg. If I try to ignore it and get on with life as I have been trying to do, then I pay for it the next day. The stiffness is greatly increased!

Running out of characters now, however my other symptoms are slight facial numbness, difficulty swallowing, but no actual choking.
Submitted: 2 years ago.
Category: Neurology
Expert:  tazechip replied 2 years ago.
Hi--did you have a screen for autoimmune disorders and were your thyroid functions checked? What about a check of your cortisol levels?
Customer: replied 2 years ago.

Hi,

I don't know if I have been screened for autoimmune disorders, is there a specific blood test? I'm guessing this is looking for antibodies?

Looking at my blood test papers I can see the thyroid was tested:
Serum TSH Level: 2.77 mU/L


Serum free T4 level: 19.1 pmol/L

would those two results indicate normal thyroid?

I have other blood test results such as: ESR is 2mm/h
HbA1c 30mmol/mol
GFR 86 mL/min/1.73m2
Serum Bilirubin 18 umol/L
Serum ALT level 12 U/L
Gamma GT 12 U/L
B12 510 ng/L



There are some other blood test related to blood count and minerals, which all says normal accept the mean platelet volume which is 7.3fl normal range being 7.4 - 11. fl.

I have no idea if I've been tested for cortisol levels. There doesn't appear to be anything on the blood work papers mentioning cortisol, unless it has some other name?

Expert:  tazechip replied 2 years ago.
Sorry for the delay. An autoimmune screen would include a sed rate, antinuclear antibody titer, rheumatoid factor titer, and C reactive protein
Customer: replied 2 years ago.

Sed rate is ESR, right? You can see my answer to ESR in my previous reply.

I can't see the word protein anywhere on the blood work sheet, so it appears as though I haven't had AAT, RFT or CRP blood work. Are these the correct acronyms? As I will be asking for these asap from my GP

I'm assuming the creatine kinase, magnesium levels, electrolytes and serums are of no help here?


Expert:  tazechip replied 2 years ago.
Just ANA and RF but I don't think you had them done. What were your magnesium levels?
Customer: replied 2 years ago.

serum magnesium is 0.94mmol/L

Expert:  tazechip replied 2 years ago.
OK Gareth--one other question--did your doctor discuss his thoughts with you as to what was going on?
Customer: replied 2 years ago.

No. My G.P is a lovely man, but he said he is satisfied with the current blood tests. I asked him for a referral to a neurologist, which he said was ok, however I went private to speed up the process rather than waiting the standard 12 weeks (uk).

Neurologist I seen Dr UC Weishmann, who I seen about 3 weeks into my symptoms said I was fine after doing some basic strength tests and and tested my reflexes. He advised me to try a book on cognitive behaviour, I was very emotional at the time, he said he didn't think it was MS or ALS. The muscle spasms at the time of the appointment weren't happening, which is bad luck I suppose. He asked me if I can see the spasms, I said yes, I've even noticed my laptop move on my lap, almost like an electric shock reaction.

I asked the neurologist for tests, but he isn't interested. I decided to take a trip to London and ordered myself a full MRI, as per the above results. I haven't shown these results to him yet.

G.P suggested to take the beta blockers for a month and see how I feel after that. When I described the pain behind my knee to the G.P he said it could be hyper-extension purely on what I was explaining.

As I lie here on the sofa relaxing, I feel this bubbling sensation which is happening in my calves and thighs and other various places in my legs. If I rest my legs on top of each other I feel as if I'm not allowing my leg muscles to contract which is what might be causing the pain. I'm guessing here. This isn't just reserved to my legs, but the legs gets the twitching the most because they are used more than my arms and face etc. Yesterday I did a cheeky wink to my girlfriend and for the next hour or so could feel mild spasms around my eye socket muscles. It's so strange!

I've also noticed strange spams in the back of my neck brought on by looking upwards. When I look up to the point of feeling the skin ripples on the back of my neck and then relax my neck downwards again, those muscles that were just use contract 2 or 3 times (very fast spasms). I've not had that for a few days, but I just thought it was worth mentioning.


 


In my mind this is either neurological, muscle wasting or some sort of Arthritis. Other things I've noticed are my knees from the front go a very deep red almost purple when I stand for say 15 minutes+ and the top of my feet. I first noticed this a couple of years ago and just put it down to sunburn at the time, but I suppose this could just be normal. This doesn't bother me in the slightest but it could be apart of the puzzle.


 


My biggest concern is that I'm deteriorating, and these muscle spams are a sign of a more serious condition. I want to believe its blood / circulatory related because crossing my legs etc seems to bring on the pain as if the muscles are being starved of blood.

My legs are happiest when i'm sitting down, either in a normal sitting position or when my legs are slightly bent. If I fully straighten my legs even when in bed its slightly uncomfortable and the spams are felt more. Maybe this is just because I'm not stretching the muscle out and it feels less stress when its not having to work so hard at a more shortened and relaxed state.


Emotionally I feel slightly better than I did, not sure why, almost acceptance I guess, however I know this is getting worse and I feel it's my duty to not give up and find the answers even in the face of the Dr's telling me the contrary, very frustrating though. Thanks

Expert:  tazechip replied 2 years ago.
I understand Gareth and we can continue beyond this if you need. I think you need to see a rheumatologist at this point. My two thoughts are an autoimmune disorder like lupus or polymyalgia rheumatica, or fibromyalgia. I agree not MS or ALS and it looks as though your blood work so far doesn't indicate anything amiss. Some of this could indeed be anxiety but only so far as it can aggravate the symptoms you have had.
Customer: replied 2 years ago.

I think seeing a rheumatologist is a reasonable suggestion. As well as lupus do you think it could be lyme too?

My other symptom which I thought is strange, I seem to be going the toilet(bowel movement) once or twice per day, this might seem normal for most people, but I've also been a twice or 3 times per WEEK man. I know it's healthy to pass everyday, but the exact time my problems started I have been having bowel movent X2 or X3 as often as i used to.


Expert:  tazechip replied 2 years ago.
Lyme would be very unlikely here Gareth, but a simple blood test would check for that. I don't think your change in bowel movements is at all related here and nothing really to worry about. Please let me know how it goes and remember to rate my service to you
Customer: replied 2 years ago.

Ok thanks. Let's finish up here, however before I do, I still need the original question answering regarding the MRI. I want to understand what those problems are. Please give the maximum amount of detail.

Expert:  tazechip replied 2 years ago.
No problem. The brain MRI is normal. As for the spine there's some arthritic changes in the neck and there's a bulging disk but since it isn't affecting either a nerve root or the spinal cord it can't be responsible for your symptoms, and neither can the changes seen in your cervical spine
Customer: replied 2 years ago.

OK, when I copy and pasted the various parts of the report into google the closest match was this link http://www.spinal-foundation.org/Conditions/Lateral-Recess-Stenosis

When I read it, it felt exactly what I thought was happening to me. Almost as if I had wrote it about myself, what do you think about that?

Expert:  tazechip replied 2 years ago.
Your lateral recess problem is mild and only on the left so it wouldn't affect both legs and isn't affecting the nerve roots or the spinal cord. Also you've had that for quite some time so it wouldn't just now be announcing itself. Also, nothing it the lumbar spine would give symptoms in the arms

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