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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5218
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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How common is it to have Ms with lhermittes, intermittent

Resolved Question:

Hi
How common is it to have Ms with lhermittes, intermittent foot burning and stiff painful legs
But with normal neuro exam and clear brain and cervical spine mris?
Could these symptoms if not Ms be caused by bulging discs at c3/4 c4/5 c6/7
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Bob replied 1 year ago.
Hello. L'Hermitte's is a non-specific symptom. It is most commonly encountered in cervical spinal cord demyelination caused by MS but has been found in many other conditions as well, especially those that cause a traumatic or compressive cervical myelopathy. The list includes cervical spondylosis (possibly with bulging discs in the upper cervical cord) and epidural, subdural, and intraparenchymatous tumours. It has also been reported infrequently in radiation myelitis, pernicious anaemia, pyridoxine (B6) toxicity, nitrous oxide misuse, cisplatin and docetaxel neuropathies, cervical herpes zoster myelitis, paroxetine withdrawal, Behçet’s disease, and systemic lupus erythematosus. If you have this sign then your neuro exam is not normal, technically. While unusual, a diagnosis of MS can be made clinically even in the absence of plaques on MRI. Did you also have a normal spinal tap?
Customer: replied 1 year ago.
Hi
The lhwrmittes sign is gone now and I thknn be user it's subjextive they won't consider it, all reflexes cerebral tests were normal which is what they mean with a normal neuro exam I think
The lhermittes also only ever went down my left arm never moved to anywhere else
I've had three mris since January and three neuro exams, spinal tap was only done today
Could the bulging diacs at c3/4 c4/5 c6/7 cause the lhermittes and the tingking plus burning in feet and leg pains?
Expert:  Dr. Bob replied 1 year ago.
Hi Kri. I think you're thinking about this the right way. L'hermitte's is considered a "soft" sign, particularly when it comes and goes, so it is not always helpful in this type of situation. If the radiation is into the left arm, this would suggest a radiculopathy (pressure on a cervical nerve root), which certainly could be from a herniated nucleus pulposus (slipped disc). This should have shown up on cervical MRI. If suspicion is high, you can get nerve conduction tests done that will tell you if there is a nerve problem going into the arm. If they do all 4 limbs the tests might shed some light on the burning pain in the legs and feet. If not from spinal or neuroforaminal stenosis, you would want to rule out a peripheral neuropathy.
Customer: replied 1 year ago.
Hi
The neurologist has said he is going to order one of those asap, it's all
Done privately not nhs so It tends to speed things up too
My concern has been progressive MS, I worry about this because of the tight stiff legs. Would the fact that some symptkms have remitted completely and others partially, suggest that if it was Ms it's not ppms?
Also the discs are all bulging none herniated, on the mri you can see them pushing into the cord, also he showed me overhead views of the mri where at one level in particular it looked to be impacting the cord a lot, he also said it was impacting right in the middle of the cord which is unusual, as it tends to be one side or the other.
Would this lend more weight to the discs being a possible cause?
Expert:  Dr. Bob replied 1 year ago.
Yes, the relapsing-remitting form (RRMS) is the most common, though it typically transitions to SPMS over time. The PPMS form is much less common.
Hard to say about the discs. When one is pressing on the middle of the cord, there is an increased chance of a central cord syndrome in which injury or sudden strain on the neck can cause the cord to get pinched temporarily.
This puts the maximum force on the center of the cord where the fibers from the arms ascend up the cord to the brain. The arms are therefore more involved than the legs (whose fibers travel up the outer portion of the cord.)
This would only be an issue if there were a history of trauma or injury of some sort to the neck.
Customer: replied 1 year ago.
Hi thanks
I know about the percentages of the different types etc
But at the same time I'm asking with regards ***** ***** sympotoms I have had not a generic percentage. Can stiff tight legs spasticity be common in the early stages of RRMS?
I have have had 3 big car accidents in ten years 2 over 70mph into fixed objects, so I would assume this could cause this
Also I am yet to have the lumber spine mrid but have pain on extension in he lumbar spine, only at the site of the spinr? Could this be pain from an Ms lesion or disc issue? What is the more common lumbar or cervical disc bulges?
Customer: replied 1 year ago.
Is there going to be an additional answer or is that it?
Customer: replied 1 year ago.
Is there going to be a answer to me reply if not please let me knoow
Expert:  Dr. Bob replied 1 year ago.
Hi Kri. Had to go offline for awhile.
Can stiff tight legs spasticity be common in the early stages of RRMS? YES, absolutely, though it is more likely to be in one leg at a time.
I have have had 3 big car accidents in ten years 2 over 70mph into fixed objects, so I would assume this could cause this. YES, it could.
Also I am yet to have the lumber spine mrid but have pain on extension in he lumbar spine, only at the site of the spinr? Could this be pain from an Ms lesion or disc issue? NOT MS, possibly from a disc.
What is the more common lumbar or cervical disc bulges? LUMBAR > CERVICAL
Customer: replied 1 year ago.
Hi Bob
Thabkyou, I wake up most days with extreme pain in my leg muscles from hamstring to Calf they feel tight and with a pinching type pain
I assume this cannot be caused by a disc issue? I thought it was more commonly numbness etc? I will arrange an mri asap of the lumbar area
The pain in the lumbar spine you think is more likelu to be a disc?
And sorry also the pain is in both legs I was told more common one or the other that is what has worried me the most really, although as I said it's been 4 weeks so far so it may go away if it is Ms
I do hope it is from a disc or spinal issue
Customer: replied 1 year ago.
Hi Bob
Sorry I mean in the middle of my back which I assume is thoracic and not lumbar so unlikely to be a disc issue? Is that correct, it's only a bit above halfway up my back
Customer: replied 1 year ago.
Hi Bob
I have an MRI next week of lumbar and thoracic
Also one more question and I'll close the question, I have been lying on sofa today after the Lp to stop headache etc and the leg pains are worse and are up in my buttocks too both sides, would this suggest a structural problem is more likely than Ms ? Or can Ms do this too?
Expert:  Dr. Bob replied 1 year ago.
This would be unusual for MS. It seems more likely to be mechanical or musculoskeletal. The MRI should help to sort this out. Nerve conduction tests might also be quite useful.
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5218
Experience: Neurology & Int Medicine (US Trained): 20 yrs experience
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