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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5657
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Dear Doctor In may of this year I had a sudden onset of

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Dear DoctorIn may of this year I had a sudden onset of right lower limb weakness and numbness in three toes.I had partial saddle anaesthesia of the left side but cauda equina was ruled out following MRI scan.The scan identified two very slight protrusions on my lumbar spine but was otherwise normal.I was unable to fully weightbear for several weeks on my right leg, and recently began mobilising again, although my right leg often appears to have a mind of its own at times and is left with a weakness now. I also have virtually constant pins and needles in the left foot and occasional altered sensations in the ring and little fingers of the left side, with altered sensations around the left thigh and buttock area.The head and total spine were normal on MRI and other more sinister conditions (MS) have been ruled out although I have been informed that it may not be possible to rule out MS until there is a longer history of symptoms. It is interesting to note that the symptoms that I have described now appear and disappear very quickly as opposed to fading and resolving before occurring once again as I would expect with MS.At present my main symptoms appear to stem from the lumbar spine at the left side as I get awful back pain and don't know where to put myself. I have no incontinence but sensation is altered on micturition and bowel movement. Anal sphincter control was noted to be fine on medical examination (neurologist).In terms of my medical history, I am otherwise fit and healthy, however I did have right club foot surgery as a child through to adulthood.In summary, the symptoms began on right side but are now on my left side mainly, and position doesn't make any difference.I would be grateful for your opinion as to what the possible causes may be, and whether or not it would be worth obtaining the opinion of an orthopaedic specialist in the event that you consider this to be a mechanical cause rather than some underlying disease.Kind RegardsWG

Hello WG. Your normal MRIs are very reassuring. I would suggest you now get nerve conduction testing (EMG/NCV) of the lower extremities, if not the upper extremities as well. This will give you information about the integrity of the nerves, where any problems may be, and how severe the process is. Important diagnostic clues can be obtained in this way. In addition, if your doctors deem it appropriate, you could get a lumbar puncture to assess the spinal fluid.

Customer: replied 1 year ago.
Dear Bob
Many thanks for your advice.
Would an orthopaedic referral be advantageous at this stage given that the main pain derives from my back?
Kind Regards

It sounds neurological in origin, so I would not give up on that angle. That said, you likely have a musculoskeletal component as well (or 2 separate issues), so an ortho referral and/or physiotherapy referral would make sense. Just keep in mind that orthopedists focus mainly on the bones and joints of the body as well as those levels of the spine that have ribs (i.e. not the neck or low back, which is typically the perview of the neurosurgeons).

Customer: replied 1 year ago.
Thank you very very much, your advice is much appreciated.
Kind Regards

You're welcome. Hope all works out for the best!

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