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Thread: Can't figure out what this is.

  1. #1

    Can't figure out what this is.

    Hi. This is my first posting. I am hoping that my sister's symptoms sound familiar to someone.

    She is 40. She was in a rear-end auto collision in early Aug.
    MRI revealed slight herniation at C5-C6. Doctors said nothing major.

    She began having visual symptoms; blurred vision;distortion.
    She had occasional dizziness; difficulty walking
    She needed to sometimes grab onto furniture, walls, etc. to maintain her balance.

    At the advice of her neurosurgeon, she began PT and Chiropractic visits.
    She always reported increased visual disturbances after the PT visits, with no improvement in symptoms.

    She began to experience increased pressure at the base of her skull; pain and discomfort in her jaw and teeth.
    She also developed tingling and numbness in her arms and fingers.

    After 4 trips to the Chiropractor she had heightened pain in her neck, base of skull, with pressure radiaiting to the top of her head.
    She was unable to move her neck side to side and complained about visual disturbances constantly. She had very acute pain in her thoracic area.

    Her legs and feet began getting numb/tingly.

    She has had 3 visits to the ER.
    Two of those visits were a result of her collapsing. The first time she was simply trying to walk across the room and she crumbled into a heap; became very agitated, could not get up, nor move her legs and I could not lift her. The second time she was recovering from the stomach flu, was seated and "melted" out of the chair, as her body went totally limp. She did not lose consciousness, but lay on the floor in my arms convulsing.

    In addition to those symptoms, which remain (the pressure in her skull seems to have lessened) she now has numbness and lack of feeling in her torso, sense of urgency and loss of bladder control, weighted or heavy feeling in her legs and buttocks. She also complains of hot fingertips and heat at the back of her neck and thoracic area.

    She has had a repeated brain MRI, complete spine MRI, EEG, EKG, Echocardiogram, CT scan, numerous blood tests and urine tests. The only finding besides the C5/6 was a 5mm Chiari Malformation, which a specializing Neurosurgeon deemed as minor and not problematic.

    She responds HORRIBLY to any medication, except Ativan for anxiety and Motrin for pain.
    Most of the physicians recommend an anti-depressant, which she is afraid to take because of potential side effects.

    Her symptoms seem very real to me. I think she is becoming desperate because of her inability to see any solution. I don't think that depression is a large component here.

    If this sounds remotely similar to anything that anyone has experienced, I would really appreciate your feedback.

    Thank you.

    She has been to several Neurosurgeons, Neurologists and a Physiatrist.

  2. #2
    Hi,
    Sounds like your sister has been through quite a lot.

    I will ask Dr. Wise to comment when he can.

    AAD

  3. #3
    Quote Originally Posted by bigsister View Post
    Hi. This is my first posting. I am hoping that my sister's symptoms sound familiar to someone.

    She is 40. She was in a rear-end auto collision in early Aug.
    MRI revealed slight herniation at C5-C6. Doctors said nothing major.

    She began having visual symptoms; blurred vision;distortion.
    She had occasional dizziness; difficulty walking
    She needed to sometimes grab onto furniture, walls, etc. to maintain her balance.

    At the advice of her neurosurgeon, she began PT and Chiropractic visits.
    She always reported increased visual disturbances after the PT visits, with no improvement in symptoms.

    She began to experience increased pressure at the base of her skull; pain and discomfort in her jaw and teeth.
    She also developed tingling and numbness in her arms and fingers.

    After 4 trips to the Chiropractor she had heightened pain in her neck, base of skull, with pressure radiaiting to the top of her head.
    She was unable to move her neck side to side and complained about visual disturbances constantly. She had very acute pain in her thoracic area.

    Her legs and feet began getting numb/tingly.

    She has had 3 visits to the ER.
    Two of those visits were a result of her collapsing. The first time she was simply trying to walk across the room and she crumbled into a heap; became very agitated, could not get up, nor move her legs and I could not lift her. The second time she was recovering from the stomach flu, was seated and "melted" out of the chair, as her body went totally limp. She did not lose consciousness, but lay on the floor in my arms convulsing.

    In addition to those symptoms, which remain (the pressure in her skull seems to have lessened) she now has numbness and lack of feeling in her torso, sense of urgency and loss of bladder control, weighted or heavy feeling in her legs and buttocks. She also complains of hot fingertips and heat at the back of her neck and thoracic area.

    She has had a repeated brain MRI, complete spine MRI, EEG, EKG, Echocardiogram, CT scan, numerous blood tests and urine tests. The only finding besides the C5/6 was a 5mm Chiari Malformation, which a specializing Neurosurgeon deemed as minor and not problematic.

    She responds HORRIBLY to any medication, except Ativan for anxiety and Motrin for pain.
    Most of the physicians recommend an anti-depressant, which she is afraid to take because of potential side effects.

    Her symptoms seem very real to me. I think she is becoming desperate because of her inability to see any solution. I don't think that depression is a large component here.

    If this sounds remotely similar to anything that anyone has experienced, I would really appreciate your feedback.

    Thank you.

    She has been to several Neurosurgeons, Neurologists and a Physiatrist.
    Bigsister,

    What your sister describes is not uncommon but her symptoms are rather complex and may be due to several potential causes. First, a little anatomy and physiology may be helpful.
    • Vestibulospinal and reticulospinal pathways connect the neck to critical brainstem centers. These include pathways that control head movement, eye movement, and balance (vestibulospinal). Many people suffer from dizziness, visual symptoms, balance, and related problems after having had injury to the neck.
    • Two of the four blood vessels that supply the brain are situated in the neck vertebra, i.e. the vertebral arteries. They join to form the basilar artery which is the main artery supplying the brainstem. Damage to the blood vessels may cause brainstem symptoms.
    • Arnold-Chiari syndrome is a condition where part of the brain may have herniated through the foramen magnum (where the spinal cord exits the skull) and cerebrospinal fluid flow has been occluded. This may result in the formation an enlarged central canal, called a syrinx.


    Your sister may have involvement of all three systems. The fact that she has had Arnold-Chiari may be significant, given her symptoms. Most of the cerebrospinal fluid in the brain comes from the choroid plexus located in the fourth ventricle. The fourth ventricle is just above the brainstem. Each day, the choroid plexus makes 1-2 liters of cerebrospinal fluid, half of which goes upward to bathe the brain and is absorbed by the meninges there. The other half goes down the spinal cord, usually in the subarachnoid space between the spinal cord and the arachnoid membrane and is absorbed by the meninges (arachnoid) as the fluid goes down the spinal cord.

    If there has been any occlusion of cerebrospinal fluid flow in the subarachnoid space, some of the flow is shunted into the central canal which extends into the brainstem. Enlargement of the central canal is called syringomyelia. The fact that she has a syrinx suggests that she has had occlusion of cerebrospinal fluid flow. This may not have been during development and one possibility is that it may have developed after her accident. If, for example, she has a narrowed spinal canal, some herniation of her cerebellum into her foramen magnum, or hemorrhage in her subarachnoid space that resulted in tethering of her spinal cord, this may explain the presence of a syringomyelia and also her symptoms.

    How can the diagnosis be determined? First, they need to take a closer look at her brain and make sure that she does not have enlarged ventricles, which may result from an increased cerebrospinal fluid flow relating to a subarachnoid hemorrage. She should have somebody look at her MRI's to make sure that she is okay there. Second, I think that it would be useful to find out whether she is getting cerebrospinal fluid flow from the brainstem to the spinal cord. This can also be assessed by special MRI that look at cerebrospinal fluid flow. Alternatively, one may be able to detect his by placing contrast. I am not an expert on neuroradiology but I have seen studies of these. Third, if the above two do not show anything abnormal, it may be useful to do angiography to look at the vertebral arteries.

    There are other diagnoses, including migraine, which would not show up on any of the scans. But, the anti-migraine therapy may help. I wonder why your sister is responding "horribly" to drug therapies. It is possible that drugs pass relatively easily through her blood brain barrier. In any case, this suggests that whatever medication she is tried on, she should start with very low doses and slowly ramp up to therapeutic doses. It is possible that she won't need very much drug to have any effect. I am surprised that her doctors are recommending that she go to a chiropractor. Without being denigrating to chiropractice, I think that her doctors probably were not taking her symptoms seriously. In my opinion, this is not a chiropractice problem.

    Wise.

  4. #4
    Bigsister,

    I believe your sister is suffering from Autonomic Dysreflexia Hyperreflexia.
    It's easy to find out with a bp/heartrate monitor. Have her lay down for 10 minutes then take her vitals. Then have her sit upright for 10 minutes then take her vitals again. With Autonomic Dysreflexia Hyperreflexia the blood pressure would be higher and the heartrate would be lower in a sitting position. Then take her vitals as she is standing up for postural hypertention-hypotention and potential Transient Ischemic Attacks (mini-strokes). Visceral distention from standing and sitting can trigger paroxymal Autonomic Dysreflexia Hyperreflexia which would explain sliding out of the chair and crumpling in a heap which preceded my first ER visit.
    Another clue is being agitated from a compromised Fight or flight mechanism.

    I have the same stiff jaw and neck that I believe are from localized Endocrinological issues (excessive adrenalin, catecholamines).

    All Physical Therapy and some Chiropractic triggered my AD.

    With this condition any adjustment that your body has to make can trigger AD and most of the 25 medications that were prescibed to me did exactly that.

    Did your sister's back arch or stiffen then relax during what you describe as convulsions. I have decorticate posturing with my condition.

    I hope I've been of some help.

    Joe

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