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Thread: Severe lumbar pain, with neurologic symptoms Hi my name is Neal, but I often go by my

  1. #1

    Severe lumbar pain, with neurologic symptoms Hi my name is Neal, but I often go by my

    Hi my name is Neal, but I often go by my middle name Anthony.

    Not too long ago back in November of 2012 around the 28th. I started to have strange unknown neurological symptoms. They began after a night I was working "the 28th", and pretty much have worsened from there quite gradually. To give a little history I was also involved in a car accident back in July of 2012, a young girl T-boned my car at a rather high speed and caused my air bags to deploy and all, this accident did whip my spine rather hard to the left side. It hurt for a little while, but seemed to eventually heal mostly, it just left some minor residual pain that remained afterwards in my lumbar spine, and both legs. But mostly had no other issues. I saw a doctor about the problem on the 27th, and she recommended and used trigger point injections into my lumbar spine to help heal the pain, they seemed to work alright. However, my PCP also noticed some odd leg weakness bilaterally on examination, and when testing reflexes she noted that both knees seemed to have hyperflexia, at the time also told her I had a sore back, but the pain seemed controllable with meds. Well this brings me back to the night of the 28th, upon going around work I began to notice severe swelling in my sacral area, and lumbar area. Both were causing pretty substantial pain at this point, but I like to think I have a good tolerance to pain so I ignored. As the night progressed the pain intensifies pretty rapidly. And suddenly both of my legs became weak, as if I was dragging 100lbs weights tied to my feet. Severe numb feeling began to spread through both legs again bilaterally. This was accompanied by a prickling/tingling sensation,and before you know it my legs were literally giving out from under me. I literally could not walk, my walking became very stiff, and my legs simply could not support my body anymore so I left work to go home, as I had massive dysfunction my body. This did not improve over the course of the week, and seemed to just get worse by the day. Returned to my doctor and complained of the symptoms I was experiencing, but added that over the week I noticed I was mildly leaking urine, and fecal matter as well. The latter was minor.but it concerned me as well as my doctor, and after checking my clinical presentation, they noted severe drop foot, radicular pain, bilateral leg weakness, and fecal/urinary incontinence. This of course troubled her, and another doctor there to second her opinion. So they sent me to the hospital to have a workup of pretty much every test under the sun,under the pretense of possible "cauda equina syndrome". I'll just skip to what tests were run at the hospital, and the results. I received 4 MRI's lumbar, thoracic, cervical, and brain, all done with contrast. The results came back fairly normal,minor disc bulge/ degeneration at L4-L5 minor enhancement of pars interarticularis, minor spondylitic changes in the thoracic spine, cervical seemed completely normal, brain normal as well. So they then proceeded with other tests over the course of a week all the tests were done. Received lumbar puncture as well, came back fairly normal; however, I developed a post dural leak, quite common I hear but mine was very nasty and lasted 22 days after my discharge, no blood patch was offered, even after complaint of symptoms. Also had SSEP also came back fairly normal. So the neurologist treating me decided it was probably acute inflammation of maybe my dura or arachnoid possibly,and said it can be common after car accidents of high speed, or the excessive strain at work following the accident. So he then decided a slow depo medrol drip of 1,000 mg each day, over a course of a few days. This sort of helped, but at the same time not really. So they discharged me with a script for percocet for the dural leak headaches, and recommended physical therapy as well. The dural leak went away after 22 days, and physical therapy seemed to be going OK; however, the symptoms began to worsen with the physical therapy. Returned to neurologist as my physical therapist noted that she sees my symptoms worsening over the course of 5months roughly, walking is still a mess as the drop foot only worsened, numbness/tingling increased, and urine had become much more incontinent. The fecal incontinence became full blown as my bowels released several times completely while walking in public. So I brought this up with my neurologist who upon seeing me gave me the fastest clinical workup I ever witnessed, I was in and out in 5 minutes.He ignored everything my physical therapist had sent him as notes, and largely shrugged me off and said nothing can possibly be wrong as he saw all my radiographic tests from the hospital, and other tests. Said since he determined 5 months ago everything is normal, then well regardless of the symptoms worsening he was sure it was nothing. He pretty much sped me out the door as fast as he could ignored every symptom complaint I had,and my PCP's and my DPT notes, all my symptoms were confirmed by their observations over the 5 month course. The neuro declared that since he already diagnosed 5 months before, then nothing could possibly be wrong now. So I left in a OK state of mind, despite my pain level being around a constant 7, and the other symptoms worsening.But I was determined to make the best of the prognosis he gave me,and went on continuing phys therapy doing every stretch, every exercise, I was switched to a pain patch by my PCP which did help. But I could still tell all my symptoms were all still increasing albeit my pain was lessened at least. Fast forward to now and this last Friday 14th, 2013, I developed full urinary retention combined with again severe back pain I would say at least an 8 now, so not good. But also my fecal incontinence became full blown, with extreme urgency, and loose anus. Legs have also become stiffer and more painful, lots of numbness down both legs but mostly centered in the saddle area especially the crotch, and also extremely where my pelvis and butt meet with pretty severe pain down the left thigh, and swelling and pain in ankles. The urine retention was very bad after 12 hours of having a very full bladder,my wife dragged me to the hospital again as it was a Friday night. The hospital did an ultrasound of bladder and I was retaining 781 ml. Doctor looked very concerned, especially with my other symptoms,and put in a Foley catheter to drain. So here I am now catheter still in several days later. Saw PCP today now a he, but he is very concerned about all of the symptoms I am presenting with clinically, but especially the leg weakness, urine retention, and fecal incontinence. I do have appointment to go back to the same neurologist; however, since my symptoms did a 180 from his original prognosis, he is now taking this very seriously as well. And I also have a appointment to see a Urologist about the catheter/urine retention. Neuro will check the other symptoms,as well as I have been referred to pain management as situation has worsened symptom wise. My question is if you were patient enough to read everything I listed. Have anyone else on this forum gone through something similar, and also to any medical people reading this, does anyone maybe have a clue what I may be dealing with here. As you can imagine this is quite frustrating, but I know sometimes it can take quite some time to get a proper diagnosis. I am not asking for a diagnosis online, as that would be foolish. I am just curious if any medical people, or just anyone with similar symptoms have maybe any ideas of what this may be? In fact just today I retained and emptied while typing this I finally released after retaining all day, even with catheter in 505 ml urine over 9 hour period its now 8:30 pm, minus a small amount of 250 ml this morning at 11:30 am! So anybody out there have any ideas?
    Last edited by anthonyh; 06-19-2013 at 11:34 PM.

  2. #2
    It does sound like you have fairly classic cauda equina or conus injury. Have you been referred to a physiatrist or a SCI comprehensive interdisciplinary inpatient or outpatient rehabilitation program?? Are you covered by insurance either for yourself or by the driver who struck your car??? I am glad you are seeing the urologist (is this a neurologic urologist???), but you also need to work with someone who can help you get your bowels controlled with a well designed bowel program to prevent both constipation and bowel incontinence. You may need custom bracing to help with your drop foot as well.

    If you have not seen a neurosurgeon who specializes in spinal surgery, I would also recommend this to determine if you have anything that could be potentially improved by surgical intervention, although long-standing compression may have already done damage that may not improve with decompression at this point.

    (KLD)

  3. #3
    Hi SCI-Nurse, and thank you for your reply, I greatly appreciate your opinion and help on this matter. As you can probably guess, it has been a bumpy road thus far in figuring this thing out. I have actually consulted a neurosurgeon in my area; however, he asked that I follow up with my regular neurologist on this, as I think he is quite aware of what you are speaking about as far as how long this has been going on. Thus I am beginning to think he does not believe surgery will benefit me this far out. Or he is just not sure where exactly the compression is occurring. As I do not have any acute compression, as my past MRI's did not show much other than what I listed, so no prolapsed disks yet that I can tell of, at least not without more diagnostic testing.

    I have heard that CES can be a bit of a snake in the grass so to say, and can sneak up on people slowly, I would prefer to hope that is not what it is, but alas many signs keep pointing back to that diagnosis. My neurosurgeon did however note that I have some minimal lumbar stenosis forming. But the previous MRI's did not show the stenosis compressing anything "yet".

    However back to CES, I have read many places, that CES can be either rapid progression, and or slow progression from degeneration of the spine. And so when it comes to slow progression CES, is it more often the stenosis that causes the compression typically, or is it the discs giving way, or kind a little of both?

    I appreciate any feedback you may have immensely, and I do have an appointment with a urologist this Friday the 21st. So I sincerely hope to maybe get a little more info about the severe urine retention, as my PCP looked rather worried today, and so got me in for an emergency appointment.

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