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Thread: Unexplained Neurological Loss

  1. #1

    Unexplained Neurological Loss

    I'm C7 15 years post. About a year ago I suddenly lost a significant amount of my sensation below my level of injury. I used to have uniform sensation of light touch. Now it is uneven and varies from mid/deep touch to none at all. I consulted several NS including 2 excellent SCI docs. I had a battery of tests MRI (neck and brain), CT, Mylogram, EMG, etc. Syrinx was ruled out. I had a follow up spine MRI a few months ago that showed no change. My symptoms have not changed since the original loss.

    Any theories? I never asked about compression but wouldn't it have been ruled out. Needless to say I don't want further developments.

  2. #2

    quadfather,

    I don't know. There are many potential causes that should be considered besides the obvious one, i.e. something happened to your spinal cord at the injury site. It is a mistake that many doctors make. Because the spinal cord injury is so dominant in the patient's life, everything gets blamed on the spinal cord injury and particularly around the original injury.

    I would suggest thinking of the problem without the spinal cord injury. What is the cause of sensory loss in those regions in a person without spinal cord injury and run through those causes first. You may want to consider the possibility of a disc that is compressing your lower spinal cord or a spinal root innervating that region. Do you hae any general symptoms that might be suggestive of a peripheral neuropathy (i.e. degeneration of peripheral nerve, such as diabetes)? Did you fall or do something that might have hurt your spinal cord?

    Wise.

  3. #3
    Dr. Young,

    I am resurrecting this very old post because these same symptoms are re-occurring.

    About a week ago I noticed a numb patch on the side of my right leg that had not been numb before. After 3 days the numbness involved the entire right side of the right leg and a bit of the foot. I scheduled an appointment with my GP for 11/10 (today).

    Upon waking this morning the numbness now involves both legs as well as reduced anal/genital sensation.

    Let me be clear, my legs are not completely numb but I have lost sensation in large portions. My spasms are intact and are up but not off the charts. I have some serious ache in my lower back (around L5) but not severe stinging pain. No AD. Other points to consider: I am on a new cushion and a couple of days before this all started I slipped transferring onto the toilet but did not hit the floor (I did pull and twist to save me from a fall)

    Today I saw the doc. He ordered plain xrays that showed arthritis and a disc that was compressed at L5-S1 , especially at the edges.

    He recommended oral steriods, ice, and weight loss (I'm about 30lbs over). I can't take NSAIDs due to prior stomach bleeding incident. I also have a lumbar MRI next week. And to return in a month. He said "these things take time to calm down". He did not seem overly concerned about my symptoms.

    Unfortunately, I did not get a formal medical term of the diagnosis. Is it stenosis, herniated disc, degenerative disc disease, slipped disc, nerve root compression? All these similar conditions are confusing. Which one of these would give me these symptoms?

    Thanks Dr. Young. I am actually suprised there aren't more posts on this kind of thing from us long term chronics given that our backs are not made for 20 or 30 years of sitting.

    Dave

  4. #4
    I will ask Dr. Young to take a look at this, but in the meantime, often an MRI is needed to determine just what is causing cord or spinal root compression, and which areas are actually compromised. Has this been done recently?

    What type of physician are you seeing for your management and diagnosis of this problem? Neurosurgeon? Orthopedic surgeon who specializes in spinal disorders? General surgeon? Internist? GP? Physiatrist?

    (KLD)

  5. #5
    Thank you KLD. My GP is an internist, but not any sort of SCI specialist. I've had him for 12+ years and he never hestitates to refer me to others. I just want to lead the push if it is needed.

    I am getting a current MRI done in 1 week. And I did have a lumbar MRI done way back in 2000 at one of my local hospitals. I wonder if they'd still have it 9 years later?

  6. #6
    Quote Originally Posted by quadfather View Post
    Dr. Young,

    I am resurrecting this very old post because these same symptoms are re-occurring.

    About a week ago I noticed a numb patch on the side of my right leg that had not been numb before. After 3 days the numbness involved the entire right side of the right leg and a bit of the foot. I scheduled an appointment with my GP for 11/10 (today).

    Upon waking this morning the numbness now involves both legs as well as reduced anal/genital sensation.

    Let me be clear, my legs are not completely numb but I have lost sensation in large portions. My spasms are intact and are up but not off the charts. I have some serious ache in my lower back (around L5) but not severe stinging pain. No AD. Other points to consider: I am on a new cushion and a couple of days before this all started I slipped transferring onto the toilet but did not hit the floor (I did pull and twist to save me from a fall)

    Today I saw the doc. He ordered plain xrays that showed arthritis and a disc that was compressed at L5-S1 , especially at the edges.

    He recommended oral steriods, ice, and weight loss (I'm about 30lbs over). I can't take NSAIDs due to prior stomach bleeding incident. I also have a lumbar MRI next week. And to return in a month. He said "these things take time to calm down". He did not seem overly concerned about my symptoms.

    Unfortunately, I did not get a formal medical term of the diagnosis. Is it stenosis, herniated disc, degenerative disc disease, slipped disc, nerve root compression? All these similar conditions are confusing. Which one of these would give me these symptoms?

    Thanks Dr. Young. I am actually suprised there aren't more posts on this kind of thing from us long term chronics given that our backs are not made for 20 or 30 years of sitting.

    Dave
    Dave,

    From your description, it sounds like you have a herniated disc. A herniated disc may compress the cord, compress the spinal roots in the spinal canal, or compress spinal roots as they exit the spinal column. Compression of the cord would result in loss of sensation and voluntary movement below the compression site. The spinal cord ends just below L1 vertebral segment and the cauda equina (spinal roots) is located at L2 and lower.

    You describe an area of numbness that started out as a patch but now involves your "whole right leg", including anal and genital sensation. To me, this means multiple segments for the right leg, as well as reduced anal and genital sensation (S2-S5). This could not be caused by pressure on a single spinal root.

    We need to determine whether or not your symptoms can be explained by a herniated disk pressing on the cauda equina from L5/S1. Does the sensory loss involve multiple dermatomes? A disc at L5/S1 would compress the cauda equina. However, it should not cause sensory loss above L5. The L5 sensory dermatome is mostly below the knee but extends up the side, as illustrated below.


    If you have sensory loss corresponding only to the L5 or S1 dermatome, this would be due to a herniated disc pressing those spinal roots in the cauda equina. However, if you have loss of all sensation in the leg below the knee, for example, this would imply that you have had a peripheral nerve damage. Or, if you have motor and sensory loss, particularly bilaterally and above the knee, this would suggest injury to the spinal cord above L1 segmental level.

    I have written a number of detailed posts concerning diagnosis of lumbar and sacral losses. Rather than reproducing all of those, why don't I wait for your answers first before discussing further.

    Wise.

  7. #7
    Wise,

    Thanks for your response. Based on your diagram I believe that my sensation changes are across multiple dermatones. The L5 dermatone is the most affected. However I do have a reduction in anal sensation. It is not dramatic but it is there. My sensation was neither uniform nor excellent to begin with so saying definitively that spot A has lost 20% feeling is difficult for me to do with certainty. That said, I think the thighs are also involved here (that's above L5).

    I saw the xray from yesterday myself. And although I have no expertise in it, the vertebre and discs look uniform in both alignment and space from the upper T region all the way through L4. At that point the spine was clouded by white artifact that the doc said was arthritis. It was tough to see the detail and since I didn't even know what I was looking for I couldn't draw any conclusions. Through it he pointed at a disc that was thinner than the rest particularly at the sides (very narrow there). He believes that is the problem.

    Will the lumbar MRI I am getting next week provide a definitive diagnosis of what's going on?

    My sensation is better today than it was yesterday but it is still not back to the way it was a few weeks ago. Your input is appreciated.

    Dave.
    Last edited by quadfather; 11-11-2009 at 12:13 PM. Reason: added another question

  8. #8
    Bumping this for Dr. Young

    Awoke this morning to significant pain and numbness. Settled down after being at work for a few hours. Same story this evening - transferring in-and-out seems to aggravate the pain and increase both the severity and coverage of my numbness. Got a script of methylpred. from my GP for inflammation (I can't take NSAIDs).

    Hoping Tuesday's MRI reveals the reason behind this and how bad it is. Not knowing is the worst!

  9. #9
    trying for Dr. Young again...

    I found some of your write-ups on lumbar, CMS and CES injuries. Well written and informative.

    My loss of sensation is across multiple dermatomes. The sensory disturbance seems to wax and wane but never goes away. Will the MRI definitively show wheter it's compression or other? Anything specific I should ask my doc or radiologist?

  10. #10
    I had a lumbar MRI and here is the radiologist's report

    ************************
    Date of Study: 11/17/2009
    Study Performed: MRI Lumbar Spine without Contrast
    Standard noncontrast MRI of the lumbar spine was performed
    There is normal appearance to the distal spinal cord and conus medullaris. There is normal alignment of the lumbar spine. Incidentally noted is that there is mild degenerative disc disease at T12-L1
    The L1-L2 and L2-L3 levels are within normal limits
    The L3-L4 level demonstrates decreased disc space height and signal consistent with mild degenerative disc disease. There is high-signal in the posterior annular fibers in the midline at the L3-L4 level in the disc. This is consistent with posterior annular tear. There is no significant disc bulge or extrusion at this level
    The L4-L5 level demonstrates mild decreased disc space height and signal consistent with mild degenerative disc disease. There is minimal high-signal in the posterior annular fibers inferiorly consistent with small posterior annular fiber tear. There is a very mild diffuse disc bulge at this level. This has some mass effect on the thecal sac and does extend laterally bilaterally to mildly narrow each lateral recess, left greater than right.
    The L5-S1 level demonstrates mild degenerative disc disease with decreased disc space height and signal. No significant disc extrusion is noted. There is very mild central disc bulging at this level. Neural foramina are patent.

    *******************************
    I would appreciate your interpretation of this Dr. Young, if you are able.

    To me it doesn't seem to explain why my symptoms are across several dermatomes, including some S2-S5 sensation loss (along with the legs).

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