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Neurology (Expert Forum)
Still radiculopathy and/or something else?
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Still radiculopathy and/or something else?
by Christina, Mar 07, 2000 12:00AM
(Sorry, I have trouble posting my message, I didn't receive confirmation and can't see it, so I'll try again...)
This is a late follow up on a posting I made dec. 30, 1998 ("lumbar radiculopathy")
In brief: I am 26 y. old, had discectomy L5-S1 in 94 and was diagnosed with persistent chronic radiculopathy (pain, paresthesia, weakness and left foot drop); a spinal cord stimulator was finally implanted in 97, with good results.
Meds: Elavil (Imovane if necessary in order to sleep).
The weakness of left leg and foot now seems to worsen gradually and very slowly over months (in the morning or when waking up at night, I sometimes have difficulty putting any weight on left leg, it just gives way and doesn't support me at all for several minutes). Leg and back pain still increase with daily activity, especially if I have to stand for a prolonged period of time.
GP recently noticed spasticity and clonus (left leg only) in response to elliciting tendon reflexes. Knowing about general UMN and LMN signs (I am a vet student...), clonus and spasticity just don't seem to fit with radiculopathy and I also begin to worry about the seemingly progressive nature of weakness in left leg. GP seems concerned and thinks this could be related to my spinal cord stimulator, is this possible? Why and how?
I really don't know what to think anymore. If you have any insights as to possible (other?) causes (or any suggestions on what to do?), I would appreciate this very much. (I am also still waiting to see my regular doctor at pain clinic.)
This is a late follow up on a posting I made dec. 30, 1998 ("lumbar radiculopathy")
In brief: I am 26 y. old, had discectomy L5-S1 in 94 and was diagnosed with persistent chronic radiculopathy (pain, paresthesia, weakness and left foot drop); a spinal cord stimulator was finally implanted in 97, with good results.
Meds: Elavil (Imovane if necessary in order to sleep).
The weakness of left leg and foot now seems to worsen gradually and very slowly over months (in the morning or when waking up at night, I sometimes have difficulty putting any weight on left leg, it just gives way and doesn't support me at all for several minutes). Leg and back pain still increase with daily activity, especially if I have to stand for a prolonged period of time.
GP recently noticed spasticity and clonus (left leg only) in response to elliciting tendon reflexes. Knowing about general UMN and LMN signs (I am a vet student...), clonus and spasticity just don't seem to fit with radiculopathy and I also begin to worry about the seemingly progressive nature of weakness in left leg. GP seems concerned and thinks this could be related to my spinal cord stimulator, is this possible? Why and how?
I really don't know what to think anymore. If you have any insights as to possible (other?) causes (or any suggestions on what to do?), I would appreciate this very much. (I am also still waiting to see my regular doctor at pain clinic.)
Doctor's Answer
by CCF Neuro[P] MD, RPS, Mar 07, 2000 12:00AM
Dear Christina:
Sorry to hear about your continued problems. Increased DTRs and clonus are a sign of upper motor neuron disease (as you indicated). Involvement of the lateral columns of the spinal cord will induce upper motor neuron signs. Weakness of muscle groups is usually lower motor neuron signs (as you indicated). After the nerve synapses with the anterior horn cell, if there is a lesion, then one gets lower motor neuron signs if the lesion is distal to the lateral columns. So, the problem might be with the stimulator or progression of your spinal cord problem. I can't tell from the internet. I suggest that you talk with your neurosurgeon and neurologist.
Sincerely,
CCF Neuro MD
Sorry to hear about your continued problems. Increased DTRs and clonus are a sign of upper motor neuron disease (as you indicated). Involvement of the lateral columns of the spinal cord will induce upper motor neuron signs. Weakness of muscle groups is usually lower motor neuron signs (as you indicated). After the nerve synapses with the anterior horn cell, if there is a lesion, then one gets lower motor neuron signs if the lesion is distal to the lateral columns. So, the problem might be with the stimulator or progression of your spinal cord problem. I can't tell from the internet. I suggest that you talk with your neurosurgeon and neurologist.
Sincerely,
CCF Neuro MD
I had an mri scan done recently with gadolinum which showed a white round lesion on my frontal lobe. Does MS lesion show up as white lesions? This was the first scan they did in along time with gadolinum and my clinical history really points to MS type illness over the years except for past mri's were negative up to now. Is one lesion enough to diagnose MS? Being on the frontal lobe how would this effect me symptom wise? I am trying to figure what the frontal lobe controls? I believe it is mood and behavier.
Thanks for your help!! Sincerely Lisa
Do you know or have you heard of any specific adverse effects that may occur with spinal cord stimulation? (Originally, I have only been told that there might be a risk of infection during the first days after surgery.) I must say though, results with pain reduction have been very positive for me.
Thanks again.
Yes, like any procedure there are side effect. Infection, the device coming loose, the device eroding the spine, etc. I would read the disclaimer that comes with the device.
CCF Neuro MD