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Neurology (Expert Forum)
what to do next?
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury
what to do next?
by sunshine3, Feb 23, 2003 12:00AM
I am having a problem walking... It started about six months ago. I thought I had a cold, my neck hurt I lost my voice and I was very tired and when I would stand up I would get dizzy and have to lay back down...then my right arm wouldn't move, then my left...I went to internal med. specialist he took blood. The tests were ok. A couple of weeks went by and it got harder and harder to walk. At first I was ok when walking but then I would just stop and I couldn't walk. It was as if I lost power and when I tried to walk I hit an invisible force field that wouldn't allow me to take normal steps. The doctor had a neurologist do an EMG, it was ok. He took more blood. He checked for inflammation redness and swelling, checked B12, electrolytes, virus, Guillian Barre, ANA..all ok. Did an MRI of brain, showed multiple bi-lateral micro emboli front lobes, could not rule out MS. Went to a neurologist at Kirklin Clinic at UAB, says he is sure not MS, he took more blood, checked for anti-DNA, acetylcholine, SSA, SSB, ANA, B12, all ok, thought it might be myasthenia gravis, perscribled mestinon. Just did a Jolly test and it was ok. Had neck and spine MRI's and they were ok. MRI's were not done with dye. I find myself crying now because I REALLY cannot walk my arms and hands are stiff, I have a hard time breathing, actually I find myself holding my breath and don't even know why, I wake up at night numerous of times and have night sweats. Reflexes are different on each side and I can't hold my head and back up well, no family histories! Any sugg.? Shouldn't something show up?
Doctor's Answer
by CCF-Neuro-M.D.-JT, Feb 24, 2003 12:00AM
Sounds like the money is in the MRI of the brain, meaning the clues are all pointing up there. Please keep in mind that as I haven't personally seen your MRI, it's difficult to comment on what this could represent. What I can say is that the normal EMG makes it less likely that this is a problem with the muscles or nerves. WIth all the extensive labwork coming back normal, the next step in pursuing these frontal lobe spots would be a lumbar puncture or spinal tap to look for diseases such as MS, sarcoids, lyme, and lymphoma just to name a few. Also, if these spots in brain are concerning to the docs, then an MRI with dye should be considered for further evaluation. Finally, if these spots are thought to be little strokes and vasculitis is suspected and MRI of the arteries also known as MRA and possibly even an angiogram should be considered. Again, this needs ot be taken into clinical context and the actual findings of the MRI. I would recommend taking your films to an academic medical center for a second opinion. (not sure if Kirklin is just an affiliate or is at the actual campus of UAB, if not then consider going to the actual university). Good luck.
Good luck!
I ask because gradient-echo is generally accepted as the best type of MRI to detect and image potential punctate (pinhead sized) lesions. Typical spin-echo MRIs normally don't pick up the very small lesions, if they exist. Gradient echo could give you more insight and possibly rule in/out some things.
Just a thought.