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Neurology (Expert Forum)
CHIARI, LYME or MS?
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
CHIARI, LYME or MS?
by daliddle1, Jun 17, 2003 12:00AM
I am a 47 yo female, diagnosed with a 5mm tonsillar herniation Chiari 1, lyme disease which caused encephalitis and now possible MS. I am at a loss. What is causing my many symptoms? I was treated with antibiotics including IV for 18 months. I stopped 3 months ago and I am again disabled and can't work. My primary symptoms now are mostly cognitive but my many symptoms include:
Achiness
Brain Fog
Burning Pain in limbs
Tongue weakness when chewing foods
Sunburn feeling in areas of legs/arms
Tightness around upper abdomen
Chilly/goosebumplike feelings in legs
Toes on both feet go numb after walking
Black spot in vision R eye
Heat intolerance
Numb lips
Clumsiness
Diarrhea-several times a day
Dizziness
L Ear Pain
L Eye pain
Fasciculation’s
Fatigue
Head Pressure
Headache
Joint Pain/swelling
Memory Impairment
Wake up every night being too hot
Nausea
Neck Pain
Palpitations
R. Arm Numbness/Tingling/heaviness
R. Leg Numbness/Tingling/heaviness
Drunken feeling most of the time
I don't know know what to do...do I re-examine the Chiari?The lyme?MS? Please review my tests and advise where to go from here.
Most of my symptoms started after a whiplash in 1996. I have been on disability for 2 years then tried to work this year for 2 months but cannot do it anymore.
PLEASE SEE THE NEXT POST FOR MY MRI's and other TEST RESULTS
Thank you for your answers to my questions
Achiness
Brain Fog
Burning Pain in limbs
Tongue weakness when chewing foods
Sunburn feeling in areas of legs/arms
Tightness around upper abdomen
Chilly/goosebumplike feelings in legs
Toes on both feet go numb after walking
Black spot in vision R eye
Heat intolerance
Numb lips
Clumsiness
Diarrhea-several times a day
Dizziness
L Ear Pain
L Eye pain
Fasciculation’s
Fatigue
Head Pressure
Headache
Joint Pain/swelling
Memory Impairment
Wake up every night being too hot
Nausea
Neck Pain
Palpitations
R. Arm Numbness/Tingling/heaviness
R. Leg Numbness/Tingling/heaviness
Drunken feeling most of the time
I don't know know what to do...do I re-examine the Chiari?The lyme?MS? Please review my tests and advise where to go from here.
Most of my symptoms started after a whiplash in 1996. I have been on disability for 2 years then tried to work this year for 2 months but cannot do it anymore.
PLEASE SEE THE NEXT POST FOR MY MRI's and other TEST RESULTS
Thank you for your answers to my questions
Doctor's Answer
by CCF-Neuro-M.D.-JT, Jun 19, 2003 12:00AM
The symptoms you report are probably not all related to one particular disease as they involve several different regions of the nervous system. The cognitive problems appear to be the most troubling symptoms at this time and it's possible that they may be related to the prior episode of encephalitis, a rare complication of Lyme disease. Reports of Lyme encephalitis in the US describe the condition as usually mild and rather vague without many objective findings, leading to cognitive impairment, fatigue, joint pains, and sensory symptoms. When you had the initial infection, a spinal tap should have been done to help confirm the disease. If the symptoms are getting worse, you may want to consider a repeat tap to see what's going on there. Unfortunately, in patients with this condition recovery is quite slow and often incomplete and one study showed that there was no improvement in patients given a second treatment of antibiotics over placebo.
One thing you can do is get a neuropsyche evaluation to see objectively which features of cognition have been impaired and where you are at this time with regards to severity of impairment. Repeat testing down the line can objectively show any improvement or decline.
As for the consideration of other diagnoses, it's impossible to say whether or not you have MS without seeing the films myself as there appear to be some non-specific changes on the prior MRI. For more confirmatory testing, evoked potentials and a spinal tap would be helpful. Finally, it does not appear that this is related to a Chiari.
Hope that helps
One thing you can do is get a neuropsyche evaluation to see objectively which features of cognition have been impaired and where you are at this time with regards to severity of impairment. Repeat testing down the line can objectively show any improvement or decline.
As for the consideration of other diagnoses, it's impossible to say whether or not you have MS without seeing the films myself as there appear to be some non-specific changes on the prior MRI. For more confirmatory testing, evoked potentials and a spinal tap would be helpful. Finally, it does not appear that this is related to a Chiari.
Hope that helps
TESTS:
MRI Brain no contrast 1/28/2000
Impression:
1. Hemispheric perivascular and central white matter T-2 prolongation.
MRI Cervical Spine no contrast 3/14/2000
Impression:
1. Partial fusion between C4 and 5
2. Mild spondylotic changes C5-6 and C6-7
2. Intensity changes seen in cord
MRI Brain no contrast 5/13/2000 Cranial cervical junction flow study
Impression:
1. Possible cerebral aqueduct stenosis, normal pulsation not visualized
2. 5mm tonsillar ectopia
3. No cisterna magna
EEG 9/27/2000
1. Over the posterior head region, moderate amplitude 10-12 Hz waves were seen bilaterally.
Electro diagnostic Testing
1. The right median motor study shows a mild decrease of conduction velocity between the elbow and the wrist.
Lyme disease AB ELISA 6/8/2001
POSITVE 1.2
Lyme IgM Western Blot 8/17/2001
POSITIVE
Lyme IgG Western Blot 8/17/2001
NEGATIVE
SPECT scan/brain 2/20/2002
Impression:
1. Moderate/markedly diminished perfusion in both orbitalfrontal regions and in the high parietal area bilaterally
2. Decreased labeling of the medial portions of both temporal lobes and the left temporal tip is also noted.
PLEASE READ MEDICAL HISTORY SUMMARY NEXT POST
Year Problem and outcome
1960 Very short stature evaluated at UCSF -All ok
1976 Motor Vehicle Accident-Neck Pain
1980 Child 1 born-Muscle wasting after delivery
1981 Diagnosed with MVP with murmur and hypoglycemia
1981 Chronic Neck pain and muscle spasms started
1984 Child 2 born-Severe Chronic cough during pregnancy
1985 Chiropractor 3/wk to alleviate neck pain
1986 Double vision, muscle weakness-Possible MG or MS
1987 Episode of severe vertigo to one side-To ER, no diagnosis
1988 Child 3 born-Premature delivery/ 1 month
1990 Episodes of chest pain/palpitations-Echo reveals mild regurgitation MVP
1996 MVA-Injured R shoulder and neck
1997 MRI C-Spine-Cervical fusion C4 & C5 (congenital?)
1998 R Ovary removed-Went into surgical menopause
1999 Pain