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Neurology (Expert Forum)
abnormal ssep
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abnormal ssep
by gabmar, Jan 20, 2006 12:00AM
I currently have a dx of transverse myelitis following a nasty sinus/bronchial infection last Feb. No bloodwork done during this illness. My sx were fatigue, spasticity, parasthesia, rt footdrop, leg pain. Sx bil but significantly worse on rt. All tests evoked (ssep, baep, vep), bloodwork, mri's (c, t, l sp,) and spinal tap were normal. Sx resolved mostly.
May, sudden onset tremors when arm supported, faint L'hermittes. Repeat c sp mri and an initial brain mri negative. 2 lesions on brain thought to be migraine event due to location.
During summer leg sx worsen in heat.
Late Aug/Sept, extreme worsening (much more severe than initially) of leg sx/footdrop, spasticity, severe electric shocks down legs when startled, freaky arm movements (pkd?) parasthesia in extremities and face. Felt like my feet were beanbags. Repeat c sp t sp mri negative a couple months later,however my ssep was abnormal in both legs. From talking to my neurologist I got the impression he thought I had a cervical lesion but due to timing of the mri or location/size of lesion it wasn't demonstrated on the films.
My question is: Where do I go from here? I'm assuming I should just keep a simple journal of my sx and if it is something more serious such as ms it will show in time. I have a followup appt with my dr next month. Would a repeat brain mri be recommended? I have a feeling the demyelination is in my c spine. Can a dx of ms be made with a negative mri? Since the repeat ssep was positive would Sept considered to be a separate event?
Thank you very much for your time.
May, sudden onset tremors when arm supported, faint L'hermittes. Repeat c sp mri and an initial brain mri negative. 2 lesions on brain thought to be migraine event due to location.
During summer leg sx worsen in heat.
Late Aug/Sept, extreme worsening (much more severe than initially) of leg sx/footdrop, spasticity, severe electric shocks down legs when startled, freaky arm movements (pkd?) parasthesia in extremities and face. Felt like my feet were beanbags. Repeat c sp t sp mri negative a couple months later,however my ssep was abnormal in both legs. From talking to my neurologist I got the impression he thought I had a cervical lesion but due to timing of the mri or location/size of lesion it wasn't demonstrated on the films.
My question is: Where do I go from here? I'm assuming I should just keep a simple journal of my sx and if it is something more serious such as ms it will show in time. I have a followup appt with my dr next month. Would a repeat brain mri be recommended? I have a feeling the demyelination is in my c spine. Can a dx of ms be made with a negative mri? Since the repeat ssep was positive would Sept considered to be a separate event?
Thank you very much for your time.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jan 24, 2006 12:00AM
1) Further tests can be done to confirm a diagnosis of MS such as spinal fluid analysis, and visual evoked potentials. Time it self is an important help to the neurologist in diagnosing neurological disorders.
2) The MRI is pretty sensitive for picking up deyelination, althjough less well inj teh brain stem and spinal cord than the brain. I don't know what the arm movements are but they might suggest inolvement of the nerve centers at the base of the brain that control movement. An MRI of the brain might help in deciding if these are the areas affected.
3) It would be difficult nowadays to make this diagnosis. Depending on what diagnostic system you use, technically you could still qualify for a diagnosis with a normal MRI, but the vast makority of time eithe r anew or an old lesion is present on MRI, although sometimes they heal to the point of not being visible
4) If your SSEPS were normal and are now abnormal then id could be interpreted as a seperate event in time (there now not before) and place (this area not affected before)
2) The MRI is pretty sensitive for picking up deyelination, althjough less well inj teh brain stem and spinal cord than the brain. I don't know what the arm movements are but they might suggest inolvement of the nerve centers at the base of the brain that control movement. An MRI of the brain might help in deciding if these are the areas affected.
3) It would be difficult nowadays to make this diagnosis. Depending on what diagnostic system you use, technically you could still qualify for a diagnosis with a normal MRI, but the vast makority of time eithe r anew or an old lesion is present on MRI, although sometimes they heal to the point of not being visible
4) If your SSEPS were normal and are now abnormal then id could be interpreted as a seperate event in time (there now not before) and place (this area not affected before)
I have seen 3 neurologists, had a repeat brain MRI, repeat cervical MRI, T and L MRI's, all normal. All three neuro's told me I do not have MS. I feel like I do or something like it. I still have constant neck pain too. I had VEP's and SSEP's done this week. I don't have the results yet. The neuro who ordered these said he thought they would come back normal. I don't think so. It's just so frustrating to have so many problems and no answers.