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Neurology (Expert Forum)
need some advice
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need some advice
by Udaysk, Mar 18, 2007 12:00AM
I am a 25y old male, Asian. I was dx'd with urinary retention about a year back and need to cath 4 times a day to empty my bladder. After about 6 months noticed sensory changes in sexual function, then two months later faced constipation. I have recently started to feel my left leg toes fan out whenever I lift up my feet + tremor in the shin/tibial muscle, can still heel walk though. Both my arms and legs are hyper reflexive 2+ symmetrically. Sometimes I get mild spasms in both my hands (simultaneously), pain behind both eyes on and off without any visual disturbances. I have no cognitive and gait problems.
I have undergone plain T1 and T2W FLAIR MRI of brain and spine at 1.5T multiple times and 3T plain sagittal screening of spine once with no detectable lesions. Had nerve conduction test done for PNS, CSF checked for various common pathogens/STD -all negative. My neurologist says that I don't show any clinical signs of MS as I don't have any upper motor problems and suggests that I undergo neuromodulation/LDDM to correct urine retention and protect kidneys.
I plan to approach a different neuro again. Would Gd contrast make a diff. at 3T for MS lesion visibility? Is it possible to have gross neurological deficts due to MS/infections without showing any lesions on MRI?
I have undergone plain T1 and T2W FLAIR MRI of brain and spine at 1.5T multiple times and 3T plain sagittal screening of spine once with no detectable lesions. Had nerve conduction test done for PNS, CSF checked for various common pathogens/STD -all negative. My neurologist says that I don't show any clinical signs of MS as I don't have any upper motor problems and suggests that I undergo neuromodulation/LDDM to correct urine retention and protect kidneys.
I plan to approach a different neuro again. Would Gd contrast make a diff. at 3T for MS lesion visibility? Is it possible to have gross neurological deficts due to MS/infections without showing any lesions on MRI?
Doctor's Answer
by CCF-Neuro-M.D.-SH, Apr 05, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms that you relate are concerning for a spinal lesion, and I can suggest a few other ways to approach this possible diagnosis. There is another demyelinating disease similar to MS called Devic's disease or NeuroMyelitisOptica (NMO) that is caused by antibodies to a protein called aquaporin 4. I mention this because this disease is demyelinating like MS, but predominantly affects the spinal cord and the optic nerves (it is also more common in asians). That being said, urinary retention is generally not the first presenting symptom of some one with demyelinating disease in the spine (although it is possible). Spinal demyelination generally presents with a 'sensory level' often a band around the body or a line on the body-that underwhich is numb/tingling. It is also common to have weakness, and bowel and bladder changes.
I would suggest that you get an SSEP (somatosensory evoked potential) which will test the 'wiring' in the spinal cord from your foot up to the brain. If a small or hard to see lesion is present in the spine, it will still cause a slow down in the signals along the cord. I would also sugges that you get a repeat MRI with Gadolinium contrast (many lesions may only show up with GAD contrast enhancement). I would also suggest visula evoked potentials (to evaluate for past optic neuritis) and sending a NMO antibody titer to evaluste for the possibility of Devic's disease.
I hope this has been helpful.
The symptoms that you relate are concerning for a spinal lesion, and I can suggest a few other ways to approach this possible diagnosis. There is another demyelinating disease similar to MS called Devic's disease or NeuroMyelitisOptica (NMO) that is caused by antibodies to a protein called aquaporin 4. I mention this because this disease is demyelinating like MS, but predominantly affects the spinal cord and the optic nerves (it is also more common in asians). That being said, urinary retention is generally not the first presenting symptom of some one with demyelinating disease in the spine (although it is possible). Spinal demyelination generally presents with a 'sensory level' often a band around the body or a line on the body-that underwhich is numb/tingling. It is also common to have weakness, and bowel and bladder changes.
I would suggest that you get an SSEP (somatosensory evoked potential) which will test the 'wiring' in the spinal cord from your foot up to the brain. If a small or hard to see lesion is present in the spine, it will still cause a slow down in the signals along the cord. I would also sugges that you get a repeat MRI with Gadolinium contrast (many lesions may only show up with GAD contrast enhancement). I would also suggest visula evoked potentials (to evaluate for past optic neuritis) and sending a NMO antibody titer to evaluste for the possibility of Devic's disease.
I hope this has been helpful.
Please be advised that I am not responding to you as a physician and that I am not advising you and that what I write is not meant to be construed as medical advice or a replacement from the forum neurologist, et al.
As you may know; Multiple Sclerosis is almost un-heard-of in Asian people. However, a taxing and similar, if not exactly the same, condition does not escape or spare different races and ethnicities. Lyme disease can present in the exact same way that you have responsibly and perfectly kept note of your health deficits.
Depending upon locale I would suggest finding what is commonly called an "LLMD" or an "LD MD." Both of these mean, Lyme Literate Medical Doctor. You may want to do some of your own research and seek support in the way of questions and answers at www.lymenet.org. You may also want to google the term, "Lyme disease and Multiple Sclerosis," where you will find that Lyme disease is a common but under diagnosed differential diagnosis for "MS." It is nearly impossible to tell the two disease apart. Many people believe that they are in fact-the same thing. This has yet to be determined. In general, the outlook for Lyme that is controlled by anti-biotic therapy is much more postive to that of socalled, "MS." This too could be debated by some.
Your symptoms, however, are variable and non-specific and can be caused my a multitude of conditions, if not, a combinatory effect (many conditions are once). Recent studies also show that lesions are no absolutely necessary to prove "MS."
I hope that I have been helpful.
Good Luck!
JCmcc.
From your description , you are describing a neurogenic bladder mainly with some sexual change isuues (is it erection issue? or ejaculation?), constipation, and a subjective sensory complaint....Putting them together means or give a possible diagnosis of subacute cholinergic failure which sounds progressive.
The differential diagnosis of this is very broad starting from a simple viral infection (wait and see issue) , rheumatological diseases (Most likly ruled out by your GP/Neurologist) , Neurological (almost excluded ), and few others could be very unlikely in your case especially you don't smoke and no history of loss of wt or loss of appetite..ext
You need to ask your doctor for a chest CT, and a better follow up on the constipation issue
Bob
Your personal attacks are absurd and disgusting. Some of us are medical students, some of us are simply educated because of our own disease and some us just know our STUFF. E.G. I know a dentist, two retired docs, and a few more professionals/students on here-who care. There is nothing absurd about my post.
Your post offers this person no help. Your comments are totally unkind-and-please, English teacher, where are the mispells? Your in need of help.
Heartless..
Talk about heartless.
THERE IS NOTHING FAKE ABOUT ME.
GET A LIFE.
AND--I HAVE HELPED SO MANY PEOPLE ON HERE, JUST ASK THEM.
FOOL!