spinal MRI needed?

Hello,
I have numerous symptoms listed below, but in particular I have parathesis and allodynia in various parts of my body,  including my scalp.  I've had two brain MRIs that were normal. Is it possible that there is an injury in my spine (located between my shoulder blades) could be responsible for my parathesis/allodynia symptoms above that area (i.e., my scalp)? I'm asking because I had a football injury there and I also tingle/hurt in that area frequently.

Thanks in advance, Jason


Key Symptoms:
Brain/fog dizzy persistent headache (6/06 to 2/07)
Sore/burning Butt (6/07 to present, gradually worsened over that time)
Cognitive Impairment: brain fog, clumsy (2-08 to present)
Bad floaters (4/08 to present)
Visual Snow (4/08 to present)
Parathesis, allodynia (3/08 to present)
Tinnitis (5/08 to present)
Esophagus/stomach pain (5/08 to present)
ALT strange (3/08 to 5/08 was high and then returned to normal 6/08)

Neuro Test Results:
1st and 2nd Brain MRIs w/o contrast (taken ~8/06 and 3/08, respectively w/o change, UBOs unremarkable), EEG, VEP taken 4/08, both normal

Blood work: std batery of tests all normal, liver and lupus panel normal, auto-immune tests normal. Complete viral testing, EBV and HHV5 high, otherwise normal

Lyme Tests (4/08-6/08): ELISA (negative, twice). Western Blot negative/inconclusive (repeated with same results: IgM +, but IgG -, but -- by CDC, ). CD57 was low (42) which indicates chronic Lyme by ILADS study.

[J T Junig, MD PhD]

This is another situation where it is tempting to try to explain everything from one source, but that is probably not the case.  To answer your question directly, no, a spinal cord injury at the level of your shoulder blades would not cause symptoms to be felt on the head.  There are many types of 'referred pain', where a lesion in one area leads to symptoms felt somewhere else, but there are explanations for the pain being felt elsewhere;  for example, a disc herniation in the lumbar spine can push against nerves at that location, giving rise to pain in the foot-- because the nerves carry sensation from that area.  In general, though, a spinal cord lesion (or spine problem that causes pressure on the spinal cord) will cause symptoms only lateral to or lower than the lesion (in a person standing with arms hanging at his sides).

Your symptoms are quite complicated-- the only thing that would cause all of the symptoms would be a psychiatric diagnosis like somatiform disorder.  This is NOT intended to be heard that you are 'imagining things'-- people have NO control over somatiform disorder.  I am also not saying I think that is the cause of your symptoms;  I think you probably have several things going on-- esophagitis related to use of ibuprofen to treat the pain, for example; a bump in ALT from a medication or a lab error  (particularly if it was an isolated abnormality); floaters from the usual source of floaters (I don't know any other term besides 'floaters')..

The cognitive symptoms (e.g. brain fog) and paresthesias, combined with pains in widespread body areas, points (once again) toward Lyme, especially given the inconclusive blood tests.
JJ

[jason80]

bump

[jason80]

Thank you for your detailed reply.

I just got some interesting results from an ID who tested for many viruses.  He thought I was rather high for EBV and HS-1 and has suggested Valtrex trial for 3-6 months (thinks that virus is more likely the case than Lyme based on blood work).  I also saw a headache specilalist who that that a chronic migraine could explain many of my symptoms (but probably not all) and suggested a 1-week trial of DHE to see if this sheds light.  

I feel I should try something (acylivir, antibiotics, or DHE), but am very confused how to proceed. Any advice would be appreciated.

Jason

[J T Junig, MD PhD]

Back to my comments about modern medicine, and the problems with everyone being a specialist!  Ideally, the two docs would discuss your case and decide which way to go.  In my opinion, you are paying 'big bucks'-- and every doc goes to med school for a reason-- so that he/she can deal with ALL areas of medicine, at least from a conversational standpoint.  I recommend calling the doc who seems to be the most responsive, and trying to get that person to have a conversation with the doc of the other specialty.  Those 'interdisciplinary' talks are sometimes very helpful-- and completely appropriate.  And necessary in this case.  

JJ