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Family Medicine (Expert Forum)
Demyelination of unknown orgin
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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Demyelination of unknown orgin
by young at heart, Aug 04, 2006 12:00AM
I have been to several Doctors and there responses all come back to demyelinating disorder but nothing specific.
Symptoms started 1998 after lumbar surgery,leg weakness(not able to walk unassisted for 11 months,numbness legs,lost cordination of both arms and bilateral visual loss.Diagnosed with lumbar lesion partial transversal myelititis.
2004 symptoms came back severe and come and go,blurred vision most brought on by heat,persistant left eye pain,fatigue,numbness in legs,spasticity,rt drop foot,electrical shocks in bottom of feet.Buzzing in neck that radiates down my spine.Hands go numb when put in hot water,ice cold sensations of water dripping down legs.Ringing in right ear.Weakness upon exertion,rt leg drags after 50 yards of walking.When walking in the dark,I lose my balance and stagger side ways.Stairs are difficult to climb and descend.
I have had 2 brain MRI's---widening cortical sulci(occipital atrophy bilateral.1 occipital lesion which enhanced on post gad.MRI C-spine mild narrowing at c5-c7 no impingment.EMG/NCS l5-s1 radiculopathy.VEP borderline abnormal rt eye.All blood test are within normal range.Lumbar Puncture--highly elevated myelin basic protein (LP done twice 6 months apart and MBP still high)
Babsinski positive right side and absent rt ankle reflex ,knees reflex 3+ Lupus,Lyme,B12,Sjorgens,sclerderma,myeopathy,neuropathy
vasculitis,RA has all been ruled out at CCF.My neuro is treating the symptoms,stronger glasses has helped the deteriorating vision.I don't know which way to turn,take the wait and see approach,symptoms seem to be out of control and its hard to function.I'm only 40.Would these symptoms be from the partial transverse myelititis from 7 years ago?Would that lesion still be detected on a MRI? I hope I just didn't over whelm you,but this all has me confused.(one Dr stated I have PPMS,but I don't meet the criteria)
Thank You so much
Symptoms started 1998 after lumbar surgery,leg weakness(not able to walk unassisted for 11 months,numbness legs,lost cordination of both arms and bilateral visual loss.Diagnosed with lumbar lesion partial transversal myelititis.
2004 symptoms came back severe and come and go,blurred vision most brought on by heat,persistant left eye pain,fatigue,numbness in legs,spasticity,rt drop foot,electrical shocks in bottom of feet.Buzzing in neck that radiates down my spine.Hands go numb when put in hot water,ice cold sensations of water dripping down legs.Ringing in right ear.Weakness upon exertion,rt leg drags after 50 yards of walking.When walking in the dark,I lose my balance and stagger side ways.Stairs are difficult to climb and descend.
I have had 2 brain MRI's---widening cortical sulci(occipital atrophy bilateral.1 occipital lesion which enhanced on post gad.MRI C-spine mild narrowing at c5-c7 no impingment.EMG/NCS l5-s1 radiculopathy.VEP borderline abnormal rt eye.All blood test are within normal range.Lumbar Puncture--highly elevated myelin basic protein (LP done twice 6 months apart and MBP still high)
Babsinski positive right side and absent rt ankle reflex ,knees reflex 3+ Lupus,Lyme,B12,Sjorgens,sclerderma,myeopathy,neuropathy
vasculitis,RA has all been ruled out at CCF.My neuro is treating the symptoms,stronger glasses has helped the deteriorating vision.I don't know which way to turn,take the wait and see approach,symptoms seem to be out of control and its hard to function.I'm only 40.Would these symptoms be from the partial transverse myelititis from 7 years ago?Would that lesion still be detected on a MRI? I hope I just didn't over whelm you,but this all has me confused.(one Dr stated I have PPMS,but I don't meet the criteria)
Thank You so much
Doctor's Answer
by Kevin Pho, MD, Aug 05, 2006 12:00AM
, Aug 05, 2006 12:00AM
I am not a neurologist, so my insight into this question is limited.
You have clearly had a comprehensive neurological evaluation for your symptoms, including the MRIs, lumbar puncture and electrodiagnostic testing.
You can evaluate for various muscle-based neurological diseases with the weakness on exertion, including various causes of myositis. Obtaining muscle enzyme tests as well as a muscle biopsy can be considered.
Inflammatory myopathies (such as Guillen Barre) can be considered and discussed with your neurologist as well.
If the diagnosis continues to be non-revealing, obtaining another opinion - preferably at a major academic medical center - can be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
You have clearly had a comprehensive neurological evaluation for your symptoms, including the MRIs, lumbar puncture and electrodiagnostic testing.
You can evaluate for various muscle-based neurological diseases with the weakness on exertion, including various causes of myositis. Obtaining muscle enzyme tests as well as a muscle biopsy can be considered.
Inflammatory myopathies (such as Guillen Barre) can be considered and discussed with your neurologist as well.
If the diagnosis continues to be non-revealing, obtaining another opinion - preferably at a major academic medical center - can be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
