What does this picture indicate?

[biowham]

Female, 40. Hx = autoimmune thyroid, thyroidectomy in April ’07. EBV, Aug ’05, sick 2.5 months. Paternal g-mother w/PPMS.

Onset, Oct 07, paresthesias/numbness, rt foot (has cont'd since, increasing in intensity; waken stiff and unable to use properly every morning. Slow but definite progression up calf). Vertigo, several episodes.

Jan 08: +Romb; hyperreflexia+clonus, rt leg; slightly hyper rt upper; NCT normal all limbs except for ½ CMAP on right vs. left hands; EMG normal all limbs. MRI, brain=several T2 hyperintensities, <3mm, more punctate, most in lt hemisphere. Spine: "mild" t-spine herniations (t6, t8) w/ arachnoid cyst also t6.

Referred for CT myelogram, LP: Both normal.

Neurosurgeons: No need for surgery. +Hoffman’s both hands, so not relevant (?)

Apr 08: F/u MRI, brain/spine—more punctate T2 spots visible, but different radiologist who called it “normal.” Tspine had “Nonspecific myelopathy” @ ~T4.

Ju ’08 on: Lhermittes, 1st noted after hot tub. Predictably triggered by heat and/or exercise. Extreme heat intolerance. Weakness, can't stand around for long. These symptoms persist. On exercise, I walk OK initially but gait degenerates considerably.

Ongoing: Since Jul ’08, fatigue, deepened by heat; trouble with stairs, especially controlling descent. Cont'd leg weakness. Cont'd Lhermittes (back lt thigh, rt heel, occasionally lt inner arm). Frequent night wakening with entire lt arm and hand numb; often rt hand, ulnar dist.

Dec 08: Spine (C,T) MRI—unremarkable. Arachnoid cyst “smaller.” Neurosurgeon released me from his care.

Dec/Jan: 2 back-to-back UTIs, persistent pyuria.

QOL: Too fatigued, especially on hot days, for my 3 young children. Pain and paresthesias distracting—before Oct 07, was effortlessly energetic and physically active. Short-term memory is FRIED; long-term OK. I’m a biology professor and teach, and have my students email me anything we discuss because I otherwise simply will have no memory of it.

Neuro confused. What do you think?

[Dr. Daniel Kantor, MD]

Bio,

Thank you for your explanation of oligoclonal bands and how they are not lesions -- you beat me to it.

"Oligo" = few; "clonal" = all the same, like "clones."

Also, I am glad you picked up on my comment "in defense of neurologists ..." and how it falls in line with all the historic "in defense" arguments.

I always fall back on literature, and we have been doing poetry readings at support groups. This is something we can try here if anyone is interested.

[biowham]

Espanol!? Realmente? Es mi idioma segundo...casi. Mi madre es profesora de espanol (y estudias medievales) a una universidad aqui, y por eso, puedo hablar y leer (y escribir) un poquito de espanol.

Thank goodness you have that fallback degree, Quix!

Bio

[Quixotic1]

Me, too.  I have  a Spanish Literature degree to fall back on.  I just have to translate everything first.  ;-))

[biowham]

Well said, Quix.

I also meant to comment to Dr. Kantor--isn't it good to know that we have our English degrees to fall back on if we need them? ;-)

Bio

[Quixotic1]

I agree that neurologists are like most specialities and, indeed, like most professions.  They represent an entire range of caring and skill from honorable and brilliant to uncaring and stupid.

On the MS Forum we advocate leaving dismissive, arrogant, and poorly educated  doctors behind and searching for one who will listen to you, look at you and think.  The "shopping" is not for a diagnosis, but for a physician who will try to help.

Our forum has a large number of people who have had horrifying experiences with their neurologists, as have I.  But, in the course of the last two years many have found those neurologists of whom Dr. Kantor speaks.  There would be no point in advising people to keep looking unless the qualities of compassion and intelligence were plentiful in the profession.

But, there really are some stinkers.

As for falling back on "anxiety" as the problem, that is often the answer of the dull mind.  

Quix

[ChunkyMonkeysMommy]

Well, once the old GP did the MRI to find the lesion, they were paying attention to it, just not wanting to actually do anything about it in a timely manner or send me on to specialists to figure out what it was. The biggest problem was that they basically FORGOT to tell me, before I left from the FIRST MRI, that the technicians saw something and requested that I be rescheduled to come back for a more extensive MRI (since they couldn't actually do more than the doctor had ordered) and they were supposed to scheduled me to come back before I left. This didn't happen until I went back to the doctor and they asked me about it, as if I was supposed to know. Then, the software/program at Cleveland Clinic (where the MRI was read) that they send all of their lab and scan reports through electronically was down and they supposedly didn't have the report from the second MRI, which was a lie. I called Cleveland Clinic and they told me that they DID send the report and that my doctor's office DID have it and had for several days. Even if it were true, there are still fax machines and telephones! Not only that, but my husband is actually a programmer for exactly those types of lab/hospital systems. He's on-call 24/7. They don't just let those things "break down" for days on end. In fact, if it goes down, which rarely happens, unless there's a problem with the client's server or something, the problem is always resolved within a couple of hours (if that) and he doesn't stop working until it is. They're not going to let a lab system, where patients' lives could be depending on those results, be down for days. Again, nonetheless, that's what telephones and fax machines are for. It was just a mess. Period.

As far as the bands and plaques, I understood all that stuff when it was first explained to me, I just don't remember now, lol. I suffer from CRS (Can't Remember S***). ;)

You are on thyroid replacement hormones, right?