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Spinal lesions, tendon reflexes; beyond the Health Pages...
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Spinal lesions, tendon reflexes; beyond the Health Pages...

Hi, all, I know it's probably late in the day to be posting this, but I figure I can always bump it up tomorrow.

My latest 3T MRIs show spinal lesions, according to the radiologist's report.  I have long been curious about my "Hug" type symptom, radicular pain beyond the small disc protrusion in my lumbar spine, bladder issues, and more.

During my one appointment with my MS specailist during a flare, when she didn't record my increased symptoms, my reflexes (especially in my legs) were much more active that usual.

I've been looking at the Health Pages and googling, and can't seem to find my answer, so I thought I'd ask my question(s) here.

If a person has spinal lesions, both C and T spine, will the reflexes always be hyper, or do they change with the severity of symptoms?  Do flares cause changes in exam findings?

Could my "hug" symptoms, including spasms between my ribs that cause slight displacements of ribs be caused by these lesions?  I wrote them off as do to an old injury, but have been told that my old injury should not/could not cause such symptoms by orthopedic and sports and spine medicine doctors, as well as a neurosurgeon.  He suggested some nerve ischemia (?).

Just curious.  Thanks for your thoughts, ideas, your time in reading my late night wondering.  :o)

Kathy
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I don't have any firm answers for you, but I do have spinal lesions (or at least I had some pretty substantial c-spine ones six months ago and two years ago and have no reason to believe they've disappeared) without hyper reflexes. I just had a f/u exam for the trial I'm in last week and the neuro said my reflexes are abnormal because they are slightly uneven, but they are otherwise in the normal range.

If you have hyper reflexes, does that always mean a spinal cord problem? I'm not sure (and to lazy at the moment to go back and look at the health page).

I do have a mild (usually) ongoing hug sensation around the bottom of my ribs, although so far as I know it hasn't actually affected the ribs in any way. I also get banding sensations around my legs and sometimes my upper arms (if I bend them up).

FWIW.

sho
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Thanks.  It's nice to hear from someone with spinal lesions; thanks for letting me know that your reflexes are pretty much within normal range.  I take it they are pretty much the same at each exam?

Mine have pretty much been normal, or even difficult to get a reflex, but that one visit during a flare they were pretty hyper; it was a big surprise to me, but apparently didn't mean much to my neuro.

I have an ongoing (fairly mild) hug sensation that prevents me from wearing a supportive bra, plus at times I get the very painful tightness that makes taking a deep breath hurt.  I was in physical therapy during a few of those episodes, and my PT noted that my ribs were displaced.

At one visit, she massaged them back into place, took me to the gym, gave me an exercise to do that annoyed my spine, and I felt that tightness.  She checked my back, and had to massage my ribs back into place.  Weird, I know.  The pain and tightness stays, even after the ribs are back in place.

I wonder if anyone with spinal lesions, or anyone for any reason, has had changes in tendon reflex during a flare of symptoms?

Kathy
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It seems just the opposite thing is happening with me.  I've got 4+ reflexes, bilateral Babinskis, the MS hug occasionally, and leg (and arm) spasms like crazy.  All of these point to spinal lesions, yet I have none on MRI (just a bunch of brain lesions that don't light up w/ Gd.).  

This is how my neuro described it:
"A little kid is going along a wall with a sledge hammer and knocking holes in the wall.  Mom or Dad comes along behind and patches them up, but the wall is no less compromised.  The lesions we see light up on the T-spine or C-spine are made by a 20 lb sledge, while the ones we can't see are made by a 5 lb sledge.  The wall is still compromised".

I found this pretty interesting, since my neuro exam is very consistent.  The really funny thing was last November I had a lower extremity EMG.  When he (my own neuro) hit my left leg with the juice, my right leg jumped!!  It was like a Warner Brothers cartoon!  I thought it was funny as h*ll, but obviously he didn't.  Anyway, he says it's all part of the hyperreflexia.

Living in interesting times,
Guitar_grrrl
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I have a spinal lesion, and I am hyperreflexic in my lower extremities, more so on the right than left. Also hyper with Hoffman's in upper--more on right than left, and differential in different reflexes on the left. I also have crossed reflexes or whatever it's called when you hit the right and the left jumps. The one thing most neuros can agree on is that the hyperreflexia is spinal in origin.

Bio
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What an interesting topic!  Here's some of the skinny.

The spine carries ALL of the nerves that communicate between  the body and the brain.  Some of these are sensory nerves which only carry info about sensation FROM the body TO the brain.  Others are motor nerves which carry commands FROM the brain TO the body (like to the muscles).

The sensory nerve fibers run together in tracts (a tract is like a road that runs up or down the spinal cord) mostly in the anterior and central (medial) part of the cord.  The motor fibers run together in the anterior and lateral (on the sides) part of the cord.

A spinal lesion may be located so that it only affects sensory fibers.  In this case we may feel numbness or a paresthesia or pain.  Or a lesion may be located so that it affects only motor nerves and causes problems that involve the muscles that it runs to.  Problems with the motor nerves would be things like weakness, spasms, paralysis, spasticity.

OR a lesion may cross enough of the spinal cord to hit some sensory fibers and some motor fibers and cause a combination of sensory and motor problems - like is seen with Tranverse (meaning "across") Myelitis (inflammation of the spinal cord).

Now, reflexes are a normal function of the muscles.   We are supposed to have reflexes.   These aid in our normal coordinated muscle movement.  The reflexes work through a loop in the spinal cord and are kept under control by a command nerve from the brain.  With this command nerve the reflexes become too active.  A spinal lesion in the motor tracts may block the modulating or calming command signal and the reflexes of that side go wonky - becoming hyperactive.

All pathologically hyperactive reflexes are due to spinal lesions in the motor tracts.  Period.  But, you certainly can have spinal cord lesions that do NOT cause hyperactive reflexes.  An example of this would be a lesion that opnly occurs in the sensory tracts.

Do relapses cause changes in the neuro exam?

Usually but not always.  The answer to this depends on the neurologist.  By definition a relapse is a change or worsening of "symptoms."  So we "feel" or "experience" a change.  Differences may be detectable on exam if the new symptoms cause a difference in our sensation or our ability to move.  If the neuro is decent and smart they could do a very intricate exam to pick up all areas of decreased sensation, for example.  They would check soft touch, pain, hot/cold, vibration, pressure, etc and you would report if there were spots that were altered.  Unfortunately, many neuros do not seem to "believe" our reports of numbness or tingling.  If they can "see" it, it isn't real.

BTW - an area of pins and needles will not have full sensation and should show a change on a careful exam.  The reality is that few neuros take the time to check  and many just don't believe a patient report.

Relapses involving motor nerves gives more visible evidence of weakness, hyperreflexia, spaticity, spasms, etc.

Do reflexes always worsen with a relapse?  No.  Only if the relapse involves worsening of lesions that involve the motor tracts.

It is very unusual for ribs to displace.  If they are going to it would be at the joint where they meet the vertebrae.  Yes, an MS Hug is spasm of the muscles that involve the chest and ribs.  It makes sense that they would/could pull on the ribs and cause them not to move normally.  There are no joints in the ribs for a rib to "displace" except at the vertebrae and the sternum (breastbone).

An MS Hug would be due to a spinal cord lesion in the thoracic (chest) region.  Banding other areas would be due to the part of the spinal cord where the motor nerves for that area leave the cord.

This was fun.

Thank you Kathy for the topic, and GuitarGrrl for the wonderful explanation from your neuro.  We all learn so much when we share the knowledge that our docs give us.

Bio - I'm going to try to look it up, but it would make sense that the more spinal cord lesions that disrupt the various "command signals" from the brain, the more likely it is that the reflexes will be my hyper and be prone to "spreading" to include other reflexes like happens to you.  The other thing that happens is something called "clonus."  This is where what is supposed to be a single reflex jerk becomes more than one.  The reflex just keeps happening.

Quix
President and Founder of the Support Group for People Who Talk Too Much -
ON-AND-ON ANON
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Thank you very much for your awesome input.

My supposed thoracic lesion is at the T10 level.  Actually, the report says "There is at least 1 linear area of increased T2 signa at the T10 level".

My ribs do indeed move slightly out of place at the sternum and vertebrae; a few years ago a PT suggested I had Tsetse syndrome because of the intense pain that I had on the right side of my sternum, with pain continuing around to my back.

At times I can actually feel the little movement, kind of a grinding feeling, right where my bra would connect if I could wear one like that.  This happens after I get the spasms between my ribs.

GuitarGrrl, I like your neuro's explanation. :o)  BTW, I told my roommate about your gig in the San Francisco area, and she wished that she could have gone (of course, I would have loved to tag along!).  Her daughter lives in Danville, and I sometimes head down there with her to babysit her 3 grandsons.  Keep us posted when you're going to appear in public; she'll be down that way the second week in August, and who knows when else.

Bio, it is so cool that you know exactly what is going on with your body.  My stuff is not so clearly defined, and my neuros to date haven't been real good at explanations; they've been better at ignoring things, and alas, they never gave more careful exams to test for changes.  

Quix, as usual your response is something I want to print out and ponder at length.  Merci beaucoup!

Kathy
Charter Member
ON-AND-ON ANON
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I'm sure glad I took the time to read this one - great explanations here.  My PT last week observed that my ribs do not move like they should and I tried to explain the MS hug to her.  This gives me more to share with her this week.

And yes, I have c-spine and t-spine lesions to go with those holes in my head.

Lulu
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Just out of curiosity I did go through the records I have to see what my reflexes were in the past.

Neuro #1 (4 visits, 9/01-9/03) 3+ all, except at last visit where ankles were 2+

Neuro #2 (3 visits, 6/04-2/06) 2+ all, except middle visit where knees were 3+ (I couldn't tell any difference myself--are you supposed to be able to notice hyper reflexes at any time except when doctors are tapping you with mallets?)

Neuro #1 again (6/07) 2+ all

Neuro #3 (8/07) 2+ all

Neuro #4 (11/08) this is the only handwritten one and I am not absolutely sure about what it says except that one knee is clearly 4 (and I think the other one is, too). The ankles look like fives and the elbows might be fives (they mostly look like T's, but I'm pretty sure that's not the right answer and they look somewhat similar to the ankle fives).

That was the appointment where neuro #4 started me on baclofen. Anybody know if baclofen has any effect on reflexes?

Anyway, there doesn't appear to be any clear pattern to me, but on the other hand I don't really have obvious relapses.

sho
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Could you tell when the neuro's did the testing, looking back, that the reflexes were stronger when you got to the 4's and 5's?

I  just have to get the clinician's notes where she listed the numbers like that.  From what I've read, 2+ is normal, 3+ is brisk but considered normal, 4+ is definitely hyper; can't remember if it also includes clonus or if that's just 5.

I'd guess that my previous neuro put 2+ for all reflexes; she might have some surprises, though.  I'll find out.

Kathy
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Quix,

I probably should know this but i feel the narcotic, muscle relaxer haze, and feel I just cant think as well as I should

I am hyperreflexive at the knee and have spinal cord compression in the neck and thoracic area due to herniations, oseophytes, spond. ridges etc.  I also have in the thoracic area due to the nerve compression and cord compression the terrible sense of compression in my chest that is like a turniquet at times.  I too at times cant wear a bra and have radicular pain at the T7/T8 level.

I too have motor weakness in my lower extremities, very very bad at times.

My disease if you will is different. but the symptoms that involve the cord are very similar in so many respects with people that have lesions from ms, hence the mimic thing I guess, its so amazing when I read the posts.

So is hyperreflexia and other pain and motor weakness just caused by signal problems in the cord and compression of nerves in general,  regardless of  why the signal problem in the cord is occuring? ie lesions or compression?

Im sorry I am on percocet and zanaflex and klonopin at this moment as im writing this, and feel it probably lacks the eloquence necessary to make sense.  But I am amazed at the similarities.

Thank you for any input and/or clarity.

missy

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I think you are right about the reflex numbers.

Looking back, I don't remember a difference, although I wasn't particularly looking for anything. At the appointment where I apparently got the 4's and 5's, I was somewhat, how should I put it?, distraught, the appointment was mostly talking and the neuro just did a short perfunctory exam at the end. I don't remember doing anything wild, but I was a bit unfocused by that point. That's partly why I keep questioning whether I'm just misreading his handwriting, although I'm hard put to make them into any other numbers.

However, in terms of how things seemed to be going with my body, my problems did significantly worsen between the time I had the 2+ scores and the higher scores. I think of this period as time of the iceberg emerging above sea level. I had had gradually worsening problems for a long time, but they were rarely obvious externally--only if I had walked a long distance (like doing touristy things for most of a day) or had been in the garden (which has always seemed to have an effect out of proportion to the cause) or sometimes to keen observers (my brother once noticed me walking more slowly than everyone else on some stairs, although not so abnormally slowly that it was painfully obvious). At some point, there seemed to be an increase in the pace of worsening, I began to have more significant problems in daily life, and eventually I crossed some line where people began to ask me if I'd hurt my legs (I don't get asked that so much now. I'm not sure if it's because I'm walking better--which I think I am somewhat--or if it's because the people who know me well enough to ask all know the answer.)

It's a little harder for me to say if I've gotten much better since then since I'm now taking meds for symptoms and for me that confounds things. However, I don't know how I got back to normal-level albeit asymmetrical reflexes.

I still would like to know if anyone knows if baclofen can improve hyper-reflexes since maybe that would explain why mine seem to have gotten better.

Sorry, Kathy, that was probably way more than you wanted to know.

sho
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All right, maybe I did manage to answer my own question. In Google Books, there is a book called Handbook of Neurorehabilitation by David C. Good and James R. Couch (1994), which says, "In some patients, baclofen reduces tendon reflex hyperexcitability, but this effect is variable" (p. 207).

The 2002 book Clinical Evaluation and Management of Spasticity by David A. Gelber and Douglas R. Jeffery says that "The effect on deep tendon reflexes is controversial, with some authors suggesting a reduction, whereas others report no change of deep tendon reflexes" (p. 106).

So I guess the answer is maybe.

sho
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You are so awesome, I swear you just explained things that I have been asking about for 21 years... Why is it that some Neurologist will become so indifferent when you present at a form of MS that isn't "Text Book" This is what happened to me, even though I had at three major lesions on the brain with numerious minor ones and three on the spine, I had early onset of internal problems as well as legs that refused to move or hold me up-right, as well as heavy duty spasticy spasms that twist me in different directions that our bodies aren't meant to go. These ranged from my neck to my feet. Almost every single one of my Dr. said this just wasn't
the way MS worked.. I was on Baclofen for about 7 years before they discovered that it was partly do to the Baclofen that the internal spasms were so very strong, so no more Baclofen they had hoped to use it in the pump with the morphine, But it was ruled out right away. Now I am on 12mg of zanaflex 4x a day. It does help somewhat, but Dr. is concerned with the high doses.
My reflexs have always been all over the place. As for my ribs, Quix you are right it is a round the joints in the back where they broke. The spine is broken at L-2,L-3,L-4 some vertebra s have collapesed with slightly bulging disc.( foregive my spelling, I don't have spell check set up on Mom's laptop yet... Guess I should do that ASAP.
One more thing, do you have any idea which one would be causing the continual spasms in the Treche Area, that's why I have the treche tube since 1986-87?
Well Mom is ready to go out side, so I'll be signing off..
Happy 4Th to all of you from me, Shadow & my Mom....{{{~!~}}}
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