help with dr. notes-any experts??? :-)

[mommajuju3]

Hi all. I just received copies of some of the doctor notes from my visits w/ the MS specialist. (for my own record keeping...and curiousity!)  I am still awaiting the results of my visual, auditory and somatosensory evoked potentials testing.  

Anyway, can anyone help me understand a couple of things. I thought I remembered him saying I had a slight hyper reflex? in my left leg, so I am just trying to understand if his notes are indeed what I remember him saying or if my memory is truly becoming a problem!!!!

Here are some of the notes:
      Deep tendon reflexes are 2/4 in the arms, 3/4 at the patellae, 2/4 at the rigtht ankle, 3/4 at the left. The left patella is also slightly more brisk than the right, and bilateral crossed adductors are present.  HAVE NO CLUE WHAT THIS 3/4, 2/4 means??  slightly more brisk--is that the slightly hyper reflex? No clue what bilateral crossed adductors are!!??

     There is no spasticity, but the right toe is clearly downgoing and the left toe is silent. Romberg sign is not present.
NOT sure what that means.

I am hoping that they will have results in this week on my EVP testing. They were not able to get my toes to twitch in the somatosensory test, which I know was discussed here on the boards recently as to why they do that at the beginning of the test!!!  Whether or not a lack of toe twitch is an important clue or not, I have no idea. But it was incredibly painful...I don't know why, but it was pretty much torture for me and I was glad it was the last part of the testing that was done!

Thanks if anyone can help with interpreting these notes!
Julie in Stressland

[AMO]

hi jUlie ,

not to butt in, but thought i put in some info i found.
I thought the silent responsee is normal. But i googled 'plantar  response' and the second linkk ..... neuro exam . com   has a short blllurb and video.
The paragrah mentions if there is downgoing one side, and silent other side that would be and abnormal exam.
I am guessing because they are not equal in both side.
I hope you feeling ok today, amo

[biowham]

Sorry, Quix...I've read them here so many times I figured they were in the health notes. Sounds like an example of dissemination in time and space to me, but probably doesn't matter if a lesion counter is involved.

Personally, I didn't have any trouble reading or understanding your info on the McDonald Criteria, but I'm probably not someone to norm to for that. Maybe you could give the greatest hits up front, with asterisks for people to scroll down and find your "editorializing." ? Dunno.

Bio

[Quixotic1]

The McDonald Criteria aren't in the Health Notes yet.  Do you think they are clear enough to be there?  I've gotten some feedback that I did too much editorializing in them, making the article too long and that this muddied them up.

BTW - you mentioned the response of having the other knee jerk when one knee is tapped.  That is also an abnormal response called called "spreading reflexes."

Quix

[biowham]

If you've had lesions and lesions that differ in time (a new one on a subsequent MRI) and space (different parts of the brain) and have clinical manifestations (spasticity, hyperreflexia) and have symptoms (facial numbness, etc.)...well, read the health notes on the McDonald Criteria. Have you had a spine MRI, specifically C spine and T spine?

Bio

[mommajuju3]

Wow! Thanks so much. Very easy for me to understand! (mostly anyway!!....my brain doesn't always understand stuff so well) .

That is really weird about the crossed adductor relex. He never verbally mentioned anything about this to me, ever, Only that one side was slightly brisk. I certainly never noticed that when he hit my knee reflex, that the other side moved. Is this something I would see, or would this normally only be something a Dr. would notice?

If not MS that we are looking at, what other neurological issue are possible? Is is possible for this to be abnormal and nothing wrong?  I am still awaiting the evoked potential results and due for a 4th MRI in July. Hopefully I will have some answers. It will either be something or he will be sending me on my way with a no MS diagnosis. He at one point was thinking MS, but the next MRI only showed one additonal lesion, which was quite small and in the frontal lobe. This resulted in him thinking that that one might be migraine related and the original one in the left cerebellar peduncle, may have been viral related and what caused my facial numbness.

I know from reading other posts that no one will think I am that weird by saying that I will be quite frustrated if my evoked potentials come out normal and/or next MRI comes out with no new lesions/changes.  Of course I don't want MS, I want answers and I am not afraid (well, ok maybe a little) but I am ready to take it on and get on with life. I feel like I am at a stand still, unable to really LIVE because I am living in he world of "not knowing".

My first post here gave a detailed report of my symptoms etc. Even some weird ones I've never got any answers for that might not even be related. Even the MS doc seemed a bit puzzled by the ones that happened prior to the facial numbness. Don't know if either of you ever saw that post---or care to see it now!!! LOL  

I do appreciate SOOO much that you took time to answer this post. It has cleared up much! I *should* have my evoked potential results back next week, per the MS nurse! Hoping for some answers!! Thanks to both of you!!!  
Julie

[Quixotic1]

Hi, You have gotten really good info.  Biowham is correct.

Any of the the reflexes that are 2/4 or 3/4 are most likely normal.  In this doctors use the 3/4 means "3 on a scale of 4".   Usually 3/4 means brisk, but not necessarily indicating nerve damage.  It is concerning though, as was said above, that the two sides were not "symmetric" that one side was more brisk than the other.

In the Babinski (also called the Plantar Reflex - the sole of the foot is also called the plantar surface)  the normal response in a small flicker downward of the great toe or no movement at all.

The Romberg is when you were asked to stand with your feet together and your eyes shut.  Maintaining your balance is the normal response.

Now, the "crossed adductor reflex" is abnormal.  It indicates a problem in the central nervous system.  And you have it on both sides.  In this reflex, when the patellar (knee) tendon is tapped, the opposite leg moves.  Specifically it moves in a way that shows the contraction of the "hip adductor."  This action brings the knee inward and causes a rolling inward motion of the leg.

Quick definitions:

Adductor - Pull in (ADD TO the stuff in the middle) The hip adductors pull the thigh in toward the midline of the body.  There is also a slight rotation inward at the knee.

Abductor - pulling away (Abduct, kidnap, carry away)  The hip abdductors pull the thigh out and away from the body or midline.

I hope this was clear and not garbled.  Quix

[biowham]

Hi--

Don't mean to step on Quix's toes, but I stopped by here and see your questions. I've asked that same question about the "silent" foot, and I've been told that it's considered normal. Only the Babinski's is abnormal. My right is silent and my left goes down, with some major encouragement.

The crossed adductors are abnormal. Looks like you're slightly more brisk overall in your left lower extremity (so you remember that correctly) and you've got this crossed adductor thing going on. A couple of possible findings that suggest more tests, which is what you've gotten. Wait and see what the evoked potentials say. That will add to your information.

Bio

[Quixotic1]

I'll answer tomorrow.  :))

Quix

[mommajuju3]

Thanks Bio.
I am still hoping Quix will be able to get back to this one...I mean....I did do my homework as requested!!! LOL :-)   I do understand about the Babinski's sign...so that it isn't present in my right foot, but what does it mean that my left foot is "silent?"  Is that there wasn't a response at all? Or is no response abnormal?

And I understand also what you are saying about the  bilateral crosssed adductors and how it works. Just not sure if you are saying that if mine were abnormal by the wording used in the dr's report, or justthe fact that it is abnormal if it jerks on the opposite side that is tapped.

I have no idea if I am even making any sense. I'm so tired lately. I think having my  kids out of school is wearing me out!!  :-0   Can't seem to get enough sleep!!!

Thanks a ton!!!
Julie

[biowham]

Hi, Julie--

Quix might not get to this, and if she does, she'll answer it better, but that is a reference to the Babinski sign. If they drag something kinda pointy across the bottom of your foot, and your toe curls down or just sits there, that's normal. If they do that and your toe goes up or toes spread out, that's the Babinski's sign, and it indicates problems rooted in the brain.

Romberg's sign is what they're testing for when they have you stand with your feet together and hands out before you and close your eyes. If you're stable, you don't have the sign. It's indicative of proprioceptive or possibly vestibular problems. If you start to fall even before you close your eyes, that's supposed to be a cerebellar issue (control of balance from the brain).

Your crossed adductor response (bilateral) means that when you get tapped on one side, you jerk on the other. It is abnormal, I believe. Quix can say if that's right or not.

"Brisk" is a way of saying "kinda hyper." But your reflexes don't sound that bad to me. What's more important in some cases is whether they're DIFFERENT between sides, rather than how hyper or not they are in general.

Bio

[mommajuju3]

Okay quix! I did my reading! Thanks for that info. I think I will do a little more searching on this site other than the message boards. (although they are really great!) I had not even looked anywhere else! That helped me understand a little bit.

Can you help me understand the  "right toe clearly downgoing and left toe is silent?"

Thanks for your help!

Julie

[Quixotic1]

Julie, before I answer your question would you go read the Health Page "Measuring Tendon Reflexes"?  The link to the health pages is in the upper right, directly under "Discussions"

After you read that my answer will make more sense.

Quix