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Neurology (Expert Forum)
Abnormal tilt test, intention tremor, other problems
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Abnormal tilt test, intention tremor, other problems
by LeeD, Nov 10, 2005 12:00AM
I am a 40 yr old female, in good health until this past Aug. At that time I had a large central disc herniation at L4-L5. Due to progressive loss of function in legs and recommendation by 2 neurosurgeons, had a discectomy & laminotomy on Sept. 27 - surgery went well. Initial recovery also good.
During the time I was experiencing the disc problems, I also had the sensation of feeling weak and that I would pass out if I did not lie down. I thought this would go away after surgery, but it did not. Examination revealed othrostatic hypotension. Tilt test results abnormal - normal during 1st phase and abnormal after administration of nitroglycerin. Heart rate first raced then dropped and blood pressure dropped to 70/40 in about 3 min. (Passed out). Symptoms improved can now stay upright longer but get headache on top of head if up too long. Occais. sharp shooting pains in head.
Started experienceing pain in arms, esp. after standing for long. Now I have an intention tremor in arms. Present in both arms and hands, more pronounced on left.
Problems walking, stumbling at times and legs cramping. Also burning pain in toes and feet - not sure if this is still from disk herniation or new. Feel that I have trouble concentrating, remembering, and some trouble with using wrong words or finding words.
Previously (this spring/summer) intermittent problems with blurry vision.
Is this likely MS or possibly MSA / something else?? What tests should I have done next? I am very scared, esp. of cognitive issues. Any advice appreciated.
During the time I was experiencing the disc problems, I also had the sensation of feeling weak and that I would pass out if I did not lie down. I thought this would go away after surgery, but it did not. Examination revealed othrostatic hypotension. Tilt test results abnormal - normal during 1st phase and abnormal after administration of nitroglycerin. Heart rate first raced then dropped and blood pressure dropped to 70/40 in about 3 min. (Passed out). Symptoms improved can now stay upright longer but get headache on top of head if up too long. Occais. sharp shooting pains in head.
Started experienceing pain in arms, esp. after standing for long. Now I have an intention tremor in arms. Present in both arms and hands, more pronounced on left.
Problems walking, stumbling at times and legs cramping. Also burning pain in toes and feet - not sure if this is still from disk herniation or new. Feel that I have trouble concentrating, remembering, and some trouble with using wrong words or finding words.
Previously (this spring/summer) intermittent problems with blurry vision.
Is this likely MS or possibly MSA / something else?? What tests should I have done next? I am very scared, esp. of cognitive issues. Any advice appreciated.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Nov 14, 2005 12:00AM
A single neurological disorder does not stand as the cause of your symptoms. You do need to get them evaluated ( I cannot give youa formal opinion over the internet).
An evaluation should include a full neurological examination - if this is normal it is encouraging that there is no serious neurological disease at the moment, tests for endocrine function such as over activity oof the thyroid gland, which commonly causes tremor, and can cause muscle problems.
The hypotension is probably not caused by a neurological disorder but should be followed and treated, by for instance with comression stockings, medications etc by a cardiologist or vascular specialist.
There is no clear indication of MSA from your post, but confirm this with the neurologist when you see him. Other tests that may be beneficial may be a cervical spine MRI (if there were problems with the lumbar discs, there may well be one with the cvervical disc, which can casue the arm symptoms) or an MRI of the brain (although the yield for this is low, if normal the cahnce that you MS is very low)
Good luck
An evaluation should include a full neurological examination - if this is normal it is encouraging that there is no serious neurological disease at the moment, tests for endocrine function such as over activity oof the thyroid gland, which commonly causes tremor, and can cause muscle problems.
The hypotension is probably not caused by a neurological disorder but should be followed and treated, by for instance with comression stockings, medications etc by a cardiologist or vascular specialist.
There is no clear indication of MSA from your post, but confirm this with the neurologist when you see him. Other tests that may be beneficial may be a cervical spine MRI (if there were problems with the lumbar discs, there may well be one with the cvervical disc, which can casue the arm symptoms) or an MRI of the brain (although the yield for this is low, if normal the cahnce that you MS is very low)
Good luck
it sounds like you may have vaso vagal syncope, this can be because your blood pressure is low, when you get up from sitting you need to do it slowly, drink plenty of water and salt your food. I have low blood pressure and have had stress test and tilt table and passed out to where they could not detect my blood pressure. I am unresponsive to all medicines to help me with this. I am going through test to determine whether i have MS.
I had an injury to my back when i was 17 i sometimes wonder if that is the cause, I have pins and needles in my arms legs etc, numbess and burning,basically odd sensations. recently discovered that i have vocal cord dysfunction. the brain fog is maddening.
I pray that you have someone to support you htrough htis time,
it defientley sounds like you have something going on in your back, i don't think that we ever really recover from a back injury etc. Have you been to any doctor to talk about the possibilty that you may have MS. i cetainly would go and see either a orthopedic or neurologist.
God bless