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Bilateral Ankle Clonus
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Bilateral Ankle Clonus

Since 1990 I've been suspected of having MS. MRI's do not support this although I have had confirmed Optic neuritis and an Afferent Pupillary defect in my Right eye. Also positive Evoked Potentials in Right eye only. Have had bouts os being wheelchair bound. Recently diagnosed with Subacute Combined Degeneration of Spinal cord, 2009.

Earlier this year, 2010, had a suspected exacerbation of the MS.  Neuro tests revealed Bilateral sustained Ankle clonus.

I have posterior disc bulges at C5-C6, T7 and L1 - L5-S1.  The worst is L4-L5-S1 which has started to impinge on the sciatic nerve causing all the known nerve pathways numbness, pain, ache etc. It changes from leg to leg and can last from minutes to several hours.

Could the clonus be caused by the disc problem's or perhaps the MS is beginning to rear it's head.  I am 49 y.o living in Australia, female who played numerous sports ( Basketball, Hockey, both Outdoor Cricket and Indoor cricket, Tenpin Bowling, Netball), at State level in the 70's to mid 80's and at the highest level for my associated clubs including Lacrosse, Cross Country running, Swimming and Diving also representing my High School at State Level in Cross Country Running, Javelin and Discus.

Could the stresses of my sports be a factor?
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

Ankle clonus is a rhythmic contraction elicited by forcefully dorsiflexing the ankle. It is usually a sign of heightened tendon reflex affecting the motor tracts from the brain that travel in the corticospinal tract. Clonus is not specific to any one disease or condition. The clonus can be related to the subacute combined degeneration you mentioned. This is a spinal cord lesion caused by vitamin B12 deficiency involving the posterior and lateral columns, which gives the characteristic vibratory sensation loss, paresthesias, clonus, weakness, and gait abnormalities. Vitamin B12 supplementation is the treatment.

The clonus could also be related to multiple sclerosis (MS) if the motor tracts of the central nervous system are involved. MS is an inflammatory demyelinating disease that affects the central nervous system. To make the diagnosis there are specific criteria, in which objective neurologic findings are present affecting two or more locations in the nervous system in two or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI of the brain with gadolinium and perhaps an MRI of the spine with gadolinium are also useful in the diagnosis of MS. I am not sure what MRIs you have had done, but if the MRIs are normal, it would be difficult to say you have MS. Also, lumbar punctures are useful to look for demyelinating markers. There is another inflammatory condition called Devic’s disease, which has characteristics of optic neuritis and cervical myelopathy and positive NMO-IgG antibodies that is usually in the differential of patients with optic neuritis.

Spinal disc herniations can cause radicular pain. This is caused by the squishing of the cushioning material from between the vertebra which may contact nerve(s). If the cord becomes compressed, you will find upper motor signs such as heightened reflexes. Symptoms suggesting the need for urgent surgery includes muscle weakness, loss of bowel or bladder control, loss of sensation, particularly in the pelvis and severe and progressive pain. Constant stress we place on our bodies is a contributing factor to the development of disc herniations.

I would continue working with your neurologist and medicine doctor to treat your conditions and monitor your back.

Thank you for using the forum, I hope you find this information useful, good luck.
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