What is the difference between spinal stenosis and cervical foraminal stenosis?
Symptoms: gait problems, falling (no dizziness) and staggering, burning pain and weakness in right thigh (need grocery cart to even get to the store), can
As usual, it appears, I have something to say, but it might not be helpful.
All of the good neurologists that I know look at the films themselves. They should be as good - or better - at interpreting the films. Obviously I think you need a second opinion. Was your neuro exam normal? Are your reflexes, sensation,etc normal? You have obvious symptoms of spinal cord disease.
How old are you?
Foraminal stenosis (was that the radiologist's final impression?) indicates a narrowing at the opening at the bottom of the skull through which the top of the spine passes. That opening is called the Foramen Magnum. (the Big Window or Hole) In your case you have bony growths, called "osteophytes" protruding into the spinal canal. It's a form of osteoarthritis of the spine. It wasn't clear from what you wrote if those bony protrusions appeared to be pressing on the spinal cord, so I can't tell you if that is your problem. It could be any form of myelopathy - or disorder of the brain or spine.
My mother had the same thing at a lower level (C5-6) and lost a huge amount of muscle strength and sensation in both her legs and hands. Her symptoms were identical to yours. Her MRI, though, showed massive pressure squishing the spinal cord into a crescent shape. She had the growths removed surgically and had some slight improvement, but she let it go far to long. Again, you need a 2nd opinion. It's also a problem which tends to get progressively worse. Find a good neurologist.
Foraminal stenosis is narrowing at the level of the base of the skull. It's a specific location of spinal stenosis which is a term for narrowing of the spinal canal at any level, ie, cervical (neck), thoracic, lumbar (lower back), etc.
I know what my mother has been through and I wish you the best. Either the first neurologist didn't want to give you his time or he isn't able to read the films. Either way he's not the doc for you.
Thanks, that was a lot more info than I got from the neurologist. As for the physical exam - well, he didn't even touch me! At least I now know that I'm not the hypochondiac he treated me as. I'll find another neurologist.
He had better not have billed you or the insurance for a physical exam. That's fraud and wow! yes, you need a different neurologist!!!! This guy needs some disciplinary action, all he agreed to do was read the MRI results to you. Quix
He billed Medicare and my HMO and I made a co-payment. I'm female, 56, and I am on disability for panic disorder, anxiety and major depressive disorder. I think drs see the mental problems and make some unprofessional judgements. For your laugh of the day - this neurologist also had a psychiatry diploma on his wall. I guess that makes him a psuch-neurologist. The only thing he did for me was to order a blood test for syphilis, since his diagnosis was dementia. Of course, it was negative. I wonder how much he charged for that piece of nonsense?
Medicare fraud is the most serious of all. But enough of that. The test for syphilis is only one of about a dozen necessary blood tests for myelopathy. You need a new neuro and a complete work-up. Dementia - which is not what your physical sypmtoms suggest - is a whole other topic.
Do you have access to a major, academic medical center? If so, try to get a referral there in the neurology department. Depression and anxiety are very common with the kind of physical things you're going through. I know both from personal experience and from my professional experience. You are going to have to be your own best advocate.
Sure wish I had seen this when it was new. After reviewing the initial note at the top, I see nothing wrong with the diagnosis. I agree with the neurologist, although I don't agree you should have been referred to a neurologist.
The first response to the original post, however, I do have to disagree with. First of all, foraminal stenosis doesn't involve the the Foramen Magnum...Ever.
Foraminal stenosis has to do with the small holes on each side of the spine, through which the spinal nerves exit. The primary thing you need to know is that spinal (central) stenosis will produce symptoms on both sides of the body due to narrowing of the canal which compresses the spinal roots on both sides. Foraminal stenosis occurs unilaterally (one side) because the narrowing is only occuring on that side.
I fail to see how the correction cited above renders the neurologist's conclusions of "dementia" and "nothing wrong" correct.
"1. Central to left paramedian C6-7 disk herniation effaces the left anterior thecal sac and cord. There is also evidence of bilateral foraminal stenosis secondary to prominent osteophytes."
The sac/cord are effaced by a good-sized disk herniation. Bony growths are causing stenosis at that level. Sounds like someone's got a root cause (ha ha) for a patient's dropsies right there. Doesn't read like "nothing" to me, and it didn't to the neurorad, either, based on the quoted notes.
I'm also bemused by your assertion that you "don't agree" with this patient's referral to a neurologist. She cites "gait problems, falling (no dizziness) and staggering, burning pain and weakness in right thigh (need grocery cart to even get to the store), can't walk heel-to-toe or stand on one foot, increasing clumsiness (dropping (without fumbling) glasses, containers, paper, just about anything)." Why do these symptoms not warrant a referral to a neurologist? You are presuming a lot here, it would seem, especially given that imaging findings indicate a neurological etiology.
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