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Clarity on MRI, NCS/EMG
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Clarity on MRI, NCS/EMG

My diagnosis came about as a result from a gunshot wound through the left elbow. The time progressed and the pain hasn't ceased so at the request of the the insurance company my Dr. ran a nerve conduction test. The results came back bilateral carpal tunnel and bilateral ulnar sensory neuropathy, which my pcp said was poly, or peripheral neuropathy. Blood work done, all pretty much normal. So it was left at idiopathic peripheral neuropathy.
After doing some research and realizing that problems that I have been having for years that I had just chalked up to normal everyday pain/ (getting too old for that stuff lol) and even changed jobs because my back and legs couldn't handle the stress any longer. I wanted to know if this was the root and what I could do to feel my age of only 33 instead of 70. So I was referred to a neurologist who did another nerve conduction/EMG and 2 MRIs and blood and urine tests. (blood and urine both fine) I then was referred to a neuro surgeon because of severity of carpal tunnel and the MRI results. One thing I don't understand is I am being sent to have a ct scan, and to see a hemotologist for what I thought was just to get blood drawn but I found out that I'm doing another work up with them as a dr. and not just a stick and leave.
I know this is long and I apologize for that, I just wanted to give a little background information because sometimes little things make a difference. The results from the tests I have so far are listed bellow, I really appreciate any help I can get on braking this down and then piecing it all together to figure out what it is I have if it can be covered by neuropathy or if its changed into something else. Again thank you for taking the time and your input!


MRI of the cervical spine without contrast

Date of Exam: 6/2/2012

Technique:

Sagittal T1
Sagittal T2
Sagittal Stir
Axial T2
Axial gradient echo

Clinical Indication: Neck Pain

Findings: There is nonspecific decreased T1 signal intensity within marrow containing elements of the cervical spine. Please see comments below.

The included contents of the posterior cranial fossa are unremarkable. Cord signal intensity is normal. There is mild degeneration of the C1/C2 level and thickening of the transverse ligament. Cervical alignment is maintained. Negative for procervical soft tissue swelling. Multilevel uncovertebral spurring is present. There is a posterior bulge of disc at C5/C6. Mild canal stenosis and mild left and moderate preferential right foraminal stenosis is present. There is minimal posterior bulge of disc at C4/C5.

At remaining cervical levels, canal and foramina are patent. There is dorsal epidural lipomatosis in the upper thoracic spine. There is nonspecific mild T2 prolongation in the C4 vertebral body centrally.

Impression:
1. Disc disease, described above with greatest disc bulge at C5/C6
2. Diminished marrow signal intensity on T1-weighted imaging, nonspecific. Consider response to anemia/red marrow expansion, smoking if applicable to this patient, less likely other marrow infiltrative conditions. CBC correlation recommended.
3. Nonspecific T2 prolongation in the central substance of the C4 vertebral body. This does not extend into the posterior elements or to the endplates. Atypical hemangioma is one consideration. Dedicated CT imaging could further evaluate. If unrevealing by CT, bone scan would be of diagnostic value.

Exam: MRI of the lumbar spine without contrast.

Date of Exam: 6/2/2012

Clinical indication: Low back pain

Technique:

Sagittal T1
Sagittal T2
Sagittal Stir
Axial T1
Axial T2

Findings:

Dorsal epidural lipomatosis present throughout the lumbar spine. This contributes to mild narrowing of the thecal sac. There is Circumferential epidural lipomatosis at the S1 level. The conus is normal in size and signal intensity. Lumbar alignment is maintained. Multilevel mild facet arthrosis and ligamentum flavum thickening is present. Negative for vertebral body fracture.

There is nonspecific decreased T1 signal intensity within marrow containing elements of the lumbar spine.

The abdominal aorta tapers normally. Negative for paravertebral mass. Congenital pedicle foreshortening is present throughout.

Broad-based disc bulge at S5/S1 results in mild preferential stenosis of the left neural foramen and of the left lateral recess.
There is broad-based disc bulge at L4/L5 with mild flattening of the anterior thecal sac.

Negative for other notable abnormality.

Impression:
1. Epidural lipomatosis
2. Congenital pedicle foreshortening
3. Mild lower lumbar disc bulges.

Nerve conduction and EMG

Descriptions
-Motor nerve conduction-

the left median nerve, normal
the right median nerve: [*wrist] decreased amplitude (1.6mV)
the left ulnar nerve: [wrist] prolonged latency (3.4ms) and decreased amplitude (2.2mV)
the left peroneal nerve:normal
the left tibial nerve: [ankle] prolonged latency (6.2ms)
the left H-reflex nerve: normal

-sensory nerve conduction-

the left median nerve: [2nd digit] prolonged latency(3.9 ms) and decreased amplitude (13.0uV).  [2nd digit]decreased conduction velocity (35.5m/s).

the right median nerve: [2nd digit]  prolonged latency (4.1ms) and decreased amplitude (13.1uV) [2nd. digit] decreased conduction velocity (33.8m/s).

the left ulnar nerve: [wrist-5th dig] prolonged latencay (3.7ms) and decreased amplitude (5.0uV) [wrist-5th digit] decreased conduction velocity (37.9m/s)

the left radial nerve: [wrist-b 1st dig] Decreased amplitude (8.2uV)
the left sural nerve: [14 CM] decreased amplitude (1.3uV)
the left superficial peroneal nerve: [ant lat mall] decreased amplitude (2.4uV) [ant lat mall] decreased conduction velocity (34.9m/s)

-F-Wave-
the left median nerve: normal
the right median nerve: normal
the left ulnar nerve: normal
the left peroneal nerve: normal
the left tibial nerve: normal

-EMG Findings-
the right deltoid C5-6: all findings are normal
the right triceps C6-7-8: all findings are normal
the right brachioradalis C5-6:all findings are normal
the right flex.carpradi C6-7: all findings are normal
the right Biceps Brac C5-6: all findings are normal
the right 1st dorsal Int C8-T1: all findings are normal
the right Abduc.Pol.Brev C8-T1: abnormal findings: Fibs.
the left deltoid C5-6: all findings are normal
the left triceps C6-7-8: all findings are normal
the left Brachioradalis C5-6 abnormal findings: Fibs. , High Amp. , Dur..
the left bicep brac C5-6: all findings are normal
the left flex.CarpRadi C6-7: all findings are normal
The left 1st dorsal Int C8-T1:all findings are normal
the left Abduc.Pol.Brev C8-T1: all findings are normal
the both C5 Parasp: all findings are normal

summary/Interpretation

The patient has bilateral carpal tunnel syndrome, left worse than right, and also the patient has left C5 and C6 radiculopathy.
1711789_tn?1361311607
Hi there!

The MRI has described diminished bone marrow signal which could occur due to a number of conditions, which could have been responsible for your symptoms. Hence you have been advised to see a haematologist for further evaluation if the bone marrow and to assess its normal function with formation of normal blood cell components. It would be best to discuss the situation and the management pan in detail with your treating haematologist.
Hope this is helpful..

Take care!
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