I am a little confused with my report findings. I have asked the doctor if it is more demyelinating or axonal, he said it is probably and axonal problem that is now affecting the covering of the nerves. What I've read online and looking at my report, it seems to be primarly a demyelinating more than an axonal.
Here are the findings of the NCV study.
Right lower extremity
PERONEAL- DML no response, Motor NCV no respose, Amp CMAP no response, DSL no response, Sens. NCV no response, Amp. SNAP no response.
POSTERIOR TIBIAL- DML 4.9, Motor NCV 43, Amp. CMAP 10
SURAL- DSL 4.3, Sensory NCV 35, Amp SNAP 20
Left lower extremity
PERONEAL- DML 7.4, Motor NCV 34, Amp. CMAP .20, DSL no response, Sens. NCV no response, Amp. SNAP no response.
POSTERIOR TIBIAL- DML5.5, Motor NCV 38, Amp. CMAP 15
SURAL- DSL 4.4, Sensory 34, Amp. SNAP 15
RT PERONEAL no response
LT PERONEAL 66.00
RT TIBIAL 65.17
LT TIBIAL 61.17
Summary of findings: No response upon motor stimulation for the right peroneal nerve. normal DML's for the right and left posterior tibial nerves. Prolonged DML for the left peroneal . Normal motor NCV for the right posterior tibial. Slow motor NCV's for the left peroneal and left posterior tibial. Normal amplitude of the CMAP's for the right and left posterior tibial. Decreased amplitude of the CMAP for the left peroneal. No response upon sensory stimulation for the right and left peroneal. Normal amplitude of the SNAP's for the right and left sural. Prolonged DSL's for the right and left sural. Slow sensory NCV's for the right and left sural, the left peroneal, and the right and left tibial. "F" waves had prolonged latencies. The "F" waves were absent for the right peroneal. The needle electrode sampling was normal.
Impression: These nerve conduction studies revealed the presence of a systemic sensory-motor peripheral neuropathy with demyelinating and axonal features. Her EMG was negative for an active radiculopathy.
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 a doctor.
Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.
Low back pain can be a result of many causes - some being a herniated disc. In most people, the pain of a herniated disk resolves over 4-6 weeks. The most severe pain actually eases up within 1-2 weeks. Only a minority of people ever require surgery. With time, the amount of disk that has herniated shrinks and with time resolves completely in most people. Therefore, for the majority of people, non-surgical treatment is the first option. This treatment may include medications (non-steroidals such as advil), sometimes steroids if there is swelling (edema), temperature therapy (hot or cold packs), stretching and controlled physical therapy, muscle relaxants, and so on, these are best prescribed by an experienced physician, each has its own indications.
In a minority of patients, surgery needs to be done urgently. This often is the case when the herniated disc is pressing on the spinal cord itself. Surgery is emergent so that permanent spinal cord injury does not occur. Another indication for urgent surgery is if there is evidence that a nerve is being compressed on to the point that its function is impaired. 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.
It sounds like you are getting the appropriate workup including the EMG/NCS. It also sounds like your neurologist is working you up for neuropathy.
It is difficult to provide another opinion or much more of an opinion since I do not know your complete history or examination. There are more tests that can be performed including lumbar puncture, paraneoplastic panel, autoimmune panels (ENA, ANA, etc), oral glucose tolerance, etc. You should continue working with your neurologist on his working diagnosis.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
41 years old
Height 5'11 Weight 140
Back problems since I was in my late twenties. Herniated discs at L/4 L/5 and L5/S1
Deginerative discs disease.
Some associated hypertrophy of the ligament flava and synovia of the respective articular factes. I was told that I have osteoarthritis by my regular primary doctor.
The Neurologist does not think that my nerve problems in my legs is being caused by my back issues. He has me listed as idiopathic at this time.
My lower back aches all the time along with my hips especially in the mornings.
He said he is not ruling out hereditary or the possibility of femoral promblem at this time.
About 2 years ago I started to experience tingling in my right foot mainly around the big toe area. Over the last year I began having mild tingling and numbness is both feet, ankles, and some in my legs, I get occasional burning sensations in my thighs especially in the right thigh. My left knee feels weak at times, it's when I take a step and then step off to take other step it feels like my knee is loose and wobbly. I don't know how else to describe it. My back issues started in my late twenties. When I wake up in the mornings my back, hips, and I guess you would call it the girdle the wing shaped bones that extends across your back, they ache and are stiff for a couple of hours in the morings until I get moving. My feet and legs also feel worse in the morings and improve as the day goes on, but the mild tingling, numbness and weakness is always present just not as bad as when I first wake up. The neurologist's examination, revealed absent DTR's on both ankles with stocking distrubution hypoesthesia, he also noted that I have high arches (pes cavus). All my lab work came back normal, diabetic, hypothyroid, vitiam B12, folate, paraprotienmia, ect. I do believe my symptoms have been worse over the past year, because I have been under a lot of stress with family issues and not much time to focus on myself. My nerve conductivity report findings are listed above. I just need someone elses thoughts about my issues I am having. It's hard to talk to family sometimes cause they just don't understand what it is like to feel this way.
If you have no response for sensory or motor stimulation of a nerve on nerve conduction studies does that mean the nerve has died? Also what would cause prolonged "F" waves of three different nerves at the same time peroneal, tibial, and sural in both lower extremities?
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