New Neurologial Problems...

[mary anne]

Good morning and thank you for this wonderful forum.
I am a 46 years of age with complications of Raynauds, hypothyroid, COPD,RA,DDD and spinal stenosis.  Drs. also are watching me to determine which mixed connective tissue I fall into - rash over chest, arms and back, low grade temp. 100 and have been scheduled for a Lumbar Laminectomy and fusion.  We've tried everything else, to no avail with pain at a 10, lower back,buttox, and radiating down to my knees. L4 L5 L5 Si to be done next week.  The stenosis is due to lateral recess stenosis from facet joint hypertrophy,  I also have the pleasure of stenosis and DDD in my cervical C6,7,8 which causes headaches and weakness in my hands at the thumb and end fingers.  But the Lumbar is first due to numbness in feet and weakness of legs.  I have also lost bladder control on occasions.  With all of this, I do manage to keep a possitive outlook and have learned to walk with a cane after a fall a while back, just didn't feel the ground or dragged the right foot.  A couple of weeks ago new problems popped up and I am wondering if something new is going on or if it's to be expected please tell me if you feel I'm going to an MS category or something else.  I now have a sensation on my scalp that feels as if my skin is raw, when I'm tired or drive a 30 to 45 minute distance I start to see double and have to fight to see objects directly, I am not constapated when before it was totally reversed (6 to 8 movements a day) Am haveing uriniary tract infections for the first time in my life and within the last three days, as I propt my legs up to rest I experience foot twitching, in the knees and total leg.  What happens is the leg will jump to the left about 3" all by itself.The first sign was when I would be trying to go to sleep and my whole body takes a jolt and it is very strong, as if someone was next to you and shoves you.  I am on procardia XL 60mg, levoxal 50mg, hydroxycholoroquine 200mg, Cytotec 400mg, Axid 300mg, Roxicodone 20mg and Ms Contin 60mg.  Can these meds cause this,  the only new one in the last month is Cytotec and Axid which I understand is for my stomach.  Please tell me if I have developed new news for my mixed connective tissue and are these new neurologial problems to begin adjusting to.  Thanking you in advance, MaryAnne

[CCF Neuro[P]MD,RPS]

Dear Mary Anne:

Sorry to hear about your back problems.  I really don't think that your symptoms of late are related to new onset MS.  Your alittle old to be experiencing MS symptoms for the first time.  Although one can not rule this out, because anything is possible the likelihood is very remote.  Your symptoms can be the result of the medications or changes in your upper cord.  I would say that the most likely thing is the medications.  Tell your physician about what your experiencing and see if minor changes in the medication will help your symptoms.

Sincerely,

CCF Neuro MD

[maryanne]

Thank you so much Dr.  I am grateful for your comments.  The onset of my systoms began in 1994, 6 years ago when I was 40, would that have any bearing on the MS opinion?

[CCF Neuro[P] MD, RPS]

Dear MaryAnne:

We have seen patients present in their 40's but usually the signs are classic and the MRI is also very classic for MS.  I still do not thing your symptoms are MS, but I could be wrong.  Your spinal problem and medications are the most likely problems.

Sincerely,

CCF Neuro MD

[maryanne]

Thank you, you have made me feel much better.

[Deborah---Mary Ann's symptoms-URGENT]

Dear Dr.

Mary Ann is describing Cauda Equina Syndrome to a T with her back and leg,drop foot, bladder problems and change in her bowels with constipation.  

I have Residual Cauda Equina Syndrome myself and recognize these symptoms.  I am shocked that you are not recommending that she see a Neurosurgeon immediately.  I know she is schedule for Lumbar Fusion next week, but I have to wonder if her Dr. is aware of Cauda Equina Syndrome.  I know this is a rare syndrome, but please encourage her to get a second opinion and not postpone surgery as she is risking permanent nerve damage!  

Please look at her her description again of her back, leg and bladder problems and isolate them from everything else, don't you agree she has Cauda Equina Syndrome?  Please help her!

[CCF Neuro[P] MD, RPS]

Dear Deborah:

Thanks you for your concern.  First, I have to assume that what Mary ann is telling me is factual as I did not get to do the neurological exam or see the films.  Second, although muscle weakness is present in Cauda equina syndrome, it is usually (most often) unilateral and not bilateral, as Mary ann described.  Again, sensory changes are also unilateral and not bilateral as Mary ann described.  Sphincter involvement occurs, although it is a late finding, and Mary ann did not describe any sphincter problems.  Within the differential diagnosis is tumor, hemorrhage, disc problem, pelvic fracture, and spondylolisthesis.  Of these, the spondylolisthesis is the most likely given her symptoms.  The MRI was also pointing in this direction.

Sincerely,

CCF Neuro MD

[Deborah to CCF Neuro MD]

Thank you for you response to my concern for Mary Ann.  When I herniated the L4-L5 disc I had severe back pain and pain running the length of both legs to my feet. I described it as feeling like a "stick person" in my legs.

However, as you stated the muscle weakness and sensory changes were in my right leg only.  Beginning in my toes and eventually encasing my entire right leg and resulting in dragging/dropping my right foot.  Additionally I had what I referred to as stress incontinence, but no problems with the bowel or sexual function.  

So I now see clearly what you are saying. Thank you for responding and Mary Ann...good luck with your fusion!

[CCF Neuro[P] MD, RPS]

your welcome.

CCF Neuro MD

[yvonne]

why are you tested for carbamazapine levels in blood,and what should the level be

[CCF Neuro[P] MD, RPS]

Dear Yvonne:

Carbamazepine is an anti-epileptic medication.  It is used in epilepsy, but some people find relief from restless leg syndrome, neuropathic pain, besides seizures.  Levels are obtained to see what concentration is in your blood, someone not taking tegretol or carbamazepine should have no levels.  Therapeutic levels for carbamazepine have been estimated to be in the 4-12 level (depending on what your lab estimates values at).

CCF Neuro MD