Re: Myelitis and questionable MS?

Posted By L. Collins on June 09, 1999 at 10:12:44
To begin, I am a 27 year old female with a history of spinal meningitis as an infant, but no other Neurological problems.
I have been suffering on and off with pain in my right arm that radiated from my neck down to my fingertips since May 1998.  I was treated for Myofascial pain in my neck and shoulder area with cortisone shots.  But within a few weeks the pain would come back and usually even worse.  The pain subsided from December through February, but I was not working very much due to planning my wedding in February.  
At the end of March 1999 I had a sharp burning sensation pain run from myneck down my right arm and my arm went numb and my hadn went ice cold.  This lasted for 48 hours, in between which I went to the emergency room and their first thought was a pinched nerve.  They put me on predisone, but it had no real effect.  
Finally after much disbute with several doctors, I finally got them to do an MRI.  What they found they did not expect.  I do not have a pinched nerve but a lession the linear length of my cervical spine.  They then followed up with a dye injected MRI of my brain and my neck to check for MS and they did not find any other lessions.
By the time I was referred to a Neurologist, I was having the pain and burning sensations in both sides of my upper body, but no severe muscle weakness.  But the right side is weaker than the left and I am right handed.  The Neurologist ran a lot of blood work and did a spinal tap, but still found nothing.  She first tried amitriptylene, but I had bad side effects from it.  She put me on a full 7 day pack of methylpredisone, but still no real change.
During all of this I was put on Noritriptylene 20mg, Feldene 20mg, Restoril 20mg and Vicodin.  
I am continuing to have cortisone shots in the trigger point ares which are all over my upper back down to my shoulder blades.  Plus I have physical therapy twice a week where they use myofascial pain release massages.
Recently I have experiences several times a burning and sharp shooting pain down my right leg.  This left my muscles in a spasm and left me limping for two days.  I returned to the neurologist and she felt that this was typical for a myelitis diagnosis.  But she took me off the Restoril and put me on 5mg of Valium on May 28th.  
Since then I have still experienced the numbness and burning sensation in both of my arms and in my right leg.   The numbness and burning sensation usually run from my neck down my arms, but recently has started in my fingertips and gone up my arms.  I do not have any paralysis, which I am thankful for.  But I have a constant dull pain and when it gets too bad I have to take Vicodin, which only masks it some.  
Does this sound like MS or is it some strange virus that caused myelitis that will never be diagnosed?
Should I have other treatment and what about a second opinion?
Also I find it strange that they have not requested an MRI of my whole spine, should I request that they do one?
Thank you for your time.
L. Collins

[Ghia__0]

Posted By Ghia on June 09, 1999 at 18:36:03
Hi Miss Collins,
Your symptoms may be suggestive of arachnoiditis. Meningitis can be a cause of this disease which is an inflammatory process affecting the spinal cord and its membranes. The diagnosis of arachnoidits is both difficult and controversial so you will have a hard job pursuing this line of inquiry. Look it up or ask your doc. A good web site is WWW.earthlink.net/~zani2u/adef.html    Good luck.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on June 10, 1999 at 21:04:33
Dear Ms. Collins:
Sorry about your parasthesias and weakness.  I am not sure what sort of lesion in the cervical spinal cord you are talking about.  Was the lesion hyperintense, did it enhance with contrast, was it hypointense?  The treatment you received should have been treatment for either MS or myelitis and since you did not respond, it may indicate that you do not have either or that the dose was not sufficient.  Some of the symptoms you have are of the MS type, weakness, some sensory loss with a waxing and waning.  The MRI in most all cases correlate (but not always) and the CSF is also usually diagnostic.  Since both of your test were negative and the steriod gave you no relief, it does not sound like MS.
Since I do not have the advantage of a physical exam or knowledge of lab work, I think I would seek a second opinion.  Whatever the lesion in the cervical cord, you need to know what caused it.  Furthermore, you need to know if it is getting worse or better.  If it was myelitis, there should be some positive labs that were abnormal such as CK or sedimentation rate.  
I would push for an etiology.  Second, I would not just try and mask the pain with pain killer if possible.  Neurontin might be a good choice, it has good pain relief without the side effects of narcotics.
Sorry I can't be alittle more definitive.
Sincerely,
CCF Neuro[P] MD










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