Reccurence of sx

[gabmar]

Hello.  I am 39yr female with dx of tm in 3/05 following a viral infection.  All mimickers (b12, Sjrogrens, lupus, sarcoid, etc) have been ruled out.  Initial mri's (t,l sp) neg, lp neg BAER,VEP,SSEP neg.  No disc pathology or stenosis responsible for sx per neuro.  Neuro found hyper reflexes on rt, rt leg weakness, emg all ext neg.

1st attack 3/05 spasticity, rt leg weakness, parasthesia, dyasthesia, extreme fatigue, urinary freq, severe approx 6wks, then intermittent

2nd attack  5/05 rt arm tremors when arm supported, hand tremors, arm jerks, severe 24hrs then intermittent, faint L'hermittes at times, brain mri 2 lesions frontal, most likely migraine event per md

3rd attack  8,9/05  very severe leg pain, banding, spasticity, weakness, rt foot drop, severe (SEVERE) electric shocks down legs, half smile on face, arm jerks, rls, sx severe lasting approx 3mos  Repeat ssep positive both lower ext, repeat mri's  ( b,c,t,l) neg

I had almost complete remittance of symptoms for several months. Now again my sx are coming back, though milder than last fall.  

Can a post viral myelitis or tm act like this? sx on and off?  

Can there be "silent lesions" not visible on mri held responsible?  Only for a "significant" event to be found on mri.

At what point should I consult my neurologist for followup?  I have been on the dx rollercoaster a few times and would hate to "ride it again" for negative results.

Any insight would be greatly appreciated.  The forum has helped me before and I am truly grateful.

[jan]

It should have posted immediately.  Sorry.

[swoozie girl]

What day did you send your question? I posted a question 2 days ago & have yet to see it? I have a Dr's appt tom @ 1 & had hoped to get some feedback from my post. Does anyone know how long it generally take?

[CCF-Neuro-M.D.-SH]

First of all keep in mind that I am unable to diagnose you, since I am unable to examine you, this forum is for educational purposes. The symptoms you decribe are complex in nature, but could possibly be explained by a post-viral syndrome.  Transverse myelitis (TM) would be unlikely to cause jerking events or any symptoms involving the face (which is controlled by cranial nerves not the spinal cord).  After a viral infection, your body can form antibodies directed against your own nervous tissue (myelin mostly) and cause a variety of problems.  Generally speaking this causes fairly evident MRI abnormalities in the white matter of the brain and/or spinal cord and often volume loss.
   I am concerned that you are having a lot of jerking with your events.  I would recommend an EEG (brain wave test) to evaluate if you are having focal seizures that are causing your symptoms.  This could explain why your MRIs have been "normal", because a seizure focus does not always show up on MRI. Focal seizures can also be caused by a post viral syndrome, (effects of an encephalitis). This would also expalin the reccurent nature of your symptoms.  It is important to tell your neurologist if you have symptoms (specifically the jerking) while the EEG is taking place.  If not, you will likely need a more prolonged EEG (3-5 days) in orders to capture one of these spells.  
  The fact that your SSEP was "positive" means that the wiring from your brain to your leg was being disrupted at any point along the way, and could be caused by a number of pathologies. I would also make sure that your MRI imaging was with contrast, and if not have them repeated.  A repeat LP with tourtelotte panel would also be prudent at this time. I hope this has been helpful.