Severe Spasticity in Legs Weakness in hands

[Gallora62]

Hi, I am a 44 yr old female who was very healthy and active until a year ago.  I had a bad fall 2 years ago where I slipped on ice and fell on my face busting my chin.  From that fall I received stitches and pain med for jaw and face pain.  The pain receded after a few weeks. Jan of 2009 I notice stiffness, weakness in my legs. Right leg worser.   Also I developed bladder incontinence. Gradually I noticed that my right hand was weak and I couldn't straighten my fingers. Over months both hands developed weakness.  Currently both legs have severe spasticity, both hands are weak, cannot straighten fingers. Have seen 2 Neuro Specialists - MRI, CT, Lumbar Puncture and a battery of blood test. MRI showed Reversal of Cervical and protrusion in C4-C5 Significant protrusion in C5-C6.  However,  both Neuro's not completely sure of diagnosis.  Referred to Emory in ATL to see another Neuro Specialist this week. Thank you for any opinions.  

[Lama Chahine, MD]

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 your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

It sounds like you have weakness in the legs with stiffness and bladder incontinence. Your imaging findings as described above do not apparently explain your symptoms. In someone your age, symptoms such as yours could be due to various problems. If you have only subjective stiffness (without specific examination findings), this may all be musculoskeleta/arthritis symptoms.

As you may know, these are symptoms that can occur with spinal cord problems. One possibility relating it to your trauma is a spinal cord contusion (like a bruise) leading to your symptoms, though this would be expected to be seen on MRI, and would be improving rather than progressing. Other causes of symptoms of spinal cord dysfunction (what is termed myelopathy) include: demyelinating disease (as occurs with multiple sclerosis or other disorders; this would be seen on a good quality MRI), certain genetic disorders (such as hereditary spastic paraparesis), specific infections (such as HTLV), specific nutrional deficiencies (vitamin B12, copper, vitamin E; these are often associated with other findings on history and examination), vascular malformations (such as a dural AV fistula), autoimmune disorders (such as one called "stiff person syndrome" and another related to another antibody in the blood) and several others.

As you can see, there are many potential causes to your symptoms. Some could be ruled out with a normal (good quality) MRI of the cervical and thoracic spine. Others would depend on the history and most importantly your examination. You are on the right track with planned evaluation at a tertiary care neurology clinic.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[kranioslesar]

Do you have your MRI, CT results? How can your doctors not be sure about the diagnosis? Can you post MRI, CT sheets here?

[Gallora62]

I do have have the results.  The MRI showed protrusions  on C4-C5 and significant protrusion on C5-C6.  The CT scans were normal.  One Dr. referred me to Neuro surgeon-
Surgeon ordered another MRI and stated that based on what he saw the protrusions were not that significant and didn't think they were causing all my symptoms.  Hence the second  referral.