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Neurology (Expert Forum)
Thumb twitching
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Thumb twitching
by Udaysk, Sep 01, 2006 12:00AM
Hi,
I'm a 24 year old male. About 2 months back I was diagnosed with neurogenic urinary bladder. During one of the tests I developed a UTI for which I was prescribed Nitrofurantoin (300mg a day) & I was asked to take for 2 months. The doc has asked me to take only 50mg since about 2 weeks now.
I used to urinate by straining abdominally. Over a period of time it got worse and worse without me actually realizing it. As far I recall this problem started around 3-4 years back. My bowels are normal. I don't have any other problems.
I underwent MRI scans of the spine and brain. It was done without any contrast enhancement. The results are that I don't have any lesions and everything is normal except for a 'tiny syrinx extending upto D10'. The neurologist said the the syrix is a fluid filled cavity and I probably had it from birth and it was not something to worry about. When I mentioned MS, the doctor simply said "a MS patient having voiding dysfunction for years without lesions is not possible". The MRI scan reports reads out 'Limited MRI of the spine was done ...everything normal'.
A week back I changed to a different urologist who suggested that I might not be releasing my urinary sphinter and prescribed baclofen 10mg twice a day for 2 weeks.
Lately I seem to have developed a twitching in my left thumb. It seems to happen spontaneously when i'm not conscious of it. The moment I realize that it is twitching it ceases. I also have some slight numbness. My doc asks me to simply ignore these and get on with life.
I'm worried that I might have MS.
I'm a 24 year old male. About 2 months back I was diagnosed with neurogenic urinary bladder. During one of the tests I developed a UTI for which I was prescribed Nitrofurantoin (300mg a day) & I was asked to take for 2 months. The doc has asked me to take only 50mg since about 2 weeks now.
I used to urinate by straining abdominally. Over a period of time it got worse and worse without me actually realizing it. As far I recall this problem started around 3-4 years back. My bowels are normal. I don't have any other problems.
I underwent MRI scans of the spine and brain. It was done without any contrast enhancement. The results are that I don't have any lesions and everything is normal except for a 'tiny syrinx extending upto D10'. The neurologist said the the syrix is a fluid filled cavity and I probably had it from birth and it was not something to worry about. When I mentioned MS, the doctor simply said "a MS patient having voiding dysfunction for years without lesions is not possible". The MRI scan reports reads out 'Limited MRI of the spine was done ...everything normal'.
A week back I changed to a different urologist who suggested that I might not be releasing my urinary sphinter and prescribed baclofen 10mg twice a day for 2 weeks.
Lately I seem to have developed a twitching in my left thumb. It seems to happen spontaneously when i'm not conscious of it. The moment I realize that it is twitching it ceases. I also have some slight numbness. My doc asks me to simply ignore these and get on with life.
I'm worried that I might have MS.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Sep 03, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms you describe are unlikely to be related to MS. Your thumb twitching is likely a normal finding called benign fasiculation syndrome. Your unremarkable MRI also is reassuring. If concern of MS persist then you should have a lumbar puncture to evaluate for inflammation and proteins found in MS (Tortelotte panel, IgG index, oligoclonal bands).
The combination of syrinx, numbness and neurogenic bladder is more concerning. A syrinx is a fluid (cerebrospinal fluid) filled cavity that can place on the nerves traveling in the cord (can be congenital or caused by trauma, etc). This pressure often causes numbness and bladder dysfunction including neurogenic bladder.
I would recommend that you get urodynamic studies and possibly a sphincter EMG (you should discuss this with your urologist). I would also recommend that you get an SSEP (somatosensory evoked potential) to measure if there are signs of dysfuntion in the spinal cord across your area of syrinx. If symptomatic, a syrinx can be dealt with surgically.
I hope this has been helpful.
The symptoms you describe are unlikely to be related to MS. Your thumb twitching is likely a normal finding called benign fasiculation syndrome. Your unremarkable MRI also is reassuring. If concern of MS persist then you should have a lumbar puncture to evaluate for inflammation and proteins found in MS (Tortelotte panel, IgG index, oligoclonal bands).
The combination of syrinx, numbness and neurogenic bladder is more concerning. A syrinx is a fluid (cerebrospinal fluid) filled cavity that can place on the nerves traveling in the cord (can be congenital or caused by trauma, etc). This pressure often causes numbness and bladder dysfunction including neurogenic bladder.
I would recommend that you get urodynamic studies and possibly a sphincter EMG (you should discuss this with your urologist). I would also recommend that you get an SSEP (somatosensory evoked potential) to measure if there are signs of dysfuntion in the spinal cord across your area of syrinx. If symptomatic, a syrinx can be dealt with surgically.
I hope this has been helpful.
I'm sure he/she looked/examined your back to see if there is any abnormal hair growth, tags, or swelling before imaging you (Congenital anomalies which could present at your age with isolated urinary problem)
As you mentioned there is no other problems this includes youe sexual life (Sorry English is not my 1st language , so I ask directly)
About the syrinx it could be due to so many reasons including trauma, infection or ideopathic (no causative) and so far what you are describing is not typical of that.
In the end I will say the same as your neurologist its not MS and twiching or a short lasting sensory symptomes are all normal things.... do not be buisy with it
Cheers
Thanks for the help. In case my concern persists I'll ask my neurologist to prescribe me the tests.
The numbness & thumb twitching have developed only after I started taking medications for my bladder condition. Of late I seem to have started to get tingling sensations which sometimes feel like the hair in the arms/legs have stood up or like and ant is taking a trip on my skin. I don't know if this can be called as itching.
The only other thing that I recall having a problem is that I also suffered for some time with irritable bowel syndrome. When ever after semester holidays I started school again, within the first week I would get loose motions which would resolve automatically within a day. Even now whenever I go out with friends on a out of city trip I start bleeding. The doc says it might be related to bowel irritation to water changes.
I consulted my neurologist and he has asked me to take a blood test report and a nerve conduction test (I wonder if this is EMG?).
Can Nitrofurantoin have caused the Peripheral Neuropathy? I have been taking it for close to 3 months now.