viral myelits

[gabmar]

Hello, I'm 38yr old female. Diagnosis viral myelitis.  Sx started late Feb inc leg weakness, spasticity, sx bil but assymetric,  extreme fatigue, t-spine mri neg.  Late May sudden onset rt arm tremors, coarse, when arm supported,severe over 24hrs, now intermittent.  Early June evoked, blood, spinal normal.  Brain mri 2 lesions bil frontal lobes, rad said early demylination possibility, neurologist said typical of migraines. Mid June sudden exaccerbation leg sx with bil arm myoclonus, bil arm sensory dist.  Talked with neurologist, likely culprit of June sx likely due to cold sore.  Sound reasonable?  

My questions are:  Can "viral myelitis" attack in different areas?  Isn't there supposed to be some sort of demarkation of symptoms?  For example below the waist.  Are my symptoms considered to be "2 attacks" due to the fact there was time in between where sx resolved greatly, then "bam" back again.

Can there be a c-sp lesion in the absence of Lhermittes? Fingers feel very slighty "puffy and tingly on occasion when chin to chest.  Very slight though.  No csp mri done.  Sx have resolved again and are now again intermittent and mild (for example rt toes burn,numb on occasion, mild sensory disturbances).  Plan on having followup with my neurologist in the fall and maybe pushing a followup mri at that time.  

Any comments would be greatly appreciated.  Thank you for your time.

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

Presumably the diagnosis of viral myelitis was one of exclusion - ie no actual direct evidence of viral infection or virus was found? I'm not sure what evoked, spinal, bloods included. Symptoms in teh legs as you describe can occur anywhere from the L Spine or above, therefore a thoracic imaging study does not include a structural lesion. Also makesure contrast was given for the MRI.

Your symptoms seem suggestive of recurrent demyelinating events, so this diagnosis would need to be pursued further. MS lesions commonly occur in the cervical spine so this may be the origin of the myelitis. A coarse unilateral tremor can occur with MS. Paroxysmal movements can also occur, ?the bilateral myoclonus, in demyelinating disease. A cervical MRI and a spinal tap can investigate further. There would be rarer causes such as sarcoid, vascular disease, meningeal growths/deposits but much less likely.

Lhermittes is present is a useful symptom but is not always present.

[gabmar]

Thank you for responding. I apologize I should have added this. My sx started w/ extreme low back pain and weakness, thought i was coming down with the flu ( that achey, tired feeling) and I had fallen down the stairs due to weakness, lightheadedness, thought I had exaccerbated an old back injury.  I sought med attn for my back and that is when an urgent care provider suggested further testing (showed signs of cauda equina syndrome: areas of numbness, sensory disturbances in saddle area,pronounced leg weakness) felt a little better the next day but then I had the worse case of bronchitis and a sinus infection (no fever), basically I was sick for 3weeks. Spasticity, rt leg weakness and  debilitating fatigue followed after the illness.  I had a l sp mri which ruled out disc pathology by 2 different radiologists and my neurologist. Nerve conduction of legs normal. My t spine and brain mri were done with contrast, closed, 1.5 tesla. The evoked potentials were extremity and visual. The spinal tap was done with testing for ms, (o bands, etc), negative.  My bloodwork (all negative) ruled out b-12, lupus, syphillis, sarcoidosis, Sjogrens, ana, sed rate, can't remember the rest.... basically anything else that it could possibly be)  As far as myoclonus, at least that's what I think it's called, my arm would "jerk" abruptly kinda like a whole arm tremor, kinda wanted to drift toward midline, not frequent, happened in bed at night.  Rt more than the left. Started at the beginning of tizanidine, ? could that have been the cause?  This lasted for a few days and has not reappeared.

Hope this clarifies more.  Do you think it I should persue a followup brain mri and c sp mri in the fall at a recheck with my neurologist?  Thank you again.

[gabmar]

I'm sorry , I forgot to add, during the time when my myoclonus started I also had a hard time standing without tipping.  I needed to hold on to something to keep my balance.  I was not dizzy or extremely weak and my legs weren't "that" severe in regards to weakness and spasticity.

Thank you