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Neurosurgery (Expert Forum)
Cervical, Thoracic or Something Else????
Answered by
Nassim Abi Chahine, MD - General Neurosurgery
Beirut - Lebanon
Welcome to the International Neurosurgery forum. This forum is moderated by Dr. Abi Chahine who is affiliated with St. George Hospital in Beirut, Lebanon
Cervical, Thoracic or Something Else????
by missy142, Apr 18, 2009 10:50AM
Thoracic done 4/09 - T1/2 thru T4/5 RT paracen.disk bulge seen with impression on the ventral thecal sac. T7/8 RT sided post. disc herniation seen impress. ventral thec.sac. Cerv. MRI - 10/08 - C3/4 post. disc bulge with ventral cord abut, central canal sten.,LT side uncinate productive change, & LT foram. narrowing. C5/6 central disc adjacent osseous vertebral reactive edema with posterior disc hern., uncinate productive change, central canal sten., ventral cord impress. & narrowing of LT foramina. C6/7 post. central disc hern. seen with cent. canal sten., ventral cord impress. & bilat. foram. narrowing.- 2 epidural - symptoms returning.
L5/S1 hern-0 nerve involvement apparent.
HX: 3/08 experience severe LE weakness (OVERNITE), Rt ft numb, next day couldnt walk. Paraesthes. in outer lat. sole of rt. foot, groin, rt butt., LT ant. thigh-going on @ 2 months prior to LE weakness. Muscle weakness has relented some, but platead & able to walk @ 20 min before have to sit. Legs feel stiff, clumsy & spastic. No bowel or bladder iss.,+migraines, word find probs, paresthesias, muscle weakness, muscle aches in LE (bad), RLS symp, very tired. Do u think injuries in my thoracic area could cause the muscle weakness and paresthesias mentioned? Cerv.report worse but when cervical inj. was dx'd didnt have the LE probs just what I described in UE. Neither ortho said my neck is cause of LE problems even though impress on ventral cord. Ortho decids to do thoracic MRI to look for any herniations & lesions, etc. but I had done on low resolution machine-.6T no lesion would show up so im told. BRAIN MRI results: done on 3T - Several scatt. nonspecif punctate periventricular white matter signal hyperintensities maybe r/t migraines. Want to get another Thor & Cerv MRI with 3T res. to make sure no lesions? When theres cord impression do u lose ur abil to walk virtually overnight? Im seeing a neurosurg this week. do u think he would have better idea cause of LE muscle weakness? thanks!
L5/S1 hern-0 nerve involvement apparent.
HX: 3/08 experience severe LE weakness (OVERNITE), Rt ft numb, next day couldnt walk. Paraesthes. in outer lat. sole of rt. foot, groin, rt butt., LT ant. thigh-going on @ 2 months prior to LE weakness. Muscle weakness has relented some, but platead & able to walk @ 20 min before have to sit. Legs feel stiff, clumsy & spastic. No bowel or bladder iss.,+migraines, word find probs, paresthesias, muscle weakness, muscle aches in LE (bad), RLS symp, very tired. Do u think injuries in my thoracic area could cause the muscle weakness and paresthesias mentioned? Cerv.report worse but when cervical inj. was dx'd didnt have the LE probs just what I described in UE. Neither ortho said my neck is cause of LE problems even though impress on ventral cord. Ortho decids to do thoracic MRI to look for any herniations & lesions, etc. but I had done on low resolution machine-.6T no lesion would show up so im told. BRAIN MRI results: done on 3T - Several scatt. nonspecif punctate periventricular white matter signal hyperintensities maybe r/t migraines. Want to get another Thor & Cerv MRI with 3T res. to make sure no lesions? When theres cord impression do u lose ur abil to walk virtually overnight? Im seeing a neurosurg this week. do u think he would have better idea cause of LE muscle weakness? thanks!
Doctor's Answer
by Nassim Abi Chahine, MD, Apr 24, 2009 08:54PM
, Apr 24, 2009 08:54PM
I hope my answer will gives you full satisfaction. I know you are worrying too much but this is your right to do that; I want you to understand that in neurosurgery we are not yet IDEAL.. : ) of course as a nurse you know that !
You can do supplementary examinations like somatostetic evoked potentials to confirm a cervical problem. I am almost sure that your cervical pathology is more "talkative".
this is finally my opinion, please continue being in contact with a neurologist who can examin you accurately, because the clinical exam is the most important in this case.
best of luck
thank you for appreciating my opinion and for being confident to Medhelp
Dr Nassim
You can do supplementary examinations like somatostetic evoked potentials to confirm a cervical problem. I am almost sure that your cervical pathology is more "talkative".
this is finally my opinion, please continue being in contact with a neurologist who can examin you accurately, because the clinical exam is the most important in this case.
best of luck
thank you for appreciating my opinion and for being confident to Medhelp
Dr Nassim
