hi folks
hope you are all feeling ok ?
i got a copy of the report sent to my gp from the MS specialist
its a little long winded but here is what he found on my neuro exam
On examination today he had intermitent tremor of his right leg when seated,
optic discs appeared normal, full range of eye movements with horizontal diplopia to the right( the right eye contributed the false image), no facial weakness, tone normal in the upper limbs,
increased tone in the lower limbs with clonus, power normal in the upper limbs, hip flexion grade 4 bilaterally on formal but appeared satisfactory when heel/shin coordination.
hip abductors and adductors, knee flexors, knee extensors, ankle dorsiflexors,plantar flexors were all grade 5 on the bed, he steps backwards on romberg's test coordination was otherwise normal,
reflexes were 3+ and symetrical in the upper and lower limbs,plantar flexor with jaw jerk, hoffman sign was present more on the left than the right, no crssed adductor responses, joint position, vibration and pin ***** were normal.
i understand from your referal letter that he had previous MR imaging which has been normal. VEP'S were suspicious of an abnormality with aninterocular latency difference,
although both the responces could be within normal range. a lumber puncture was unsuccesfull.in getting access with a needle.
ii would agree that he does appear to have brisk reflexes and clonus,there does seem to be an element of overlay in terms of the tremor and also the apparent hip flexion weakness.
i have repeated his bloods today. i would like to reveiw his ongoing inestigations in particular to look that we have covered all of the causes of a non compressive myelopathy and i am likely to advise that we repeat the lumber puncture although i have explained that this may be non contributory.
and will see him in clinic in four months.
any thoughts guys
has he found anything that helps to confirm MS in the neuro exam
regards bairdy