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Neurological Examination Questions?

Hi Guys,
I always seem to be able to rely on someone who is smart enough to explain what things mean on here and I always like to understand my tests, their purpose and their relevance to my "problems".

I will apologise in advance this will be a longer post.  

History:
I have had neurological symptoms for 16 years now with multiple MRIs of my brain and entire spinal cord. MRI is always normal.  I have also had lumbar puncture's done and Nerve Conduction Studies. Neuro number 1. told me I had MS and that he had clinical evidence to prove it, but MRI never confirmed and then he changed his diagnosis to probable MS but when subsequent MRI scans remained normal he changed his mind.

After many years of being stable and not having any progression and just getting symptoms when I was tired, hot or stressed I started to get some new symptoms (which I now wonder if they were or are due to migraine) as they are mainly sensory in nature.  I also feel my lower back is playing a role in my numbness in my foot and my spasms in my legs, but again a recent lumbar MRI was normal, so there was nothing to account for my symptoms.

At the moment I am getting terrible spasms in my thighs and backs of legs, these are painful and my toes will fan out and go numb, I am sure this is from my back.  My legs are so tight at the moment that it makes it difficult to walk, or even cross my legs, I am uncertain if this is spastisity or again from my back?

My latest thing that was happening was my hand was contorting and going into a weird spasm, it was not painful but would look weird and cause my hand to look like it had been in a vacuum pack, it would sink down in one part. This was happening a lot more frequently so I decided to get it checked out, My GP told me it was dystonia a movement disorder but my neuro whom  I sent an email to said it was prob just muscle cramps, so I told my GP who flatly disagreed with my neuro so then I was left in a total state of confusion so decided to get another opinion.

The GP I seeked the second opinion from was reluctant to say if it was dystonia or not, but carried out a very thorough neurological examination and found some abnormalities which some I have always had but I wondered about some of these and wanted some input.  And some of the things she found may be new.   I have been referred back to the neurologist.

I have a copy of the referral but won't type it all out, just the stuff I wanted to question.

It states Thank you for reviewing  Udkas whom I think may have progressive neurological issues requiring further investigation, please note my notes from today.

Her notes are 3 pages long here is some of them
Trendlenburg positive ( I have never been tested for this before)  I don't think it has any relevance to neurological stuff???)  I wondered about my back as I am sure my numbness etc. is possibly coming from my lower back.

Unable to stay steady on heel to toe walking (yep I suck at that) but I was too stiff to do it (spasticity?) maybe.
Hyperreflexic on left,
Left plantar response abnormal
Gait ataxic  (what can cause that?)
reflexes on right normal
left ** +
TJ +
SJ +
KJ +
AJ +

This is the bit I totally don't understand what it means or if it is relevant.
Decreased bone conduction on right (could not hear tuning fork in mastoid process) but some air conduction on left decreased when compared to the right.

Oh and convergent squints to both left and right (is this sometimes just normal or is this usually only associated with neurological things)

Okay I am done, any input most welcome.
Udkas.

10 Responses
1740498 tn?1328962585
Hi Udkas,

I can't help you with much of that, but I can help you with the tuning fork stuff.

She was checking for hearing loss, using a rather gross (as opposed to fine/specific) way). Sorry, I can't think of a more user-friendly word than gross. Word finding problems over here!

Air conduction would be when she holds the tuning fork near your ear but not touching you. You had some difficulty hearing it with your left ear, which might mean you have some hearing loss in your left ear. However, you don't know where the problem is until you try some other things.

Then she checked bone conduction, which you are correct would usually be at the mastoid process. But you have difficulty with the right side rather than the left. Decreased bone conduction would indicate a problem with the middle ear. Could be fluid or many other possibilities. And you heard through bone conduction better on the left side.. but better than what? Than your right ear... but you don't know how well your right ear heard. Or how much better.

I would be cautious about reading too much into tuning fork tests. What if she didn't strike the fork so that it vibrated exactly the same way for each ear? It is really imprecise. You want numbers when it comes to hearing.

I would make an appointment with an audiologist for a more accurate test of your hearing, even if you don't feel like you have a problem. It can't hurt to get it checked. At least audiology tests are painless. :)

I'm sure someone else can tackle your other questions better than I. I am the same as you: I want to understand all of my tests. No one is ever going to care as much about our health as we will. So we've got to stay on the ball. Good luck getting your answers.
Avatar universal
Hi,
Thanks for your response, I did have my hearing checked 12mths ago as my vertigo was so bad it was causing me major issues so I thought it would be a good idea to get my hearing checked.

The ENT Specialist I seen said I had hearing loss due to nerve damage in my right ear, so I am actually deaf in my right ear, I might see if I can get some copy of my notes.  They don't know what caused the deafness, I had an MRI done to check for tumors in my hearing nerves, all was normal.

Cheers,
Udkas.
1740498 tn?1328962585
Wow. I wonder if that neuro exam with the tuning fork was from before you lost your hearing in your right ear? If not, either it has come back or the tuning fork test is completely pointless. (I suspect the latter.)
Avatar universal
No my hearing has not come back, I can not hear out of my right ear, it will never return, I have been like it says I had what they thought was my first "neurological attack"
Sounds like the test was useless, if nothing else you have prompted me to get a copy of all my records from the ENT Specialist incl. my MRI of my brain, I see my neuro in a few weeks.  I doubt if I will get any answers.
562511 tn?1285904160
Bump
198419 tn?1360242356
Udka,

Is this a referral to a new neuro?  I do feel the results of the exam are important - i'm glad to know you went back though I'm sure it pains you to have to start over again.

Has your GP offered you anything in terms of symptom relief? At least in the short term?
Sorry for the new stuff, friend :( truly I am.
-Shell
1453990 tn?1329231426
Hearing and auditory issues are rough to diagnose.  Bone conduction better relative to air conduction can be mechanical, but decreased bone conduction leads me to think that a BAER might be in order.   Pontine lesions can effect hearing and motor skills.

The fact that the MRI can not detect any hyperintensities is kind of mote.  The exam should be leading the neurologist to expect that there is something there.  Just my opinion.

Bob
Avatar universal
To Cobob and Shell.
My current neuro's explanation is that I have had an episode of Transverse Myelitis and it is the reason for all my symptoms with migraine as well. He thinks I just have the two problems.

The GP I went to told me she was very concerned for MS, hence why she referred me back to the same neuro as he is a MS Specialist although he does general neurology as well as the MS outpatients clinic.  

He has prob done every test he can do and can prob only manage the symptoms, I guess I am so damn confused.  Every doctor who has ever examined me tells me that my exam is abnormal but every test I have done fails to confirm anything.  I end up feeling like a fruit loop and a time waster, but certainly I have some very weird and abnormal sensations and some left leg weakness and some bladder disturbances as well. YAY.

I guess I was trying to work out if other factors other than neurological could be causing my problems.

Cheers,
Udkas.
1453990 tn?1329231426
TM is less common the MS.  TM + Migraines would be even rarer.

As Quix has said "Common things are common, less common things are less common."  My favorite is a  Occam's razor  "simpler explanations are, other things being equal, generally better than more complex ones."  My favorite translation used in epistemology is "When you hear hoof beats, think horses. not zebras."

Bob
Avatar universal
My own gut feeling tells me that what I have is not just migraine, too much happening, it fits MS like a glove, the remittiing and relapsing, even the lhermittes and the heat intolerance.  Some could be migraine, but I never actually get a headache, just the neuro symptoms like the vertigo etc. and some weird like electrical zaps in my head.  I do think I have a cervical lesion as I get the lhermittes and it is my lower back that is sore but I have arthritis in my lower back.

I just would think by now for MS something should have shown up surely.  I keep searching for other neuro things but it fits MS the best in my opinion, I even asked the doctors if it could be stress and they have all said NO. but I admit this last round of symptoms has stressed me.

I never think Zebra's when I hear hoofbeats...lol
Thanks.
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