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Punctuate lesions not definitive.

I have had neurological symptoms for about 10 years.  It gets worse, then resolves somewhat.  I had a 2-level cervical fusion in 2003 due to spinal stenosis.  Last year, I went to the neuro due to leg weakness, and cognitive decline.  I couldn't do simple math or find words.  My balance was off, and I felt like people at work would think I was drinking.  My GP suspected MS.  Neuro said MRI was normal.  It said 1 punctate lesion was seen, but not definitive.  Six months later another MRI with same + several new punctate  lesions.  Neuro said was within normal limits.  Radiologist suggested correlating with spinal tap, etc.  Neuro did not suggest spinal tap.  Fast forward about 6 months.  i have started to have this weird pulsatile sound in my right ear and my left large toe is numb/tingling and increases with walking.   I also have many "bulging discs" throughout my spine.  The neuro did a EMG and had neuropathy in my right leg.  Does this sound like spinal cord or MS?  Neuro says its all normal and I should be happy that my MRI looks so good.
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147426 tn?1317265632
Hi, and Welcome!  

Punctate lesions (meaning pinpoint lesions) can be important, but are often written off as due to age (How old are you?), du to high blood pressure, smoking, migraines and things like diabetes.  Do any of those things apply to you?  I am concerned that the number of lesions has increased in the last year.  Someone needs to pay attention to this.  They might mean nothing, but in combination of increasing neurological problems, they can't be dismissed with a good evaluation.

But, all lesions must be noted and kept in mind along with the symptoms that a person has.  Those little lesion that we can accumulate with age DO NOT cause symptoms.  The MRI was done to look for lesions, so why are we ignoring ones that we have?  Doesn't make sense.  It "could" be that the lesions are meaningless, but we don't know for sure.  Certainly the radiologist was thinking that MS was in the mix, since he brought up the spinal tap.

I gather that your cervical neck has been evaluated for recurrence of the stenosis.  Yes, this can happen with osteophytes growing around the fused area or occuring at another level.  You have several "bulging" discs.  that doesn't say much.  Merely bulging does not mean that they will cause symptoms.  Whether they do depends on whether they press on the spinal cord or not.  Most bulging discs are not symptomatic.

Were both of your legs weak or just one?  Did it ever improve?  How about the cognitive stuff.  Did it improve/return/remain the same?

The EMG is done to look for a peripheral neuropathy.  Apparently you do have one and,depending on where it is, could be the answer for the toe weirdness.

The pulsatile sound in your ear should be evaluated.  It's called puslatile tinnitus.  I recommend that you see an ENT specialist and have it checked.

Now, it sounds like you feel dismissed by your neurologist - like he is not taking you seriously.  Is this true?  Has he done a really thorough, head-to-toe neuro exam on you?  If you are not confident in him.  One thing that I would recommend before an spinal tap is an MRI of your spinal cord.  Has that been done?

Hope to hear your answers.

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Avatar universal
Nice to meet you.  I am 34 years old.  I am not very confident in my neuro.  He looked at me, had me walk tandem, touch nose, very quick and dirty MMT;  but my impression (and I have told him this) is that if I'm not completely unable to walk or move than he thinks I'M okay.  I was confident in my neurosurgeon.  

Let me give you some history.  I started having numbness in my right small finger and pain into my right arm in 1998/99, which lead me to my first MRI, which showed disc bulges into thecal sac.  This same neuro, thought that it was not enough to cause the pain in my right arm, muscle spasms in my neck.  The neurosurgeon thought differently and traction, PT and Vioxx helped for some time.  After vioxx was taken away the neck deteriorated and surgeon said I would be a quad if I didn't have fusion done.  A couple of weeks before surgery I woke up and tried to get out of bed, collasped due to numbness and weakness in legs.  Got better as day progressed.  Surgery seemed to make right arm pain better.  Other symptoms have come and gone, through the years.  I have been diagnosed with Ehlers Danlos Syndrome, due to joint hypermobility/pain/dislocations.  I have stress incontinence, but not sure if its relevent since I had it after my first child.  I seem to have increased numbness, weakness(always seems worse on my right side, which is weird bc MRI says Left is worse), a couple times a year.  My husband says it when the weather changes abruptly, usually around October and then in May.

Oct 2007, I went to my GP due to fear of cervical spine stenosis recurrence.  I was having weakness in arms and legs, worse on right side, imbalance, cognitive issues mentioned before.  I requested and got my entire Spine MRId and he requested and got my Brain MRId.  The cervical spine MRI said "developing increased stress at C4-5 disc space level, which is bulging posteriorly, possibly mildly and chronically effacing the ventral aspect of the spinal cord, but which is not severe enough to produce spinal stenosis.  Mild neuroforaminal stenosis left>right.  No cervical spinal stenosis.  
Thoracic spine impression says"Mild diffuse degenerative spodylosis.  Normal cord signal intensity.
Lumbar spine says "at L4-5 Mild AP canal narrowing and small central disc protrusion as well as posterior osteophytosis and disc complex.  Can not say with certainty that this compresses any of the descending nerve roots, but does contribute to some mild gutteral narrowing and there is mild bilateral foraminal narrowing."

So basically, my doctors said the MRIs were okay.  My neuro made me take B12 and folate and say I have a neurochemical imbalance and am just too intuned to my body.  They put me on Some aweful anti-depressant that made me dizzy and nauseous,  I think it was Cymbalta.  They did say to come back if I had any symptoms that came and stuck around, because most of my issues eventually resolved.  They are now coming back, as previously discussed.  The ARNP thinks the cognitive issues are due to me worrying about the sensation issues, that are no big deal as she has them too.  I have not been to any doctors in several months.  My constant symptoms is that if i flex my neck too much my arms will hrt and get numb/tingly worse R>L.  My cognitive stuf got significantly better, where i didn't feel "stupid  "anymore.  But recently, I have been having more problems again.  I esp noticed at work today, many word finding problems, walking into a room  to forget why I went in there, and many more typoes than usual in my daily notes.  So, am I nuts doc?
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147426 tn?1317265632
I don't believe we gain anything by seeing doctors that dismiss us.  Yes, it would be nice if they suddenly woke up and said, "Gee, you really do have something wrong!"  I'd like to hit the Lotto, too.

Was your spine looked at with an MS MRI Protocol to examine the spinal cord for lesions or was it done to esam the discs and vertebra?  There are big differences in how they do it.

My gut feeling is that you need a new neurologist who needs to do a thorough neuro exam and look at your problems with a fresh eye.  Also, make sure that you have had an appropriate MRI of the "spinal cord" and not just the bones.  A change from one punctate lesion to "several" lesions over 6 months is NOT normal.  Even if you had migraines it would not be normal.  the thing to look at there is whether the 2nd MRI was done on a better machine.  That can make it falsly look like the lesions are increasing.

Just some thoughts.

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Avatar universal
Such good questions.  The Spine Views were not specific to MS.  The first MRI of brain was on a 1.5 tesla,  but the second did not specify on the report.  They were done at the same facility, but two different radiologists read them.  My neuro, said that the second radiologist is known to be very picky.  I am about to call and get an MS neuro referral, so wish me luck.
The twitching eye, tingling big toe are driving me insane!!!  Thanks for your input.
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Avatar universal
Just looked at the CD-Rom of the 2nd Brain MRI and it says 1.5 T, so I think they were the same strength.  I got the Numbers for 3 MS Specialty groups in my State, about 100 miles away each.  1 each, in Jacksonville, Orlando and Tampa, Florida.  
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