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Leg weakness/numbness

  : : I am a 35yo male.  I have suffered from a weakness in the left leg/ankle  for approximately 6/7 months.  Numbness in the lower left extremity is also prevalent.  My left leg sometimes feels jumpy, especially at night....
  : : I consulted my PCP, who referred me to neurologist.  My blood work was normal, no blood in the stool, etc.... blood pressure normal.  No bowel or urinary problems.  I have started walking with a slight limp on some days.  The problem seems affected by the type of shoes I wear or the amount of walking I do.  A walk in the mall causes problems.
  : : The neurologist performed an EMG on the LLE... results were fine.
  : : My PCP referred me to my orthopedic surgeon.  His conclusion, my reflexes were extremely strong in the lower part of my body.  My clonus in the right leg was about 6 beats, my left leg about 2 to 3.  Everything else seemed fine. I was diagnosed with sciatica about 7 years ago by this same orthopedic surgeon.  He feels my reflexes are hypersensitive in the lower part of my body...therefore he is sending me back to the neurosurgeon.
  : : Just curious... what could the problem be?
  : ===============================================================
  : There is insufficient information available (to anyone ) at this stage to make a definite diagnosis but a few things are obvious.
  : Clonus is known as an upper motor neuron sign, this means that it is generated by compromise of the nerve supply to a muscle somewhere in the brain or spinal cord, not in the peripheral nerve.
  : For this reason sciatica is not the cause of the problem because clonus is not a feature of sciatica. I do think you need to be seen again by a neurosurgeon or neurologist and have this reassessed, you will probably need an MRI scan of your brain or spinal cord or both, to clarify what is cauusing the problem.
  : It is possible to say WHERE the problem lies to some extent but not to sat WHAT the underlying cause is, it could be a simple as a disc high up in the spine which is pressing directly on the spinal cord itself rather than on a nerve root, which is what causes sciatica.
  I should have also indicated that the Babinski reflex exam was normal on both legs... if that adds anything to the discussion.  (In other words, toes pointed downward)

Dear Tim,
thank you for your question.
I agree with MM that clonus is a sign of upper motor neuron problem (spinal cord and above) vs. lower motor neuron (beyond spinal cord, that is the nerve root as it exits the cord all the way to the muscle). It the increased reflexes are confined to the lower extremities you will need MRI of your back *thoracic and lumbosacral level. Do you have bowel or bladder symptoms, sexual dysfunctions, in addition to your leg problems?
Good luck. If you live near Cleveland and would like to be evaluated here at the clinic, please don't hesitate to call us, 1-800-CCF-CARE.

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