About 5 months ago I ruptured by achilles tendon and as a result was in a cast and had to use two crutches to move around. About 3 weeks after this incident, one evening I noticed my left leg was numb. By following morning the numbness had spread to my entire body below my waistline.
My achilles tendon healed about two months ago and I discarded crutches around the same time. However, the numbness below the waistline has remained and has increased to some extent. In addition, I now feel considerable stiffness in both legs and feet.
I have seen two neurologists and have undergone a series of MRIs, xrays, somotosensory, blood and CSF tests. The physical examinations conducted by the neurologist were normal and, therefore, the numbness sensation or sensory disturbance (not true numbness) was suspected due to a spinal cord lesion around T11 level. One neurologist said that somehow I appeared to have damaged my spinal cord whilst walking with crutches!
MRIs of the cervico-thoracic spine and brain were normal and no lesion or spinal cord compression was evident. All the blood tests, chest and lumber xrays were normal. The CSF analysis showed a slightly high protein level, which itself was stated as non specific. No oligoclonal IgG was found in either the CSF or serum sample. The somotosensory evoked potentials in the arms were normal but those from the legs are abnormal, however, not in a way that allows them to be specific as to the pathology or the location of the problem.
I am extremely worried and would be most grateful for any suggestions or review of problem.
While neuropathies can occur due to compression in a cast, they should remain localized to at or below the cast. The more widesprad nature of the symptoms would suggest a more diffuse disorder or as you mention a problem in the spinal cord (myelopathy). The stiffness in teh legs would suggest the spinal cord, and a full workup would include looking for coindenctal (to the injury) causes due to metabolic/vitamin/infectious/immune related conditons, as well as a structural lesion on MRI. I do not know if these have been looked for. In response to injury/trauma, somtimes the immune system attacks teh peropheral nerves and causes weakness or sensory symptoms that start int eh legs and workup over 2-4 weeks, then subsides - termed Guillan Barre syndrome, the increased CSF protein would be consistent with this. Discuss this with your doctors. In most cases it ersolves, but sometimes symptoms persist, and sometimes gets worse (although not after 4-6 weeks) and involves breathing, swalowing etc
Just to add to my summary of the problem above, I am a 54 year old male, 5ft 7in height and weighing around 175lbs. No significant health problem but has had neck pain over a long period of time (20yrs +). The cervical MRI did show minor annular disc osteophyte bars at the C3/4 to C6/7 levels and narrowing of the right C5 and both C7 neural foramina without evidence of root impingement.
Did you take any fluoroquinolone antibiotic up to one year prior to your achilles' rupture?
Quinolone antibiotics are extremely well known for causing extremely debilitating and long lasting (and permanent) tendinitis, stiffness, soreness, neuropathies and above all rupturing tendons, with a preference for the achilles.
Many times, the damage is caused months after completing the treatment.
Quinolones of this class are cipro, levaquin, avelox and others.
I have these symptoms too and as of yet have not gotten a diagnosis. I will be seeing my 3rd neurologist next week. My appt. is at CCF. It's terribly frustrating and depressing and frightening. I thought I read somewhere that elevated protein in spinal fluid could indicate an infectious process.
Johnflox - I have not taken any antiboitics, including fluoroquinolone antibiotic during the last two years. Also, I have not been prescribed any medicine since the onset of the numbness as the neurologists have not been able to find any cause!
Patsy10 - Do you have exactly the symtoms I have, ie. numbness and stiffness below the waist line? When did you first noticed your symtoms? Concerning lyme, it has not been looked into as I do not have any typical symtoms for lyme.
My symptoms started after my neck surgery. I have numbness,tingling, leg weakness, stiffness, burning sensations. I have tingling in other areas too.
Lyme does cause the symptoms. Do a google search on it.
I have seen 3 neuro's and have had MRI's of brain, cervical,thoracic and lumbar spine. All normal except for the disc. No one can find anything wrong. The neuro who answered your question said possible infectious cause under his response.
Thank you Doctor for your comments posted on 19/12/05. Since I posted my original query, I have had an MRI of the lumbar spine done and a number of anomolies have been picked up. As the MRIs of head, cervical and thoracic spine had been largely normal but this lumbar spine MRI is showing some problems, I wonder the reason for my numbness below the waist line could be due to this?
The lumbar spine MRI report states:
"Sagittal T1 and T2 weighted images were obtained of the lumbar spine, supplemented by axial T1 and T2 weighted scans through the L3/4, L4/5 and L5/S1 discs. The appearances suggest that there maybe 1 to 2mm of anterior subluxation of the body of L4 on L5. Bone alignment is otherwise normal. There is some narrowing of the L4/5 disc, and all the lumbar intertebral discs have lost T2 signal, indicating dehydration. There is minimal annular disc buldge present at L4/5. Facetal overgrowth is noted at both L4/5 and L5/S1. The lumbar canal lumen at L4/5, though slightly narrowed appears adequate. The combination of facetal overgrowth and slight subluxation has narrowed both neral exit foramina at L4/5, a little more so on the left although in the position scanned the exiting nerve roots do not appear compressed. The other neural exit foramina are not compromised."
By the way, I note from the report that no axial T1 and T2 weighted scans through the L1/2 and L2/3 had been taken? Is this a normal practice? Also, no mention of the state or the condition of the L1, L2 and L3 is made in the report.
Will be most grateful for your comments on the above and your suggestions for any further course of action or treatment?
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