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evoked potentials & MRI results

Hello.
I will try to be as short as possible, but that will be difficult if I want to include necessary information. I will do my best.
Let's go to what led me to my first major symptom:

I am a 41 year old female.

Feb 24, 07: left sided facial numbness.  This numbness greatly improved by early May, but I still have minor residual tingling. It is sometimes more noticable when I spend a good amount of time in hot weather. MRI(1.5) revealed a 5x16 mm active lesion in the left cerebellar peduncle. Several small rounded foci along both cerebral convexities w/ signal characteristics corresponding to CSF, likely representing prominetn CSF spaces.
Lumbar puncture was normal--no signs of infections.
All blood work is normal (thyroid, diabetes, B12, lyme, lupus, gout, RA etc.)

August 07: severe bout of vertigo. Another MRI(1.5) shows "improvement" of prior lesion, non active, smaller. No new lesions.

Jan 08: repeat MRI(3T) shows a 0.75-cm focal area of abnormal T2 prolongation is present in the left lateral pons near its junction w/ the middle cerebellar peduncle near the trigeminal nerve root entry zone. (not enhanced) A tiny focus of T2 prolongation is present in the left anterior deep frontal white matter.

July 08: Comparison made to prior 3T MRI of the brain shows there has been no interval change since previous exam. There has been no interval increase in the size or number of a few small foci of increased signal intensity deep to the anterior insular cortex on both sides. These small foci are nonspecific.

Now, the evoked potentials I had at the end of May 08 are as follows:

The VEP and BAER were normal.
The SEP lower limbs:
With stimulation of either nerve, a popliteal fossa potential was present (what's this?), but the subsequent potentials were poorly formed and could not be identified w/ confidence.
(I am guessing that this was due to the fact that I had trouble with how PAINFUL it was for me. I was in tears and no matter what, could not relax. It obviously affected the test results.)

The SEP upper limbs:
With stimulation of the left median nerve, the response over the cervical spine was not well formed, but an N20 potential was present over the scalp which had a normal latency of 19ms. With stimulation of the right median nerve, an N20 response could not be clearly identified over the scalp.
IMPRESSION:
abnormal finding bilaterally

The MS specialist doctors notes also note: Deep tendon reflexes are 2/4 in the arms, 3/4 at the patellae, 2/4 at right ankle, 3/4 at the left ankle. The left patellae is also slightly more brisk than the right, and bilateral crossed adductors are present. There is no spasticity, but the right toe is clearly downgoing and the left toe is silent. Romberg sign not present.

I have also had two incidents 3 months apart in which a hand has swollen overnite, was painful and couldnt use. No bugbites. Xrays and labs normal.(first the left, then the right)A few months later, same thing w/ my shoulder, but they did find some mild tendonitis.(these incidents were back in 06)

I also have had unusual sensations when driving where my fingers will feel huge and the steering wheel like a piece of spaghetti. I have had if reversed also, fingers feeling skinny like spaghetti and steering wheel huge. About 4 times I have a feeling of my tongue feeling huge--not impairing breathing or swallowing. It's just a sensation.

Recently, I've had an issue with my feet. The bottom of my right heel felt like I had walked of rocks barefoot. It would wake me up at 3 or 4 in the morning, crying in pain. It was intense and hard to walk on. After about a week, some of the pain started to move toward the inside of my ankle bone...like the tendon area. The left foot had hurt a month earlier, but only near the tendons on the OUTSIDE of the ankle bone. These both lasted about 2wks for each foot.

Prior to this last MRI, my MS doctor has said he felt that the peduncle lesion was possibly viral related and the frontal lesion migraine related (Had migraine/tension headaches since 1992) and he was thinking this was less likely MS. But he wanted another MRI and EVP tests. He said if these tests were good, he'd wait 1 year and do another MRI. If that was good, he would release me w/ a NO MS diagnosis.

**********************Is there anything abnormal in the neuro exam? ******************************************************
**********************Are the small foci on the MRI anything concerning? *************************************************
**********************Is this abnormal EVP test going to help provide any clues? ****************************************
**********************Or is there still not enough evidence for diagnosis here? ********************************************
**********************Should I be looking at better testing for other diseases? (Lyme?************************************
**********************Where should I be going from here? *******************************************************************

I do apologize for the length of the post. I just wanted to be as thorough as possible with my history in order to try and get as much feedback as I can. I am started to have a bit of anxiety because it seems nothing seems to match up.
Thank you.

Julie


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Avatar universal
Hi Judy,

I do remember him telling me that my left side was a bit more "brisk" than the other. But other than that he said my physical exam was pretty good.  He did not mention anything else at the time that I remember, nor has he done any more of these exams since.

I just can't understand why I can't get a doctor to comment on this. Most of the great people on these boards aren't going to be able what I am really wanting to know. Mostly the questions I posed toward the end of the post. I posted this twice and keep bumping it up to the top, but it just keep getting passed up.

At first, this specialist thought it was likely that this was MS, and we did talk about the option of starting meds. He did not feel it was urgent (but of course it was my choice)  and thought waiting 6 months for another MRI and see what happens with that. That showed improvement of the original lesion and one small new one in the frontal lobe which he thought might be migraine related and I hadn't had any "new" symptoms. So, he really backed off of the MS diagnosis and wanted to do more testing (MRI and EVP).

So, here I am. I just want a doctor to try and give me an idea of what I should be thinking about so that when I go to my next appointment, I am ready to know what to ask. I tend to get really forgetting and just very agreeable and then get home and disappointed that I didn't ask what I needed to ask.

Thanks for responding, Judy

Julie
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562599 tn?1217008125
Regarding:  The MS specialist doctors notes also note: Deep tendon reflexes are 2/4 in the arms, 3/4 at the patellae, 2/4 at right ankle, 3/4 at the left ankle. The left patellae is also slightly more brisk than the right, and bilateral crossed adductors are present. There is no spasticity, but the right toe is clearly downgoing and the left toe is silent. Romberg sign not present.

This is not a normal exam.  Did they not tell you what is going on with you?  


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