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  • shobhan
    Member
    Post count: 2

    Dear Dr. Corenman,
    I am a 35 year old male of erstwhile good health.

    I have been suffering from mostly neurological symptoms for the past 7 months or so. It started with dizziness, then tingling in hands. Finally, about 5 months ago, I had a “explosion” of symptoms which with minor variations I have to this day. These include tingling in all four limbs, mild weakness in all four limbs (specially left leg and the area around the right should), mild tremor throughout the body; and jerks, stiffness and mild pain in the neck area.

    I was tested for lyme disease (negative), had brain mri (clean) and spine mri. On the spine MRI a small central herniation at c4-c5 was discovered causing “mild central canal stenosis” ( I have included the complete report below).

    I have seen two spine surgeons (one neurosurgeon and one orthopedic surgeon), both of whom, after reviewing my MRI described my problems as “mild” and my spine to be “essentially normal”. I was initially convinced, but after getting no diagnosis from a Neurologist as well, I am starting to wonder if it could be my spine after all, specially since:
    1. I typically feel much worse when lying down on my back, and
    2. Carrying even a mildly heavy backpack (say with a laptop and two books) cause my symptoms to worsen.

    I would like your opinion of this.

    MRI report: There is normal marrow signal noted throughout the visualized osseous structures. There is preservation of cervical lordotic curve. Vertebral body height appears preserved. There is a normal appearing posterior fossa without evidence for tonsillar extension below the level of the foramen magnum. The cervical cord shows normal signal intensity as does the CSF space. The facet joints appear in satisfactory anatomic alignment.

    Examination of c2-c3, c3-c4, c5-c6 and c6-c7 demonstrate no evidence for significant disc bulge, protrusion or herniation. There is normal disc space height and signal. There is no significant central canal or neuroforaminal stenosis.

    Examination of c4-c5 shows a small central hnp with resltant mild central canal stenosis and the neural foramina are patent. The facet joint are unremarkable.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    In your case, spinal stenosis should not cause myelopathy (see website for description). The physical examination is critical here. If you do not demonstrate gait abnormalities, hyperreflexia, clonus or Hoffman’s signs, you would have no corroborating evidence for myelopathy. Also, in general “mild” central stenosis does not generally lead to cord compression and myelopathy. It is unlikely that the spinal compression is causing your symptoms.

    Dr. Corenman

    shobhan
    Member
    Post count: 2

    Dear Dr. Corenman,
    Thanks a lot for your considered and quick reply. I appreciate it very much.

    Upon physical examination, I showed no evidence of gait abnormality, and hoffman and babinsky tests were normal. I have hyperreflexive knees, however.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Many patents do have non-pathological increased reflexes at one area. Based upon your history, it appears that the mild disc bulge in your neck is not the cause of your symptoms.

    Dr. Corenman

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