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  • Pinales
    Member
    Post count: 18

    I’m in the midst of hopefully having my problem diagnosed and trust my neurosurgeon. But I’d really like to hear what you think. This has been such a long and uncomfortable journey.
    Symptoms:
    1. duration: 2.5 years
    2. intense tightness occiput and top of back of head
    3. paresthesia around eyes, ears, across cheekbones
    4. muscle spasm: neck, shoulders, upper arms
    5. a feeling of disassociation between head and body
    6. Tinnitus that changes location and sound on right side of head only
    6. MRI reveals “significant foraminal narrowing left 3rd cervical vertebrae”
    7. Just had a transforaminal injection of Lidocaine and cortisone 6 days ago. Initially, the symptoms were more intense. Now, they are as they were before the procedure.
    Ideas?
    Thank you.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    You have had symptoms for the last 2 1/2 years at the base of your skull consisting of tightness, bilateral shoulder muscle spasm and what I’ll assume as pain. You have some symptoms that are associated with sub-occipital pain such as facial paresthesias and tinnitus.

    Your MRI revealed significant left C3-4 foraminal stenosis. Is there anything else the MRI revealed? It would be unusual to have just C3-4 foraminal stenosis without other findings on the MRI.

    If your only finding was that noted in the MRI above, the symptoms would be generated from a C4 nerve root compression on the left. C4 nerve compression could cause pain to refer into the left shoulder but not into the right and not into the face. Tinnitus and facial paresthesias would not be part of this syndrome. This would also not typically cause “tightness” at the base of the skull.

    The selective nerve root block you underwent should have given you 3 hours of temporary relief if that area was the source of your symptoms.

    What could cause some of the symptoms you describe is irritation to the C2-3 facet.

    I would have an opinion from a skilled spine surgeon.

    Dr. Corenman

    Pinales
    Member
    Post count: 18

    Thank you. I will follow up with the neurosurgeon. The facet joints were only mildly effected in the MRI. But maybe there needs to be another look. You are very generous to offer this help to those who have not been able to solve their difficulties.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Many times the facet disease will not show up on MRI. The inflammation is not defined enough. The resolution of the MRI will have to improve to be useful for this diagnosis. The diagnosis is made by relief of symptoms with a diagnostic facet block.

    Dr. Corenman

    Pinales
    Member
    Post count: 18

    Looks like it is back to the pain-management doctor. If you are interested (and you have so many virtual and actual patients…), I’ll let you know what happens.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    Thank You

    Dr. Corenman

Viewing 6 posts - 1 through 6 (of 17 total)
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