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  • potomachomesalf
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    Post count: 1

    Dr. Corenman –

    I have been dealing with a myriad of symptoms for 2 years. It is easier to chronologically summarize my journey. Prior to the onset of these symptoms, I have been in excellant health. My question is do you have thoughts on a cause of my current symptoms (see 1/11 entry).

    7/2009: acute onset of bilateral foot (level of arch to toes) tingling, burning pain
    6/2009: acute onset of bilateral hand/finger(1-4) burning, tingling pain
    12/2009: having much difficulty walking & using my hands from pain. No hand/foot weakness. MRI: Chiari Malformation with very small cervical syrinx
    2/2010: underwent Posterior fossa decompression for CM, all symptoms completely resolved initially then gradually returning
    5/2010: all original symptoms returned
    8/2010: developed tingling in posterior upper/lower legs, buttocks, ba20ck, arms
    8/2010: Lumbar MRI results “disc degeneration of the L4-5 and L5-S1 with probable L5-S1 annular tear. Mild to mod central canal stenosis at the L4-5 level secondary to facet hypertrophy and ligamentum flavum thickening”
    9/2010: developed significant tightness in both feet, L>R. eventually both great toes began turning up (hyperextension of 60+ degrees)
    after multiple tests, doctors..still do not know what is cause of symptoms.
    11/2010: consulted with neurosurgeon who determined I had severe cervical stenosis (8-9.5 mm). physician states stenosis may be common with Chairi Malformation
    12/2010: Underwent ACD with fusion of C4-C7.
    1/2011: hand/arm symptoms primarily resolved. feet/leg symptoms continue with worsening (tightness in feet, big toes turning up, decreased sensation to pain & temperature in both feet, burning in posterior and medial section of upper/lower legs, buttocks. (No radiating symptoms)
    5/2011: referred for EMG of lower ext to r/o tarsal tunnel syndrome. EMG (knees to toes) shows tibial nerve impairment. referred to podiatrist for injections & PT
    6/2011: Podiatrist does not believe it to be TTS. Tinel’s sign negative; in 30 yrs of practice has never seen bilat TTS much less with the same onset of symptoms in each foot; dermatones affected do not match with TTS. referred for repeat Lumbar MRI
    6/16/11: Lumbar MRI completed. all physicians who previously reviewed the 8/10 lumbar MRI state cause not originating in Lumbar region. Today I viewed both lumbar MRI’s for comparison & do not see any real change.

    Will be seeing another neurologist with new Lumbar MRI in a few weeks.

    Thank you for any thoughts you have!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8436

    I’ll start with interpretation of what has occurred.

    Symptoms started in mid 2009 from spinal cord compression at the base of the skull. You mention Arnold Chiari Malformation which is an alteration of the normal relationship of the brain stem with the skull base. There is overcrowding in this region and symptoms of myelopathy with brain stem dysfunction occur. The posterior fossa decompression surgery enlarges the foramen magnum and possibly part of the back of C1 is removed. The symptoms abate but not completely (not uncommon).

    You start with symptoms again in both upper and lower extremities but suspicion is given to lower back as there is mild-moderate stenosis. You however do not give a history of pain or numbness that starts out in the sacrum and extends to the buttocks and then posterior thighs with walking that is relieved with sitting or bending forward. These are the symptoms consistent with lumbar stenosis.

    Tightness occurs in both feet (not a typical symptom of stenosis) and you develop up-going toes (could be a Babinski sign) which could indicate a cord problem. There is no cord in the lower back below L1. Cervical stenosis is diagnosed (a possible cause of your unusual symptoms). Cervical stenosis would be easily visible on an MRI. 12-2010 you undergo an ACDF at C4-7 for the stenosis. Surgery did help the upper extremities but not the lower extremities. Lower extremities exhibit loss of pain and temperature and develop burning symptoms.

    You have a neurologist (I presume) perform an EMG/NCV test which demonstrates bilateral tibial nerve involvement. You do not indicate where the lesion is suspected but indicate it is bilateral. Another lumbar MRI is performed with no change in images. Do I have it right?

    Everything written here is on assumption. You don’t state your age but i assume you are in your 50-60s. The symptoms in your legs which include loss of pain and temp as well as the burning symptoms lead me to consider peripheral neuropathy. This would also explain the delay in conduction in your EMG tests bilaterally. If this was from the cord, the EMG would be negative. You don’t mention weakness or imbalance symptoms. The up-going toes could be a residual from your prior cord problems as surgery is designed to prevent further progression but damage that was already done may not improve.

    The neurologist seems to be the way to go. You might need another EMG/NCV as these tests are very operator dependent and the skill of the test giver makes all the difference in the world. There are various vitamin deficiencies that can cause these symptoms as well as disease processes and even alcoholism and various types of infections.

    Please let me know what the conclusion of the neurologist is.

    Dr. Corenman

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