Doctors Lounge - Neurology Answers
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Forum Name: Neurology Topics
|dama - Mon Feb 25, 2008 7:24 pm||
I'm a 37 y.o. Caucasian female with postgraduate education. I recently developed hypertension and am taking meds for that only. I have a sister with Arnold Chiari malformation. I have been having weakness on my right side (mostly arm). I also have incontinence (mostly bladder, but twice bowel). My doctor sent me to the ER 6 months ago for extreme right-side weakness with right arm tremor (that was the only day I had tremor; I was working on home repair projects at the time). I am frequently tired. I had an EMG that was normal, but showed hyperreflexia on my right side along with clonus and Babinski sign. Three doctors thought I might have MS. I just had an MRI which showed no lesions. :) Results showed "disc bulge osteophyte complex at c3-4 in the left paracentral region producing mild central spinal canal stenosis with no neuroforaminal stenosis." Spinal canal meaurement was 8.5mm.
I thought the spinal stenosis might be causing my symptoms, but my doctor's office said it was an odd finding given that the bulge was on the left side and my symptoms are on the right side. She said the news is good but not definitive. She is referring me to a neurologist. I appreciate any thoughts and ideas about what I should ask the neurologist. I really don't want to go through a lot of tests - do I even need to get into the follow-up cycle of finding a bunch of unrelated things? But I also don't want to neglect my health. I do have a sleep study scheduled and I believe that sleep apnea may be my biggest concern. Perhaps I'm in denial?
I really appreciate any guidance or thoughts!
|Dr. A. Madia - Wed Apr 16, 2008 6:12 am||
Hyperreflexia and babinski mean Impaired upper motor neurones. These will always be in the brain upto medulla and never in the nerves below. So cervical spinal stenosis never gives hyperreflexia and babinski. In any case the supposed stenosis is on the left and your symptoms on the right.
On the other hand Upper motor signs on right means lesion in the Left brain hemisphere. Now you got hypertension, that is one of the risk factors for development of atherosclerosis in the brain arteries which ultimately could lead to impaired brain circulation and your kind of symptoms.
In my view an MRI Brain with MR angio of intra- and extra- cranial arteries is definiteively indicated.
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