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Forum Name: Neurology Topics
Question: Vagal Neuropathy?
|Galena - Fri May 15, 2009 10:18 pm||
Apologies in advance for the long post...figure I would give as much background in advance as I can :)
About 10 years ago I was diagnosed with a bulging lumbar disk that was causing some numbness in my left thigh. It hasn't bothered me too much so I've carried on.
In December, I herniated C5-6 and C6-7 (no accident/fall). There was cord compression at C5-6 so a neurosurgeon did an ACDF with fusion (and allograft) at both levels in early Feb. Voila! Most neck and arm symptoms were gone!!!
Except for my voice. I am still hoarse, and an ENT has confirmed right vocal cord paralysis.
A week post op, I developed what I thought was my (nearly) annual chronic cough. I still have it with minimal improvement. I do not cough once I am lying down.
My allergist put me on prevacid (to rule out GERD for the cough), and I've taken several courses of steroids (medrol and 2 courses of prednisone). I had a septoplasty and sinus surgery in March...still coughing.
Over the last few months, I have developed a lot of spine pain between the shoulder blades, including a "sticky" sensation on my left shoulder blade. I was woken up on 4 nights by pain on my spine right under the shoulder blades...like someone ran me through with a hot poker for a few minutes, and which included a lot of abdominal pain directly opposite this, with burping and bloating.
I have general upper back pain with tender spots on the spine. My stomach is still a problem - burping, strange hiccups, fullness, appetite changes but not really any pain. The prevacid is not helping this. It is worse when I sit up, stand and move (not a problem lying down) and can last hours. Simethicone can help somewhat.
Over the same time period I have had trouble sleeping (not common for me at all). I can fall asleep but wake up and have to move around a lot. Ambien doesn't help.
When I wake up at night, I am very aware of numbness and "prickling" in the thighs. My right leg is now much worse than the left in terms of having the thigh numb spot (which also hurts, burns, itches, tingles, etc). I can get stabbing pains and my lower back is hurting more and is quite stiff. I had muscle twitches and "electric shock" symptoms at that time of the herniations and they continue to this day (I suspect those are residual).
I requested a thoracic and lumbar MRI and the radiologist report said there are no issues, and this is what the neurosurgeon said. He recommended as a next step going to a neurologist and doing a bone scan. The voice I may wait on or try an injection.
I am frustrated with the symptoms, especially the stomach and sleeping issues. I do fear the possibility of hearing the "its in your head" diagnosis!
Is it possible that the voice/cough/stomach could be related as they have a tie in to the vagus nerve? Someone also suggest fibromyalgia but I don't think I have the key "sore spots" and am not sure that it has the same nerve pain patterns (eg sciatic pattern)?
I really appreciate any thoughts!!
|Tom Plamondon PA-C - Tue Oct 27, 2009 2:32 pm||
Irritation of the vagus nerve is an interesting and plausible idea. The vagus nerve sends branches to the larynx via the recurrent laryngeal nerve. It also upon irritation along with the phrenic nerve is the leading cause of intractable hiccups.
At it's upper level, testing vagus nerve is done by saying "ahhh" and see the uvula (the thingy hanging down in the back of the throat) move, if it moves assyemtrically, then there may be a upper vagus nerve problem.
The thigh problems are a different story. This is likely due to recurrence of lumbar spine pathology and will need re-evaluation.
I think it is wise to see a neurologist for full history and physical. There is more than one cause of the symptoms and there will be some distinctions between the causes.
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