Yes Frank I was very impressed, and I didn’t see the consultant, but hope that standard will continue and that whatever happens i find out whats going on, don’t care what it is just need to know
OK, here goes… A wide based gait means that you walk with your feet wider than normal (so your footprints would be on tramlines rather than in line or nearly in line). Different types of gait point to different problems. A wide gait suggests problems with balance, coordination, spasticity and other things, but it’s basically an immediate sign that tells a neuro all is not well. Stiffness is just what it says. This relates to the increased tone referred to later in the letter: it means extra muscle tone otherwise known as spasticity. It is caused by a problem in the upper motor neuron(e) which is the pathway between the brain and the muscles which tells them when to relax. The tandem, toe and heel bit means that your heel to toe walk (putting your heel down first each step) is stable and you can stand (walk?) on your toes and heels. (All normal) Your reflexes were abnormally large, and when she tested your ankle reflexes, your feet tapped the floor afterwards (“clonus”). This is all consistent with upper motor neuron (UMN) damage. The down going plantars means a positive Babinkski’s sign - also a sign of UMN damage. Your strength is normal / marginally affected. (5 is normal) Your left leg has some signs of sensory disruption, but nothing major. Your right leg is fine. (Sensory and motor info are carried in different pathways in the spinal cord. It looks like your motor tract has been affected on both sides, but the sensory tract is mostly unaffected.) Heel/shin is when you rubbed one heel down the other shin. You were OK at it. (This tests coordination.) Your arms are similar, but without the spasticity: abnormally large reflexes and some slight weakness but generally normal strength. Normal sensation and coordination. You have slight tremor as soon as you held your arms out. (Postural tremor is shaking when we try to hold something still.) This can mean a problem with the cerebellum or basal ganglia and related parts (the bits of the brain that keep movements smooth and coordinated). Tremor is a common symptom of several conditions, e.g. Parkinson’s. This will be why she mentions bradykinesia (slowness of movement) and dystonia (spasms and sometimes twisted, out of position muscles). The cranial nerves include the optic nerve, the nerves that control sensation and muscles of the face, eye movements, tongue sensation and movement, etc. Yours seem to be working fine. The summary says that you have significant problems with your UMN. The pyramidal bit refers to the part of the UMN in the brain - she’s saying this because of the slight weakness she found. Essential tremor means tremor at rest and refers to your postural tremor. The tests for B12 etc are to rule out possible causes. The MRI will be of your head, neck and upper back. Given that your legs became a problem first, it would be expected that there is more than one area of damage (the thoracic scan should show up the cause of your leg symptoms and the cervical your arms). I have a feeling that she is thinking MS is a possibility, but is keeping an open mind and will do the evoked potentials and LP if needed, depending on the bloods and MRI results. (For example, B12 deficiency can cause your symptoms and can cause lesions very similar to MS, but it normally has a negative LP result.) The ESR test shows inflammation. It’s not specific to any condition. I’ve done this on my phone so I may have missed things and/or not explained things brilliantly so please ask again if needed. Kx PS Remember I’m an amateur - and I do sometimes make mistakes!
One thing that just occurred to me: MS is not normally symmetrical and it sounds like most of your problems are? This might be why she hasn’t mentioned it (and mean that I’ve jumped the gun!). However, it must be one of the possibilities she’s considering I would think. Kx
I agree with Karen and you have UMN problems. I started with a positive babinski on my right side, now it’s on my left side too.
Hypereflexia in both legs and arms usually points to a problem in the cervical spinal cord. A beat of clonus five beats or more is sustained clonus and is definitely a sign of an UMN disorder and spasticty. Baclofen can help with this.
Diagnoisis can be problematic. I’m now in my fifteenth year and with a neurogenetics team. I’ve used a wheelchair outdoors for a few years and I;m now having a muscle biopsy in November to check for complicated hereditary spastic paraplegia.
As symptoms suggest a cervcal spinal cord disorder they need to rule out cervical spondylosis, ALS, HSP and primary progressive multiple sclerosis. You sound as though you have a form of cervical myleopathy If your brain MRI is normal they definitely need to lok at an alternative diagnosis.
Having received this letter has thrown me a bit and had a bit of an emotional wobbly, tearful weekend. I guess thats only to be expected. Dr signed me off for a couple of weeks, due to go back to work on monday, must admit struggle working, usually on my feet all day, come home exhausted and its almost as much as i can do to walk to the car at the end of the day and its only a short distance. GP did say she was still happy to sign me off if not ready to go back to work. My MRI isn’t till 23rd nov aith follow up for results 7th Dec
In my experience going back too early and then having to go off sick again is worse on your sickness record than a long period of sick.
I would think carefully and realistically if you are ready to go back. If you think working is better for you than being at home,would they make adjustments for you. You can get a note from your doctor stating the things you need to avoid doing.
How much does your employer know about whats happening?
very little they know i had the spinal surgury, and that the symptoms have returned, and that the neurologist thinks there is an underlying neurological problem, but they don’t see the affects, and i try hard to carry on as if nothings wrong, they dont see struggles/pain or the exhaustion, and of course until i get some answers i am not being treated apart from pain killers (co-codamol 30/500) thought may be i should take the letter down to my line manager to show him to put him in the picture. Scared people won’t/don’t believe me and think i’m swinging the lead, my job is an area relief dispenser so my role is going into different branches to offer support and to cover sickness and holidays, which i love and am frightened they will push me back into a single branch which i would fid far more stressful, and financially i couldnt afford to reduce my hours.
