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What Does Normal MRI Report And Spasms In Leg And Foot Indicate?
Question: Three months ago, dx with ataxic gait and nystagmus. MRI unremarkable and all labs negative. Two months ago, I started have strange spasms in my leg and foot. The arch of my foot is very rigid and my toes move in odd positions. The spasms occur every other day or so and last anywhere from a few seconds to an hour. I can stop the spasm by standing on the foot or flexing the toes with hand. Muscle feels odd, even when there is no visible movement. Not sure if this symptom is an isolated problem or if it is related to the ataxia and nystagmus.
No medication and other than these symptoms, good health. 51 years old.
I am uploading a few of the foot pictures. I attempted to send a "normal" picture, but was over the limit. My normal feet do not have a gap between the toes.
Thanks for your review,
No medication and other than these symptoms, good health. 51 years old.
I am uploading a few of the foot pictures. I attempted to send a "normal" picture, but was over the limit. My normal feet do not have a gap between the toes.
Thanks for your review,
Brief Answer:
Needs a neurological re-examination.Its time to get specific investigations
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
Its about a couple of months back that I had a discussion with you on your problems(refer to previous query).I feel concerned,that you still face the same situation.In fact,the disease seems to have progressed in a way that your leg spasms have apparently increased. I would like to know whether or not did you notice any improvement in nystagmus and ataxia pon stoping ativa? Logically and clinically,leg spasms are a part of the same disorder. So, it is likely that nystagmus and ataxia may not have shown any improvement. Please confirm if I am correct here.
These leg spasms are a new development and evolution in the temporal profile of the disease. Probably, in addition to cerebellum, corticospinal tracts are also involved which are manifesting as leg spasms. Sincerely, it is a time to get a re-neurological examination done because I am curious to know that 'deep tendon reflexes' are still normal or have they gone from normal to brisk (in your previous examination documents,they were normal)? Plantars are extensors or flexors? These two findings are most important to determine the involvement of corticospinal tracts.
May be, you will need a repeat MRI Brain and a MRI spine too (to be decided after the neurological re-examination). Meanwhile, let me know if you are having some tightness or stiffness in limbs except for the duration when you have those spasms?
Your foot arches seem to be disturbed. This whole cerebellar syndrome picture needs to be investigated. Did you get 'Thyroid function tests' and 'vitamin E levels done' which I have told you last time too. If not,please get them done. We are not concerned with all lab reports; but some specific investigations are recommended; that includes-
1) Thyroid function tests
2) Vitamin B12
3) Vitamin E
4) Chest X-Ray
If these investigations turn out to be normal, further plan-
5) Gynaecological check up to screen malignancies and other age related cancer screening (actually progressive cerebellar syndrome at this age mandates to find the cause, as its not at all a psychosomatic disorder).
6) Repeat MRI Brain and MRI Spine
7) HIV,Hepatitis B and Hepatitis C
One last question-What is your profession or occupation? I just want to give a thought whether there are any chances of it being occupation related?
Hope I have answered the query for now. If you have no further queries, please close the thread-rate it and write a review as your rating will be of help to me else, I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Needs a neurological re-examination.Its time to get specific investigations
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
Its about a couple of months back that I had a discussion with you on your problems(refer to previous query).I feel concerned,that you still face the same situation.In fact,the disease seems to have progressed in a way that your leg spasms have apparently increased. I would like to know whether or not did you notice any improvement in nystagmus and ataxia pon stoping ativa? Logically and clinically,leg spasms are a part of the same disorder. So, it is likely that nystagmus and ataxia may not have shown any improvement. Please confirm if I am correct here.
These leg spasms are a new development and evolution in the temporal profile of the disease. Probably, in addition to cerebellum, corticospinal tracts are also involved which are manifesting as leg spasms. Sincerely, it is a time to get a re-neurological examination done because I am curious to know that 'deep tendon reflexes' are still normal or have they gone from normal to brisk (in your previous examination documents,they were normal)? Plantars are extensors or flexors? These two findings are most important to determine the involvement of corticospinal tracts.
May be, you will need a repeat MRI Brain and a MRI spine too (to be decided after the neurological re-examination). Meanwhile, let me know if you are having some tightness or stiffness in limbs except for the duration when you have those spasms?
Your foot arches seem to be disturbed. This whole cerebellar syndrome picture needs to be investigated. Did you get 'Thyroid function tests' and 'vitamin E levels done' which I have told you last time too. If not,please get them done. We are not concerned with all lab reports; but some specific investigations are recommended; that includes-
1) Thyroid function tests
2) Vitamin B12
3) Vitamin E
4) Chest X-Ray
If these investigations turn out to be normal, further plan-
5) Gynaecological check up to screen malignancies and other age related cancer screening (actually progressive cerebellar syndrome at this age mandates to find the cause, as its not at all a psychosomatic disorder).
6) Repeat MRI Brain and MRI Spine
7) HIV,Hepatitis B and Hepatitis C
One last question-What is your profession or occupation? I just want to give a thought whether there are any chances of it being occupation related?
Hope I have answered the query for now. If you have no further queries, please close the thread-rate it and write a review as your rating will be of help to me else, I shall be glad to have you in follow-up.
Regards
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Prasad
Hi Dr. Panwar,
Thanks for your prompt response and clinical expertise.
I stopped all meds, including the Ativan and Cerefolin in November. The ataxia has greatly improved w/ moderate improvement nystagmus. However, the double vision in the peripheral vision remains and the fingers (RUE) are stiff and slow. The spasms in the feet occur more frequently, last longer and are more intense. I am uploading l pictures of both hands. Please note the difference in the fingers on each hand. The fingers on the left are straight and move quickly and easily while counting. However, the fingers on the right (I am right hand dominant) do not straighten while counting and movement is ~70% slower than the right.
Since the initial consult with you, there have been two follow up appointments with the neurologist. Both visits were brief with a quick check for nystagmus and tandem walk. I mentioned the foot spasms and brought my cell (foot pics). However, the neurologist replied that everyone gets foot cramps and did not view the pictures.
I have no idea of the DTRs or plantar reflex as they were not tested in the last two visits. Given the unremarkable MRI and clean labs, no follow up appointments were scheduled. I think I was tested in December for thyroid levels and vitamin deficiency. However, the report showed only minor issues with lack of potassium. I will follow up for a complete gynecology work up as it has been many years since my last check up. I feel certain the neurologist will not complete any additional testing.
Of possible clinical significance, is a horrendous sleep disorder (present since childhood) with severe muscle spasms, visual and auditory hallucinations. MRI and sleep study 20 years ago were also unremarkable. The hallucinations continue. Oddly, they appear as snapshots of textures that I have seen at random, usually at the office or in my house. The hallucinations are clearer than physical vision, take up the entire visual field and last for ~30 seconds or so. In the past two years, I’ve also noted an increase in confusion during the twilight phase of sleep…occasionally; I don’t remember where I am. However, when fully awake, the confusion passes. I continue to have ongoing problems with short term memory. But, otherwise highly functioning with work history 2014 (90 hour work week) as a disability insurance examiner.
Thanks for your time and advice.
My fear is Lewy body dementia. Can this be ruled out?
Thanks for your prompt response and clinical expertise.
I stopped all meds, including the Ativan and Cerefolin in November. The ataxia has greatly improved w/ moderate improvement nystagmus. However, the double vision in the peripheral vision remains and the fingers (RUE) are stiff and slow. The spasms in the feet occur more frequently, last longer and are more intense. I am uploading l pictures of both hands. Please note the difference in the fingers on each hand. The fingers on the left are straight and move quickly and easily while counting. However, the fingers on the right (I am right hand dominant) do not straighten while counting and movement is ~70% slower than the right.
Since the initial consult with you, there have been two follow up appointments with the neurologist. Both visits were brief with a quick check for nystagmus and tandem walk. I mentioned the foot spasms and brought my cell (foot pics). However, the neurologist replied that everyone gets foot cramps and did not view the pictures.
I have no idea of the DTRs or plantar reflex as they were not tested in the last two visits. Given the unremarkable MRI and clean labs, no follow up appointments were scheduled. I think I was tested in December for thyroid levels and vitamin deficiency. However, the report showed only minor issues with lack of potassium. I will follow up for a complete gynecology work up as it has been many years since my last check up. I feel certain the neurologist will not complete any additional testing.
Of possible clinical significance, is a horrendous sleep disorder (present since childhood) with severe muscle spasms, visual and auditory hallucinations. MRI and sleep study 20 years ago were also unremarkable. The hallucinations continue. Oddly, they appear as snapshots of textures that I have seen at random, usually at the office or in my house. The hallucinations are clearer than physical vision, take up the entire visual field and last for ~30 seconds or so. In the past two years, I’ve also noted an increase in confusion during the twilight phase of sleep…occasionally; I don’t remember where I am. However, when fully awake, the confusion passes. I continue to have ongoing problems with short term memory. But, otherwise highly functioning with work history 2014 (90 hour work week) as a disability insurance examiner.
Thanks for your time and advice.
My fear is Lewy body dementia. Can this be ruled out?
Brief Answer:
Its not Lewy body dementia.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Its great to know that your ataxia has improved well.Possibly drug induced?
However,increasing leg spasms and hands problem are a cause of concern.
I strongly feel its high time you should request your neurologist to re-examine you specifically for the involvement of corticospinal tracts.I hope we are not missing anything.
Your childhood illness is not Lewy body dementia(DLB) as DLB onset is usually seen in more than 50 years of age.Also,other important features like extrapyramidal symptoms(tremors,rigidity) and significant memory loss is present. This is probably unrelated to the present syndrome ,specially as MRI is normal.
Please undergo gynaecological checkup and other investigations as suggested and be in follow up.
Hope that I have answered your query for now.If you have some follow up questions,I shall be glad to answer else please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Its not Lewy body dementia.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Its great to know that your ataxia has improved well.Possibly drug induced?
However,increasing leg spasms and hands problem are a cause of concern.
I strongly feel its high time you should request your neurologist to re-examine you specifically for the involvement of corticospinal tracts.I hope we are not missing anything.
Your childhood illness is not Lewy body dementia(DLB) as DLB onset is usually seen in more than 50 years of age.Also,other important features like extrapyramidal symptoms(tremors,rigidity) and significant memory loss is present. This is probably unrelated to the present syndrome ,specially as MRI is normal.
Please undergo gynaecological checkup and other investigations as suggested and be in follow up.
Hope that I have answered your query for now.If you have some follow up questions,I shall be glad to answer else please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Answered by
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