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By Middle Of November 2020 I Was Diagnosed With A
Question: By middle of November 2020 I was diagnosed with a “Parkinsonism suggestive of PSP”, being freezing of gait (FoG) my complaint.
Diagnose by the neurologist is based in my FoG complaint and in a MRI showing an insipient “hummingbird sign” (report says due to age). Neurologist says that the presumed PSP is at a very early stage.
On the other hand I’m not responding to Amantadine and to Sinemet.
This is the end of a long road of complaints (inbalance, neck pain, dizziness, radiculopathies, a.s.o.) after being submitted in November 2015 to a ACDF surgery to decompress my spinal cord at C4-C5 (asymptomatic myelomalacia discovered by casuality in a MRI).
Could this FoG be a consequence of the problems I feel in my neck? Progressive myelomalacia, ...?
PS: I have a folder with the RMI I mentioned (encephalic and cervical) that i can send to you (by googledrive, or other means)
Diagnose by the neurologist is based in my FoG complaint and in a MRI showing an insipient “hummingbird sign” (report says due to age). Neurologist says that the presumed PSP is at a very early stage.
On the other hand I’m not responding to Amantadine and to Sinemet.
This is the end of a long road of complaints (inbalance, neck pain, dizziness, radiculopathies, a.s.o.) after being submitted in November 2015 to a ACDF surgery to decompress my spinal cord at C4-C5 (asymptomatic myelomalacia discovered by casuality in a MRI).
Could this FoG be a consequence of the problems I feel in my neck? Progressive myelomalacia, ...?
PS: I have a folder with the RMI I mentioned (encephalic and cervical) that i can send to you (by googledrive, or other means)
By middle of November 2020 I was diagnosed with a “Parkinsonism suggestive of PSP”, being freezing of gait (FoG) my complaint.
Diagnose by the neurologist is based in my FoG complaint and in a MRI showing an insipient “hummingbird sign” (report says due to age). Neurologist says that the presumed PSP is at a very early stage.
On the other hand I’m not responding to Amantadine and to Sinemet.
This is the end of a long road of complaints (inbalance, neck pain, dizziness, radiculopathies, a.s.o.) after being submitted in November 2015 to a ACDF surgery to decompress my spinal cord at C4-C5 (asymptomatic myelomalacia discovered by casuality in a MRI).
Could this FoG be a consequence of the problems I feel in my neck? Progressive myelomalacia, ...?
PS: I have a folder with the RMI I mentioned (encephalic and cervical) that i can send to you (by googledrive, or other means)
Diagnose by the neurologist is based in my FoG complaint and in a MRI showing an insipient “hummingbird sign” (report says due to age). Neurologist says that the presumed PSP is at a very early stage.
On the other hand I’m not responding to Amantadine and to Sinemet.
This is the end of a long road of complaints (inbalance, neck pain, dizziness, radiculopathies, a.s.o.) after being submitted in November 2015 to a ACDF surgery to decompress my spinal cord at C4-C5 (asymptomatic myelomalacia discovered by casuality in a MRI).
Could this FoG be a consequence of the problems I feel in my neck? Progressive myelomalacia, ...?
PS: I have a folder with the RMI I mentioned (encephalic and cervical) that i can send to you (by googledrive, or other means)
Brief Answer:
I think symptoms are justified by the myelopathy.
Detailed Answer:
Hello and welcome to “Ask a Doctor “ service.
I have read your question, I saw two MRI images that you uploaded. I don’t understand the report because of the language.
A characteristic sign of PSP is the inability to aim the eyes properly, besides the gait issues.
In my opinion, your symptoms are justified by the myelopathy that is evident in the MRI done few months back.
If it is possible, comparing this last MRI with a previous one, should give valuable information about the progression or not of the myelopathy.
The hummingbird sign ( or the midbrain atrophy with sparing of the pons) is present in the MRI, but the diagnosis of PSP is mainly clinical.
There was no response to the Parkinson’s drugs, so, this is an element against PSP.
If you will provide the MRI-s I will be happy to examine them and give you a more concise answer.
Hope you found the answer helpful.
Let me know if I can assist you further.
I think symptoms are justified by the myelopathy.
Detailed Answer:
Hello and welcome to “Ask a Doctor “ service.
I have read your question, I saw two MRI images that you uploaded. I don’t understand the report because of the language.
A characteristic sign of PSP is the inability to aim the eyes properly, besides the gait issues.
In my opinion, your symptoms are justified by the myelopathy that is evident in the MRI done few months back.
If it is possible, comparing this last MRI with a previous one, should give valuable information about the progression or not of the myelopathy.
The hummingbird sign ( or the midbrain atrophy with sparing of the pons) is present in the MRI, but the diagnosis of PSP is mainly clinical.
There was no response to the Parkinson’s drugs, so, this is an element against PSP.
If you will provide the MRI-s I will be happy to examine them and give you a more concise answer.
Hope you found the answer helpful.
Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
I think symptoms are justified by the myelopathy.
Detailed Answer:
Hello and welcome to “Ask a Doctor “ service.
I have read your question, I saw two MRI images that you uploaded. I don’t understand the report because of the language.
A characteristic sign of PSP is the inability to aim the eyes properly, besides the gait issues.
In my opinion, your symptoms are justified by the myelopathy that is evident in the MRI done few months back.
If it is possible, comparing this last MRI with a previous one, should give valuable information about the progression or not of the myelopathy.
The hummingbird sign ( or the midbrain atrophy with sparing of the pons) is present in the MRI, but the diagnosis of PSP is mainly clinical.
There was no response to the Parkinson’s drugs, so, this is an element against PSP.
If you will provide the MRI-s I will be happy to examine them and give you a more concise answer.
Hope you found the answer helpful.
Let me know if I can assist you further.
I think symptoms are justified by the myelopathy.
Detailed Answer:
Hello and welcome to “Ask a Doctor “ service.
I have read your question, I saw two MRI images that you uploaded. I don’t understand the report because of the language.
A characteristic sign of PSP is the inability to aim the eyes properly, besides the gait issues.
In my opinion, your symptoms are justified by the myelopathy that is evident in the MRI done few months back.
If it is possible, comparing this last MRI with a previous one, should give valuable information about the progression or not of the myelopathy.
The hummingbird sign ( or the midbrain atrophy with sparing of the pons) is present in the MRI, but the diagnosis of PSP is mainly clinical.
There was no response to the Parkinson’s drugs, so, this is an element against PSP.
If you will provide the MRI-s I will be happy to examine them and give you a more concise answer.
Hope you found the answer helpful.
Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Dr. Erion Spaho,
Many thanks for your interest in my case.
I’ll try to upload a selection of images (H - Hummingbird sign C- Cervical) as well as an automatic translation of the last report.
I’ll appreciate very much your evaluation, concerning the evolution of the hummingbird sign, as well concerning the myelopathy.
Like you say, I believe that there is at least a great amount of myelopathy in place.
Concerning the eyes movement, either horizontal or vertical, I was not alerted by the neurologist to anything abnormal – anyway he stressed that the disease is at a very early stage, based mainly in my freezing of gait and in the hummingbird sign.
I’ll try to have an ophthalmic evaluation.
I also intend to have a SPECT DatScan by mid of March trying to get some conclusions, particularly concerning the degree of Parkinsonism (if so). Since I fear I’m allergic to iode I will proceed to the scanning without taking Ludol (iode)… on the other hand I don’t know the risks of this for my thyroid.
Kind regards,
Julio Ramires
Many thanks for your interest in my case.
I’ll try to upload a selection of images (H - Hummingbird sign C- Cervical) as well as an automatic translation of the last report.
I’ll appreciate very much your evaluation, concerning the evolution of the hummingbird sign, as well concerning the myelopathy.
Like you say, I believe that there is at least a great amount of myelopathy in place.
Concerning the eyes movement, either horizontal or vertical, I was not alerted by the neurologist to anything abnormal – anyway he stressed that the disease is at a very early stage, based mainly in my freezing of gait and in the hummingbird sign.
I’ll try to have an ophthalmic evaluation.
I also intend to have a SPECT DatScan by mid of March trying to get some conclusions, particularly concerning the degree of Parkinsonism (if so). Since I fear I’m allergic to iode I will proceed to the scanning without taking Ludol (iode)… on the other hand I don’t know the risks of this for my thyroid.
Kind regards,
Julio Ramires
Dear Dr. Erion Spaho,
Many thanks for your interest in my case.
I’ll try to upload a selection of images (H - Hummingbird sign C- Cervical) as well as an automatic translation of the last report.
I’ll appreciate very much your evaluation, concerning the evolution of the hummingbird sign, as well concerning the myelopathy.
Like you say, I believe that there is at least a great amount of myelopathy in place.
Concerning the eyes movement, either horizontal or vertical, I was not alerted by the neurologist to anything abnormal – anyway he stressed that the disease is at a very early stage, based mainly in my freezing of gait and in the hummingbird sign.
I’ll try to have an ophthalmic evaluation.
I also intend to have a SPECT DatScan by mid of March trying to get some conclusions, particularly concerning the degree of Parkinsonism (if so). Since I fear I’m allergic to iode I will proceed to the scanning without taking Ludol (iode)… on the other hand I don’t know the risks of this for my thyroid.
Kind regards,
Julio Ramires
Many thanks for your interest in my case.
I’ll try to upload a selection of images (H - Hummingbird sign C- Cervical) as well as an automatic translation of the last report.
I’ll appreciate very much your evaluation, concerning the evolution of the hummingbird sign, as well concerning the myelopathy.
Like you say, I believe that there is at least a great amount of myelopathy in place.
Concerning the eyes movement, either horizontal or vertical, I was not alerted by the neurologist to anything abnormal – anyway he stressed that the disease is at a very early stage, based mainly in my freezing of gait and in the hummingbird sign.
I’ll try to have an ophthalmic evaluation.
I also intend to have a SPECT DatScan by mid of March trying to get some conclusions, particularly concerning the degree of Parkinsonism (if so). Since I fear I’m allergic to iode I will proceed to the scanning without taking Ludol (iode)… on the other hand I don’t know the risks of this for my thyroid.
Kind regards,
Julio Ramires
Brief Answer:
I still think that the spinal cord damage is the culprit.
Detailed Answer:
Hello again.
I saw the new MRI images that you uploaded, I read the report too.
There are still problems with your cervical spine such as the listhesis at the C3-C4 level and stenosis below the ACDF level.
There is also compression of the posterior columns from the degenerative changes of the posterior spine at the level of the myelopathy.
All these findings may cause issues with proprioception and coordination, problems also with the gait.
So, it is very likely that the gait issues are linked with the spinal cord damage.
The report doesn’t mention the hummingbird sign.
In my opinion, it should be considered, but it should be correlated to other elements in favor of PSP.
I think that the PET scan together with Ophthalmologist’s evaluation will help in understanding correctly your condition.
Hope this helps.
Feel free to ask if you have further questions.
I still think that the spinal cord damage is the culprit.
Detailed Answer:
Hello again.
I saw the new MRI images that you uploaded, I read the report too.
There are still problems with your cervical spine such as the listhesis at the C3-C4 level and stenosis below the ACDF level.
There is also compression of the posterior columns from the degenerative changes of the posterior spine at the level of the myelopathy.
All these findings may cause issues with proprioception and coordination, problems also with the gait.
So, it is very likely that the gait issues are linked with the spinal cord damage.
The report doesn’t mention the hummingbird sign.
In my opinion, it should be considered, but it should be correlated to other elements in favor of PSP.
I think that the PET scan together with Ophthalmologist’s evaluation will help in understanding correctly your condition.
Hope this helps.
Feel free to ask if you have further questions.
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
I still think that the spinal cord damage is the culprit.
Detailed Answer:
Hello again.
I saw the new MRI images that you uploaded, I read the report too.
There are still problems with your cervical spine such as the listhesis at the C3-C4 level and stenosis below the ACDF level.
There is also compression of the posterior columns from the degenerative changes of the posterior spine at the level of the myelopathy.
All these findings may cause issues with proprioception and coordination, problems also with the gait.
So, it is very likely that the gait issues are linked with the spinal cord damage.
The report doesn’t mention the hummingbird sign.
In my opinion, it should be considered, but it should be correlated to other elements in favor of PSP.
I think that the PET scan together with Ophthalmologist’s evaluation will help in understanding correctly your condition.
Hope this helps.
Feel free to ask if you have further questions.
I still think that the spinal cord damage is the culprit.
Detailed Answer:
Hello again.
I saw the new MRI images that you uploaded, I read the report too.
There are still problems with your cervical spine such as the listhesis at the C3-C4 level and stenosis below the ACDF level.
There is also compression of the posterior columns from the degenerative changes of the posterior spine at the level of the myelopathy.
All these findings may cause issues with proprioception and coordination, problems also with the gait.
So, it is very likely that the gait issues are linked with the spinal cord damage.
The report doesn’t mention the hummingbird sign.
In my opinion, it should be considered, but it should be correlated to other elements in favor of PSP.
I think that the PET scan together with Ophthalmologist’s evaluation will help in understanding correctly your condition.
Hope this helps.
Feel free to ask if you have further questions.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Doctor Erion Spaho,
Many thanks for your kind support.
I also don’t discard the presence of some Parkinsonism (may be PSP/PAGF) in addition to the preponderant aspects related with the cervical lesions.
Indeed, I have many and increasing complaints clearly related with the cervical - neck pain and stiffness, right hand tingling, etc.
By the way, I remember now that one year ago I was proposed to devitalize some nerves in the cervical spine by Radiofrequency, because the pain was considered to be a consequence of a too high ACDF Cage at C4-C5 level, impacting the other levels. What do you think about this technique (Radiofrequency Denervation). Would I get some benefits?
I fully agree with you concerning the hummingbird sign issue - it appears to me that the Brainstem images look very very similar from 2014 to 2020 but I admit some atrophy of the Midbrain starting in 2018 that may be normal for my age.
I’m willing to come back to you again as soon as I get the PET scan (by mid of March) and the Ophthalmologist’s evaluation.
Kind regards
Many thanks for your kind support.
I also don’t discard the presence of some Parkinsonism (may be PSP/PAGF) in addition to the preponderant aspects related with the cervical lesions.
Indeed, I have many and increasing complaints clearly related with the cervical - neck pain and stiffness, right hand tingling, etc.
By the way, I remember now that one year ago I was proposed to devitalize some nerves in the cervical spine by Radiofrequency, because the pain was considered to be a consequence of a too high ACDF Cage at C4-C5 level, impacting the other levels. What do you think about this technique (Radiofrequency Denervation). Would I get some benefits?
I fully agree with you concerning the hummingbird sign issue - it appears to me that the Brainstem images look very very similar from 2014 to 2020 but I admit some atrophy of the Midbrain starting in 2018 that may be normal for my age.
I’m willing to come back to you again as soon as I get the PET scan (by mid of March) and the Ophthalmologist’s evaluation.
Kind regards
Dear Doctor Erion Spaho,
Many thanks for your kind support.
I also don’t discard the presence of some Parkinsonism (may be PSP/PAGF) in addition to the preponderant aspects related with the cervical lesions.
Indeed, I have many and increasing complaints clearly related with the cervical - neck pain and stiffness, right hand tingling, etc.
By the way, I remember now that one year ago I was proposed to devitalize some nerves in the cervical spine by Radiofrequency, because the pain was considered to be a consequence of a too high ACDF Cage at C4-C5 level, impacting the other levels. What do you think about this technique (Radiofrequency Denervation). Would I get some benefits?
I fully agree with you concerning the hummingbird sign issue - it appears to me that the Brainstem images look very very similar from 2014 to 2020 but I admit some atrophy of the Midbrain starting in 2018 that may be normal for my age.
I’m willing to come back to you again as soon as I get the PET scan (by mid of March) and the Ophthalmologist’s evaluation.
Kind regards
Many thanks for your kind support.
I also don’t discard the presence of some Parkinsonism (may be PSP/PAGF) in addition to the preponderant aspects related with the cervical lesions.
Indeed, I have many and increasing complaints clearly related with the cervical - neck pain and stiffness, right hand tingling, etc.
By the way, I remember now that one year ago I was proposed to devitalize some nerves in the cervical spine by Radiofrequency, because the pain was considered to be a consequence of a too high ACDF Cage at C4-C5 level, impacting the other levels. What do you think about this technique (Radiofrequency Denervation). Would I get some benefits?
I fully agree with you concerning the hummingbird sign issue - it appears to me that the Brainstem images look very very similar from 2014 to 2020 but I admit some atrophy of the Midbrain starting in 2018 that may be normal for my age.
I’m willing to come back to you again as soon as I get the PET scan (by mid of March) and the Ophthalmologist’s evaluation.
Kind regards
Brief Answer:
I would explain as follows.
Detailed Answer:
Hello again.
If the pain is unbearable, radiofrequency denervation may be tried to mitigate the pain.
But also, botulinum toxin injections may be of benefit in your case, since there is stiffness that may cause aggravate the pain.
So, if there is no improvement with simple measures such as antineuralgic drug use and physical therapy, you can consider injections or radiofrequency denervation.
Hope this helps.
In good health.
I would explain as follows.
Detailed Answer:
Hello again.
If the pain is unbearable, radiofrequency denervation may be tried to mitigate the pain.
But also, botulinum toxin injections may be of benefit in your case, since there is stiffness that may cause aggravate the pain.
So, if there is no improvement with simple measures such as antineuralgic drug use and physical therapy, you can consider injections or radiofrequency denervation.
Hope this helps.
In good health.
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
I would explain as follows.
Detailed Answer:
Hello again.
If the pain is unbearable, radiofrequency denervation may be tried to mitigate the pain.
But also, botulinum toxin injections may be of benefit in your case, since there is stiffness that may cause aggravate the pain.
So, if there is no improvement with simple measures such as antineuralgic drug use and physical therapy, you can consider injections or radiofrequency denervation.
Hope this helps.
In good health.
I would explain as follows.
Detailed Answer:
Hello again.
If the pain is unbearable, radiofrequency denervation may be tried to mitigate the pain.
But also, botulinum toxin injections may be of benefit in your case, since there is stiffness that may cause aggravate the pain.
So, if there is no improvement with simple measures such as antineuralgic drug use and physical therapy, you can consider injections or radiofrequency denervation.
Hope this helps.
In good health.
Above answer was peer-reviewed by :
Dr. Kampana
Dear Doctor Erion Spaho,
Many thanks for your so kind and useful reply!
I will now be closing the discussion, and will get in touch again as soon as I get the results of the Spect DaTscan (mid of March) and of the Ophthalmologist’s evaluation.
Best wishes
Many thanks for your so kind and useful reply!
I will now be closing the discussion, and will get in touch again as soon as I get the results of the Spect DaTscan (mid of March) and of the Ophthalmologist’s evaluation.
Best wishes
Dear Doctor Erion Spaho,
Many thanks for your so kind and useful reply!
I will now be closing the discussion, and will get in touch again as soon as I get the results of the Spect DaTscan (mid of March) and of the Ophthalmologist’s evaluation.
Best wishes
Many thanks for your so kind and useful reply!
I will now be closing the discussion, and will get in touch again as soon as I get the results of the Spect DaTscan (mid of March) and of the Ophthalmologist’s evaluation.
Best wishes
Brief Answer:
Answered below.
Detailed Answer:
Okay, glad I helped you.
In the future, you can contact me directly at : http://tinyurl.com/DrSpahoAnswers.
Greetings.
Answered below.
Detailed Answer:
Okay, glad I helped you.
In the future, you can contact me directly at : http://tinyurl.com/DrSpahoAnswers.
Greetings.
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Answered below.
Detailed Answer:
Okay, glad I helped you.
In the future, you can contact me directly at : http://tinyurl.com/DrSpahoAnswers.
Greetings.
Answered below.
Detailed Answer:
Okay, glad I helped you.
In the future, you can contact me directly at : http://tinyurl.com/DrSpahoAnswers.
Greetings.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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