Can MS inflammation cause high signal oedema and what does postop bulging disc mean in an MRI?
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Three years ago, a PT was working with "trigger points", as he called them, on my cervical area. He progressed over to my side. He placed a pillow between himself and me (he was standing and I was lying on a PT table). He began mashing on my upper rib area. Fifteen minutes later, when my session was over, I noticed that my breathing was a little laboured. That evening odd sensations took over my lower legs. I had to wrap a blanket around them in order to fall asleep. The next day, a huge tingly sensation travelled to my left foot. Over the next few days, I developed terrible thoracic pain and sensations in the back of my head that felt like blood moving around. I also had sharp pains that went to my lumbar spine. Within a week or so, my balance was way off and my memory started to change. A neurologist prescribed huge doses of Lyrica and Lamictal to control the sensations, he oddly left this out of my records altogether. I had a brain MRI done by a different neurologist that said I had generalized cortical atrophy. He also did evoked potentials that determined abnormal upper and lower motor controls. The first neurologist disagreed with the MRI. I took the MRI to GA where a neurologist agreed that there was cerebellar atrophy. So when I came back to TN the first neurologist and his partner completely disregarded this facilities opinion. They did their MRI that said no significant white matter disease. Two years ago I went to another neurologist in my same area, in hopes of finding out something about my brain. She did an MRI that said I have two punctate lesions of restricted diffusion just superior to the left atrium of the left lateral ventricle which may be remote calcifications. No acute findings. No evidence of abnormal enhancement. During the past three years, my memory has gotten so bad I can barely leave my house alone. I stay tired all the time, my muscles have atrophied, I have tremors and coordination problems, and I believe that I now have MS. I also had a bone scan that determined I had a broken rib and physiological activity in my axial skeleton, the fourth and fifth ribs I think. If that is not enough for one person, I was taking PT for my balance in 2011. I worked so hard to build up a little muscle back in my calves. I had a large herniated L5-S1 disc that started leaking because of all the extra strain. I should have known better, but the PT didn't say to stop. I was petrified when I felt another weird sensation from my sacral area down to my toes on the right foot. I was afraid that I would have more sensations that the medication could not control. I was so scared that I let my small town orthopedic spine surgeon operate rather than waiting for another opinion from a neurosurgeon. There were so many red flags that should have stopped me. All the medication I was taking blunted my brain so much. I would never have had any type of surgery in this particular hospital before I became brain impaired. Immediately after the surgery I knew something was wrong because my right forefinger was blue. The surgeon adamantly said there ws no way a lumbar surgery could cause that to happen. After I got home from the hospital, I could not even turn on either side in bed without a strong flow of pain coming from my rectum. My legs and feet had nasty sensations. The more I walked, the worse they got. I didn't know at the time that I had scattered boney densities in my nervous tissue, according to a CT scan that I later had. The surgeon had done a left-sided pedicle screw and rod instrumentation at L5S1. He dismissed me when I went back to him with severe pain. I could not find a neurosurgeon that would even talk to me. I felt like a screw was digging into my neural tissue. I spent six weeks lying on ice packs until my legs had more weird sensations, so I had to stop using anything cold. One doctor did a SEDrate test, another did other blood work, and they all said everything was normal. I finally went to a rheumatologist and found out my Igg level was 272. I truly felt like something very abnormal had happened to me because I became very and weak, my legs became hypersensitive to the sun. (They still are, of course). I did, unbelievably, find an immunologist that started me on subcutaneous infusion therapy to rebuild my immune system. I managed to get a new PCP to do a lumbar and sacral MRI. I had L5S1 nerve root swelling, enhancement in the laminectomy defect extending to the left L5S1 neural foramen, and additional nonspecific enhancement in the posterior paraspinal soft tissues/musculature. (No other abnormal CNS enhancement). Small incompletely imaged sacral perinueral cysts. 5mm XXXXXXX dimension. My EMG test said I had chronic L5S1 nerve root injury. They did not test the paraspinal muscles. I was in so much pain that I had to go to the ER. They admitted me which turned into another nightmare because the hospital doctor and staff made it clear that I was not welcome. The doctor gave me steroid infusions for three days and put me out of the hospital. (I was by myself at the time, my husband had to leave for a meeting at work). I was on so much pain medicine that I didn't really know what was going on. I kept telling the doctor that I needed a vascular surgeon to look at my lumbosacral plexus. The doctor just told me I should go somewhere else as soon a possible. I travelled all the way from TN to TX. This neurosurgeon looked at my MRI, sent his PA back in to tell me the doctor was sending me to interventional-neuro. for a spinal cord stimulator. I knew that was the last thing I needed with all the inflammation I had going on. I didn't have enough foresight to schedule seeing another neurosurgeon in that area. After fourteen months of suffering, I found a neurosurgeon in TN that would see me. He said he needed to do two surgeries, one for tethered cord and the other for stabilization. He had a good reputation so I went along with this, although he didn't respond to my questions. One regarding why my left paraspinal muscle was larger than the right one, and on the fact that I had so much sacral/rectal pain that I could barely sit down on anything, hard or soft. After the surgeries, I do not feel any real improvement. My legs are getting weaker because I can't use my thigh muscles. If I bend over two times, the inflammation comes right back. After looking at the doctor's notes, after the surgeries, I learned he had put preop and postop spondylolisthesis at L4 and L5, and at L5 to S1. Postoperative diagnosis: history or L5S1 transforaminal lumbar interbody fusion at another facility with a single interbody spacer and single sided screws placed with psuedoarthrosis, haloing around the screws and progressing back pain. Also has DDD with facette hypertrophy, discogenic back pain at L4-5. The CT scan that he did after the surgeries said there were additional boney fragments L4-S1 region, star artifact from metallic fixation hardware both posteriorly and anteriorly, L3-4 mild to moderate disc bulge, L4-5 overall mild concentric disc bulge with a small broad-based central disc protrusion projecting back 3mm. Partial bilateral laminectomies at L3. Some interval incorporation of bone fragments posteriorly with probable complete boney fusion superior aspect of the right facet joint at L5S1. Visable paravertebral soft tissues normal. Before he did the first surgery, I ask about removing the hardware from the terrible surgery that ruined my spine. He said he did not think this would make any difference, but that he would see how everything went after the surgeries. Since the pain was not gone, he offered to take the original screws out, so I agreed although I knew it would be futile at this point. So, after the screw removal, the pain is still there. The surgeon's PA told me the doctor had done everything he could for my pain. I had to go to the ER again. They did MRI which said I have undergone a L2-L3 laminectomy, some high signal STIR changes in the paravertebral soft tissues in the region which are presumably postoperative, posterior to central canal at the laminectomy defect there is small 8mm rounded fluid collection which may represent a tiny pseudomeningocele. Ghost tracts from leftward L4-5 PLIF homogenously enhancing material which is isointense to muscle on T-1 weighted sequences, likely perineural fibrosis. This collection extends inferiorly and surrounds exiting S1 nerve roots. A T-2 hyperintense nonenhancing collection within the midline subcutaneous tissues posterior to the spine likely represents a postoperative seroma. An 11mm T2 bright collection adjacent to the left L4-5 facet shows mild rim enhancement, nonspecific. I ask the ER doctor what all this meant. He basically said the only thing I could do would be to try some injections. Since I am still having to go to the pain clinic, which will be forever, I asked my NP about injections. They said I could try a caudil injection. I don't thing this will help because I tried one after the first surgery. It lasted for one day. Maybe they thing it will work. What do you think? I am more concerned about MS at this point than pain. What do all the comments about nonspecific enhancement, homogenuously enhancing material, a T2 bright collection showing rim enhancement, nonspecific;and paraspinal STIR high signal edema mean? Does this indicate MS inflammation? What about all the postop bulging discs? Now, the last thing. I just had a new brain MRI done because of my terrible gait and ten other MS symptoms. It, amazingly, doesn't show anything abnormal. How can this be?
Posted Tue, 14 Jan 2014 in General Health
Answered by Dr. Raju A.T 4 days later
Brief Answer: Need the scan images Detailed Answer: Hi, Thanks for your query. It was an informative history. I am medical doctor, an associate in Department of Neurology, working with an experienced Neurologist and Neurosurgeon. I answer on his behalf. I would like to have a look at the MRI scans which showed two punctate lesions of restricted diffusion just superior to the left atrium of the left lateral ventricle and the recent one which shows no abnormality. Most of times the MS signs appear to fade and recur this happens in some types of MS comprising of migratory sclerosis. Yes, the high signal oedema could be due to MS inflammation and is very commonly encountered finding in the MRI. The bulging discs as for now should not be disturbed. You may have to continue to visit the pain clinic. any further intervention in the spine, damages it more than helping. Kindly attach all reports possible here. I would get a better idea after looking at them. Waiting for your response,
Follow-up: Can MS inflammation cause high signal oedema and what does postop bulging disc mean in an MRI? 2 days later
I have two CD's but I can't send them by e-mail. Can you send me an address so I can mail them to you.
Answered by Dr. Raju A.T 17 hours later
Brief Answer: The reports Detailed Answer: Hi, If the images cannot be attached, do attach the reports of the same here. Regards,