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Dr. Andrew Rynne

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What are the symptoms and side effects of Eagle's syndrome?

Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 1412 Questions

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Posted on Mon, 20 Oct 2014 in Brain and Spine
Question: Hello, this is XXXXXXX You answered my questions on healthcaremagic and we also talked on healthtap several weeks ago.

To remind you of what we talked about - I've been having some psychological/neurological symptoms such as severe fatigue, sluggish thinking, memory lapses, derealisation episodes/temporal seizures, urinary dribbling, reading problem, etc. ((for a more detailed reminder, I'm enclosing your assessment from healthtap below this.))) The doctors did all kinds of tests, including MRI of the brain, all possible blood tests, EEG, EKG, and so on and so forth. Everything came out clean. You suggested that I see an immunologist and have some additional tests done otherwise I should consult a psychologist. I did the latter and was diagnosed with mild concentration/memory impairment. I also had all possible urological tests done (ultrasound, microscopy, intravenous tomography, etc.) which came out clean, except for one - uroflowmetry, where a residuum of urine was found in my bladder after urination, which objectivised my subjective problem. I began physiotherapy and the exercises that I'm doing are making my urinary problem better. I think it's more than clear now that the dribbling is caused by a pinched nerve or some sort of physical rather than psychological/neurological problem.

A few weeks ago my muscle spasms got worse, especially in the throat and neck area. It got so bad that I could't sleep at night and I was waking up with throbbing pain. My phyisotherapist gave me tetrazepam which was the only thing that helped (analgesics did not). On his recommendation I visited a jaw and neck surgeon who did a CT scan and physical examination and found that I probably have the Eagle's syndrome (proc. styloideus elongatus), myofacial pain syndrome and myofunctional algic syndrome. Someone who enjoys black humour might comment that at last I've found a doctor who gave me a diagnosis :-) The surgeon is going to give me a jaw splint and prescribe further rehab. If that doesn't help though they'll have to operate.

1) I wanted to ask if you think that the Eagle's syndrome could be contributing or causing some of the pseudo-neurological/psychological symptoms.

2) The second question I have for you is what could be causing the urinary problem. I've been doing rehab exercise for a month now and it does make it better but as soon as I sit down for longer than a few minutes it comes back. Obviously I want to know what's causing the problem. Perhaps something with the spine? Is it worth doing an MRI?

If you can't answer these questions because they're outside your specialisation then if you could recommend whom I should ask that would be much appreciated!

If you feel that you would rather speak with me then let me know and I can call you on healthtap. I just thought that my question was too long for that system.

Thanks a lot for your help!

Best,
XXXXXXX




if you need a more detailed reminder, let me paste your report from our conversation on healthtap here:

((((22 year old male from the Czech Republic with complex set of symptoms for the past year including significant fatigue which has interfered so much that he has had to stop pursuing studies in school as a graduate student in economics. He lives with parents and states that everything is fine at home. He likes being with friends. He is well read on the internet with respect to his symptoms and physical issues. He has a history of multiple episodes of tonsilitis infections and pulmonary infections which at times have been severe. Recently he was bedbound for 4 weeks and "very sick." He was not hospitalized on that occasion. He says that having frequent tonsillar infections is not that unusual for him. He was worried about ALS. I had written a response to him on another network of detailed reasons why I didn't believe he had this problem and therefore, will not repeat that discussion here. After our discussion he said he was no longer worried about that as a potential problem. He mentions dribbling at the end of urination and that is something that has come and gone over time. He's been told that he had weak "belly muscles." No reference made to urinary tract symptoms. Has seen different physicians at home with not much success in determining what's going on with him. Labs and testing have been normal. MRI of the brain (without contrast) unremarkable although his braces give artifact display in the frontal lobes. Other metabolic and general screening tests for thyroid, B12, CBC have been unremarkable. Has not had Vit. D done nor cortisol testing. Sleep study has been normal.

Assessment:
Patient with several concerns of a somatic nature but no etiology discovered just yet. I believe that one of his primary problems is FATIGUE. I don't find his EEG results very compelling for anything significant in terms of a seizure disorder or focal or unusual slowing to suggest a regional problem in the brain. I suggested to him that he get his Vitamin D looked at for completeness sake and consider an immunology consult since I feel he gets a higher frequency of UR infections that could be contributing to his factor of fatigue. I don't know why he is intermittently dribbling unless there is an urinary tract infection of some sort. He is going to have neurocognitive testing done this coming week and will let us know the results in a few weeks. In the mean time, I suggested that though his zeal for medical information on the internet was commendable and felt that he did not need to STOP reading that he should consider not reading too much INTO what he is researching and allow his physicians to guide testing and therapy. He agreed and he will check back in with us in a few weeks. I considered recommending an MRI with gadolinium contrast but I honestly don't believe we are looking at a chronic demyelinating type of disease entity and don't think the money out of pocket that he would have to spend justifies the likely outcome of the study.)))))))))


doctor
Answered by Dr. Dariush Saghafi 10 hours later
Brief Answer:
Just spent the last 2 hours writing response

Detailed Answer:
System did not capture it and I didn't copy it to repaste!!!

Oh my goodness! Wow!

Unfortunately, I do not have time to repeat that whole treatise again.

Here are the highlights then, just so I can get a response of some sort to you and then, maybe I can try and add more detail again this evening when I get back from the office and rounds with my patients!

I absolutely despise when these sorts of system problems occur....just so disheartening...

Here are the major points to what I just wrote:

1. I am thrilled XXXXXXX that you've returned to fill me in on what's been going on.
2. No need to have reminded me of your case since in your absence I've actually been conferring with several colleagues and have another idea or two....I was hoping you'd return for some updates...so THANK YOU FOR coming back (Again, I'm so sorry that everything I wrote jut got trashed....just pitiful for the computer to do that--- oh well,,,,).
3. Thought by another colleague is that some of your symptoms sounded consistent with consequences of Rheumatic Fever or Rheumatic disease of the central nervous system causing a condition known as choreoathetosis (St. Vitus Dance). I had never SERIOUSLY entertained that diagnosis for several reasons, however, there is a common "textbook" complaint that is seen and heard in such patients and that is the feeling that their eyes "jump across the page while reading" and they have trouble sort of focusing on reading things and appear to lack concentration or attention span. Choreoathetosis was felt to be what you were possibly describing when you said things like not being able to accurately press buttons on the microwave due to somehwhat of an uncontrollable jumpiness of the hands, arms, etc.
4. Bottom line, has anybody considered the diagnosis of Rheumatic Fever and consequences of Strep infections of the throat based on your history of multiple tonsillar infections and in particular your one history you said where you were very sick and bedridden for a month with some type of pulmonary process.
5. Chronic strep infection, Rheumatic Fever sequelae, Choreoathetosis, ASO titers in blood (anti-STREPTOLYSIN) titers.
6. Eagle's syndrome (I wrote tons on this including my father who is a practicing surgeon). Bottom Line- I am not thrilled, convinced, or impressed with the surgeon's take on either your diagnosis or the fact that "surgery will have to be done." And I went through a whole discussion and rationale for that.
7. I suggested that you not make any definitive decisions regarding any surgery and that if anything you may wish to pursue a 2nd opinion on his diagnosis since I find it tough to believe that you suddenly acquired that problem out of the blue sky. I suggested that you search out a big academic teaching institution in your area or close and make an appointment to see doctors there to coroborrate the information that this guy claims is pointing to surgery....I think surgery is a POINT OF NO RETURN....
8. Is the surgeon so sure of the diagnosis that if the surgery doesn't completely and permanently relieve all of your complants in the head and neck that he'll return all the money you spend on such as procedure. I doubt he'd agree to such a thing. Then, in my opinion, he's not THAT SURE of his diagnosis.
9. I went through a whole long explanation of how to determine whether your bladder issues are neurogenic or not. My thought was to trial standard medications first for such a thing such as oxybutynin to see first if that solves the problem of dribbling. I wasn't thrilled about getting an MRI of the back since I don't really expect to find anything...you're so young nor are you really complaining on radiating back pain to any extent, right? We could do an EMG to determine neurogenci bladder or not but that's invasive and I'd rather avoid that right now until we see how other things go.

Unfortunatley, that's all the time I have right now.

I had asked you also to upload please the psychological reports and urodynamic and cystogram tests if you have those so I can look at them.

We will talk again soon but to let you know it won't be until about another 14-16 hrs. before I can return to this question....got an incredibly busy day scheduled in the office and outside.

And guess what I just did? COPIED THE DAMNED THING.....I'm still in shock from having lost all of that material! All the same:

CHEERS!!!

Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Dariush Saghafi 3 hours later
Thanks so much. I really appreciate your time and your effort. I'm so sorry that your work got lost!! That sucks!

1) About Eagle syndrome
I have not acquired the problem suddenly out of blue sky. I had a congenital problem with my jaws which was being corrected with braces since the age of 6 (underbite, open bite, crossed bite). About 6-7 years ago I developed symptoms which really sound exactly like the Eagle's syndrome (feeling of having a foreign body in the neck that clicks when moving the head... I also did have several occasions where I almost lost consciousness when I moved my head). I think I never mentioned to you that I suffer from muscle spasms almost constantly but let me explain - I thought it was mainly due to sitting a lot studying for uni etc.. so I didn't think it relevant to my other symptoms. It's been getting very bad in the last few weeks though, to the point of not being able to sleep at night. That's why I saw a physiotherapist and the jaw surgeon. The muscles got so tight that I woke up almost choking and I developed swallowing problems.

I'm convinced there's some problem either with my jaws, or neck, or throat, or the neck vertebrae, or some combination of thereof. Whether it's compressing the arteries and secondarily causing the other symptoms I do not know. I think the best and cheapest way to find out about the arteries is doppler ultrasound (or at least that's what I was told). The other things - MRI I guess. I repeat that I have been developing this particular problem for many years. I am sorry that I never mentioned it.

The jaw surgeon I went to is the number 1 in the whole country. After a lot of really bad experience with Czech doctors I paid to see the best one. I quite trust this guy. Actually, I went to see two surgeons. The first one said I had the myofacial syndrome and the other one said the rest.

I do understand that surgery is point of no return and I will do whatever I can to avoid it. I'm no surgery enthusiast.

Now perhaps I should mention that I've been so many doctors, each telling me something else. Perhaps you will understand my remark from our last conversation that I feel that I know more than the doctors. Which doctor should I trust when everyone's telling me something else? Nobody. But I do trust you because you're the only one who's spending so much time and so much effort trying to find out what's wrong with me. I appreciate that more than I can express with words. Maybe it's also clear now why I read so much on the internet about all possible medical conditions. I'm no doctor but you know - nobody's there to help me in Czech republic (at least so far) so what do I have left but to study everything myself. I've been in this s*** for half a year know and I have no intention of wasting my life on it. That's why I'm putting all my effort into trying to solve it. A good start would be a diagnosis.


2) Rehumatoid fever, etc...
- Nobody has seriously considered the diagnosis of these. My neurologist told me that she has no idea what's wrong with me, except suspecting temporal lobe epilepsy and depression. Neither of which has been confirmed. I am still to undergo day-long EEG monitoring in November.... the cognitive tests done were rather obsolete to my mind and I sadly do not have the results. The doctor refused to provide said it was unnecessary. She said that I have a minor concentration and memory problem.
- I had the C3/C4 complex, ESR and CRP tested and they were within range. This I guess lowers the probability that I have something Rheumatoid-related.
- I presume that I should get the Anti-streptolysin O tested for.
- A bit more about my medical history -- As a child I had persistend tonsilitis sterptoccocus infections, a few times a year. 3 years ago when I started my undergrad I had another such infection, after which I developed the urination problems. They did all kinds of tests like now and found nothing (no infection), except for streptoccocus in the urine tube. The urination got better after a few months but it never felt the same again, I had to sit down when on the toilet not to have the dribbling afterwards... Very unpleasant. This year the fatigue got massively worse after a bronchitis infection in January (not diagnosed just assumed by my GP;;; treated with 3-day course of antibiotics), so did the urination problem. It came again after the infection. That's what made me think of MS because that also comes after infections (or at least wiki says so). I don't believe in MS, ALS or any of those serious diseases anymore. But something's going on and I do not think it's psychological, at least not primarily.

3) Urination problem
I do have persistent back pain. As I said above, I never mentioned it because I had so many symptoms to present that I just got lost in it...... The pain always comes when I'm sitting for longer than a few minutes (such as I'm doing now) and gets better after rehabilitation and exercise which I've been doing. But as soon as I sit in front of computer it comes back (and it doesn't matter what chair I'm sitting on). I have back and belly muscle spasms almost all the time to one degree or another. I do not have the tests, sadly again and don't think I can get them. The urologist refused to provide them. I only have a report which says that nothing was found and that on uroflowmetry the pressure/current was OK, except that there was a residuum of urine.

Since the rehab and exercise DO help quite a lot (not with the neck though, just the spine and urination) I think it points in the direction of this being a nerve-compression problem or just a spinal problem (( I have scoliosis by the way)) -- both caused by excessive sitting --- that in turn causes muscle spasms which cause urological problems.


4) Conclusion
I don't care about the money. I have saved up enough and I'm willing to invest it in health. What else should I invest it in? I won't let monetary concerns limit my diagnosis. Besides, I might be able to get the insurance company pay for it. They paid for my brain MRI without question.

What I would do is get the doppler blood flow ultrasound thing, then an MRI of the whole spine, including the TMJ and neck/throat in general. If the doppler shows something then angiography of carotids as well. Will this definitely confirm/ rule out Eagle's syndrome, the pinched nerve hypothesis or generally spinal problems? I think it WILL help with diagnosis, if only by ruling things out. That's worth the bucks. And it's a way to avoid surgery if the tests come out negative of anything physical.

Secondly, I'd get the blood tests for rheumatoid fever etc... done.. What all tests would you recommend? anti-DNA, anti-ENA antibodies as well perhaps? I need to tell my GP the exact blood tests otherwise he'll just stare at me as usual not knowing what's going on...

I agree that it's too soon for EMG at the moment.

I do not believe that everything I'm experiencing is psychological or at least not primarily. I do have some troubles and worries but so does everyone from time to time... That's life. I don't think I have depression - I'm not sad and I enjoy doing things. You don't know how much I'd love to get back to my studies of Economics and Cognitive Science... I love playing tennis, the piano, composing music. I just can't do anything because of muscle pain, sluggish thinking and terrible fatigue! I love and enjoy life so much - I'm not depressed and I absolutely refuse such a diagnosis from my neurologist. I think that's sloppy thinking and a lack of effort in finding a diagnosis. If I have anxiety then that's because I don't have a diagnosis and quite severe symptoms. Not the other way round.

5) Thanks
Sorry for writing such a long thing. Without doubt you seem to be the only person who can and who's willing to help me. I am tremendously grateful. You represent the very finest of the medical profession and my sole experience with you repairs a dozen bad experiences with other doctors and restores my faith in the profession. If you're right and your efforts finally lead to a diagnosis than no doubt I'll be in great debt. A life's debt.

Best,
XXXXXXX
I'm more than happy to call you on healthtap if that's easier for you!! You won't have to write so much I guess. Just let me know.

And one more thing - when you mentioned choreoathetosis, I remembered that at one point I was thinking of having Huntington's disease until I read that only 2% of people with this disease have no relatives with that gene. Since almost all my relatives died in old age and never showed any signs of huntingtons' i think that's almost certainly ruled out.


doctor
Answered by Dr. Dariush Saghafi 25 hours later
Brief Answer:
Sorry it took so long to get back to you

Detailed Answer:
Very sorry XXXXXXX that it's taken so long to get back to you but yesterday was extremely busy in the office and today is my son's birthday and so I kind of promised everyone I would try and keep my time on the computer to a minimum....but at least I will write a little to you to let you know I've not forgotten your problem and have been actually reading snipets of what you've written back and thinking about things. I very much appreciate your confidence in my help. I'm going to try and be more meritorious of that support by coming up with something meaningful here...so let's see. In the interest of keeping my promise to my wife and kids...I will try answering a bit a time of your paragraphs...which by the way are very helpful in terms of compartmentalizing certain problems....uh oh....the wife just pulled in.....she's going to kill me....was supposed to get the cake at 10a! EEekkk.....

Let me just go to the paragraph of Eagle's Syndrome.....so those are the braces I saw on you? I thought that was just for dental purposes and making a hit with the ladies or your next tryout role for the movies!

So just briefly on that count...I better understand your involvement with the surgeons and retract any comments that may have unnecessarily based them for wanting to offer you surgery for no reason at all. I now understand why they may be thinking as they are and why they may be pushed to consider surgical approaches. Notwithstanding, I still maintain that any procedure still fails to get at the root cause of what's causing all of this to begin with...be it a neuromuscular issue or something else. I really don't think compression of arteries causing muscle spasms and nothing else in the way of hypoxic or even anoxic consequences is likely or even possible. And that's why, in my opinion, getting more studies in the way of dopplers and MRA's is not likely to show anything that will help us. Having said that, I do understand that you wish to be as sure can be that nothing is missed and that you are willing to pay as necessary to cover the costs.

So, if we just look at the muscle spasms occurring from the base of the neck up...does that basically describe the GEOGRAPHY of where most of the negative action is taking place? Are your vocal cords affected during these attacks of spasms? Can you have someone videotape any of these attacks as they occur? Do they happen with regularity when asleep? Perhaps, you can set up a webcam to record you while asleep? As they do in a sleep lab? I don't know how much memory you'd need to record 8 hrs. of sleep but could that be useful? Could this be a regional form of dystonia...possibly brought on by Eagle's Syndrome?

Just how long is your Styloid process on the affected side anyways? Of course, I probably don't need to tell you that elongated styloid processes occur as anatomic variants in about 5% of the U.S. population anyways and of those only about 5% are actually symptomatic. And of THOSE....nearly 3x more people affected are women compared to men......so THOSE ARE THE NUMBERS that push me away from your problem....

But, no doubt the symptoms you describe of the throat pain, the feeling that something is in your neck....yada, yada, yada....are consistent with the typical symptoms of Eagle's.....Can you upload the X-ray of your head so I can see that elongated styloid? Anybody else in your family with this problem.....I mean, you're right...this is a dilemma....maybe this IS what is causing all of this.

But at least, one thing is clear.....you're no longer pursuing a diagnosis of ALS, right? At least we got you off of that bandwagon! HAHA!

So, do this...see if you can upload an x-ray and if there's a report where they actually measured the styloid. Numbers are not universally agreed upon in terms of what the styloid normally measures but in Eagle's supposedly it's about 38-44mm.

BTW, the psychologist who didn't want to give you their report is a jerk in my opinion....if you were in the U.S. you could report them to the board and likely XXXXXXX them since you have every right to the record. The issue with that person is that they never wrote a report up in all likelihood that's worth anything for another professional to read. And you paid for it I suppose? I've got some contacts with Czech National Wrestling Team.....I can have someone visit that person if you'd like!

Ok...got to go buy my son's birthday cake....but I'll look for more information later tonight.

I still want to comment on the ideas of choreathetosis and Rheumatic fever as well although admittedly some of this is making more sense now without trying to invoke all these other zebras into the picture.....we'll see.

Cheers!
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Dariush Saghafi 3 hours later
Hi again,

Please don't apologise. I'm the one who should be sorry for taking so much of your time. It's almost funny that you should apologise for letting me wait a few hours when czech doctors typically let me wait weeks or months. I'm used to waiting for much longer periods so no worries at all!

.........so those are the braces I saw on you? ---> yes, I've had these for 2.5 years now. Prior to that, since the age of six, I had removable braces for night. As I said, I had a large underbite; crossed and open bite.

........And that's why, in my opinion, getting more studies in the way of dopplers and MRA's is not likely to show anything that will help us. --->>> Yeah, most likely.. But the ultrasound is quick and cheap so the cost benefit ratio is good I think. MRI of the spine can rule out some thing, albeit unlikely as you say, but it's not gonna hurt. Maybe the wallet, but as I said, I'll survive that. At least for the peace of mind.

......So, if we just look at the muscle spasms occurring from the base of the neck up...does that basically describe the GEOGRAPHY of where most of the negative action is taking place? --------->>> I have muscle pain and .. I just checked the dictionary for the word spasm - it means sudden contractions of muscles, right? I have something more like slowly progressing tightening of muscles until they become sore. It's not sudden. I probably used the wrong word... Well, my English isn't perfect! It doesn't happen so much when I'm walking or standing. But as soon as I sit down or lie down the muscles start getting tighter and tighter, and it starts hurting more and more until it forces me to get out of bed and do some stretching. I've had this problem for the last 6-7 years, they've been getting worse and worse. It's on the front of the neck, on the face, on the back of the neck, and also my jaw bones and the muscles connected to it hurt. Furthermore, I have this feeling of having something 'extra' on the left side of my neck... which sort of stands in the way when I for instance draw in my chin. When I move my tongue in a specific direction (back and forth) it clicks and moves away. Strangely enough, I can sense the click with my hand not when I put it on the place where I feel this thing.. but when I put my hand close to the jaw. Which makes me think that the click could actually be coming from the jaw. I can't feel the click in the jaw though... So mysterious!


------Are your vocal cords affected during these attacks of spasms? --->>>> No, my vocal chords are fine. My voice is quite veiled but I've had this for a long time... and it's maybe because of my nasal airway hypertrophy......

-----Can you have someone videotape any of these attacks as they occur? --->>> In light of my previous answer, you couldn't see anything on the camera so there's no need to record it... Everything, all pain, the fatigue and other problems are worst in the morning... The tightness of muscles is also worst during sleep..

-----Just how long is your Styloid process on the affected side anyways? --->>> yeah, I've seen the stats... highly unlikely... but when have we excluded the most likely things? perhaps... I don't know, I haven't been told. I've uploaded the x-ray.

--- If it's not Eagle's syndrome, then there's definitely something that's causing the pain in the neck muscles and the phantom object in the throat... I had an ENT examination and everything seems fine from the inside... there's no lump or anything... thyroid's ok, lymph nodes are Ok, throat tube is OK, saliva glands ok, just everything... what's clicking is the jaw bone, the hyoid bone or a tendon or a calcified something.... I don't know.. That's why I thought that MRI might be able to help.

-- ok, that's all for now... it's more than enough... the urination thing is a separate problem I think


Thanks so much again! Hope you had a good time....

P.S... I've noticed that if you're writing for too long the system always fails to save the message... better to always save a copy in a text editor..

doctor
Answered by Dr. Dariush Saghafi 26 hours later
Brief Answer:
If getting studies will help put you at more ease

Detailed Answer:
Then, that is what we need to do. I agree that if getting the vascular tests are going to help you feel more at ease at how things are or how your anatomy is then, by all means let's get it done.

I wanted to get some type of response back to you as the length of time had hit the 24 hr. mark and the system doesn't like it when we wait more than 20 hrs. to respond. I've got more that I want to say about what you've written about your muscle pain so please write back so I have an open door to write back....I've still got patients here in the hospital and then, I have another I have to see at home....but essentially, I wonder if there's any way we can do a surface electrical recording (no needles) on the neck to see if we can 'SEE' the pain through changes in electrical conductance as in a NCV test. You've had EMG's done to thsi point, right? But were the neck muscle involved?

I'm trying to see if we can quantify what's going on with the buildup of pain that then, causes you to have to get up. Is there any way to biofeedback, acupuncture, deep breathing exercises, visualization, meditation, or any of those types of complementary activities could short circuit this buildup of pain which then, causes you to have to get up and stretch? Can all of that be perhaps a very BIG and annoying type of TIC behavior.....what if somebody would literally TIE YOU TO A CHAIR when you felt you HAD to get up because of the throat pain? What would happen to you physically? You say your vocal cords don't seem to be affected. Would you get short of breath, would there be SPASMS that would ensue or would nothing much happen except perhaps the eventual dying down of the pain sensation that cause you to jump and stretch.

Kind of like NOT CRACKING YOUR KNUCKLES even though you have this incredible urge to do so....what would happen if you didn't crack them? Usually nothing, right? And if you forced yourself not to crack your knuckles when you felt automatically compelled to do so.

At any rate, sorry for the brevity of this note and not having covered all the bases I wanted to....write back so I can have another open note to shoot more info back. Also, do you have any studies you can upload? X-rays of the neck, etc.?
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dariush Saghafi 53 minutes later
Hi,

thanks for the response. I've booked myself for an ultrasound study next Monday and the anti-streptolysin O blood test for tomorrow. I'm going to wait with MRI until my braces are taken off in 3 weeks (and also for the results of these tests).

I haven't had EMG done or any nerve conduction study.

What helps with the pain is doing a light activity - like playing table tennis or just walking or playing with the dog... And doing exercise prescribed by my rehabilitation doctor. If somebody tied me to a chair then the muscles would get stiffer and stiffer and the pain would gradually build up to an unbearable level (not just in the neck area but also in the lower back area). I would start getting short of breath because my muscles would get so tight that they wouldn't allow the belly to expand very much. I would slowly start crouching a little.

Hmm, thinking about the tic behaviour... That's a good idea - and I agree it may be a part of it. I don't think it's the primary cause though... The primary cause is excessive sitting or some other problem or a combination thereof. But there IS a psychological factor present I think - I'm a perfectionist and I have often ignored pain just to get work done and get the best results at uni. I tend to forget my body and live a little bit in my head if you know what I mean. That's why for the last month I've stopped working and really focused on my body. The lower back problem has improved but not the neck...

Actually, today my grandmother brought me an ointment made from cannabis and I was quite surprised that it helped relax the muscles...

I uploaded an x-ray of the neck with the last entry. I'm going to do it again to make sure it gets uploaded.

Thanks a lot again.

Best,
XXXXXXX
doctor
Answered by Dr. Dariush Saghafi 22 hours later
Brief Answer:
Panorex does not seem to include styloid process

Detailed Answer:
Hi Jacob-- How are you today on this last day in September?

I reviewed your Panorex....wish I had teeth like that anymore! Unfortunately, reading Panorex's is only on the basis of need anymore....USUALLY MY OWN NEED! I am unable to identify the styloid processes which are the focal points of attention when discussing Eagle's Syndrome. Do you have any films that might show those entities?

You realize that I've am outside of my element of expertise and comfort zone relative to fund of knowledge of this problem so please check on what I've been telling you regarding EMG studies etc. with someone before going out and getting anything done. Kind of sounds like the diagnosis is pretty solid just from a clinical perspective. EMG's (especially in the face and head) are not comfortable at all. I for one would probably be crying during the whole test! LOL....well, maybe not crying but I would not be a very cooperative patient and probably turn a 1 hr exam into at least 3! LOL.....

I agree with waiting on the MRI until you get the braces off so as to minimize artifact.

Some additional reading and digging around speaking with colleagues has revealed that some procedures such as EMG, Ultrasound, and Doppler studies are considered either experimental or of very low yield by some authors terms of making diagnoses of Eagle's Syndrome.

There are some authors who strongly believe in doing EMG studies specifically of the temporalis and masseter muscles which generally show HYPERACTIVITY in presumptive cases of Eagle's. Those same muscles were used as barometers following treatment and intervention be it conservative or surgical to determine the success or not of treatments.

I've also discovered that if in fact, the diagnosis of Eagle Syndrome is considered solid and becomes either highly presumptive or the working diagnosis that it becomes necessary to check the integrity of the carotid arteries which could be compressed at some point in the future though they may be asymptomatic now. In other words, getting the MRA makes sense...perhaps, even the carotid U/S thought the sensitivity of the MRA is going to be higher and less operator dependent than U/S which has higher interoperator variability in terms of successful outcomes and measurements as well as a very small window through which the study must be shot due to the size of the probe and the trajectory of the carotids within the neck and head.

In fact, in terms of neurological issues involving the carotid...I almost never get U/S's anymore since I get much more information from a well done MRA and if I'm really suspicious for a subtle lesion or defect, I'll get it with contrast or even double contrast.

Now, this is not to be confused with U/S that may be employed to TREAT masticatory muscle PAIN (thought to be related to spasms or dystonic dysfunction of the jaw and neck muscles). This is considered a viable treatment option.

Ok....well, I think my position on what's potentially going on here is definitely different than what it was a few weeks ago. I think the idea of an elongated Styloid ligament or styloid process in general is an attractive diagnosis given your symptoms. I think that the literature certainly seems to support doing some of the testing you've mentioned so I'll be curious to see how they come out.

Neuropsychological testing, in my opinion, not as critical now to be worried about getting (or the report from the Wicked Witch of Czechoslovakia)...notwithstanding your own admitted contributions of exacerbatingly potentiating behaviors...(I doubt those are all words but I sense you probably get my drift).

I think that if you've got good people treating your TMJ that there should be some significant improvement in your neck symptoms and believe that's where the money is right now in terms of a single unifying diagnosis to cover most if not all of your major symptoms of pain and discomfort that you've had.

Please keep the information flowing when available.....and of course, do not forget to leave a few generous comments behind (as your others were greatly appreciated) so that the network folks can tell we're talking about medically relevant things for which your life should improve.

I have an article that I can send you which you may read some of this information. If you'd like to provide me your email and I'll ship that over to you...likely tomorrow at some point....well, maybe tonight yet since I'm on call.

All the best.....

This query required 41 minutes of physician specific time to review, research, and document in final draft form for envoy.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Dariush Saghafi 38 minutes later
Hi,

thanks for the reply! Today I had some additional tests done (anti DNA, anti-ENA and anti-streptolysin O - the one you recommended). Next week I'll have the doppler thing and in 3 weeks MRI + MRA.

I want to do dopplers to see if there's a carotid artery compression that might be causing the fatigue and the other symptoms... It may sound far-fetched but something's telling me it could be related... People see what they want to see but generally my fatigue and other symptoms (memory problems, the pseudo-seizures or whatever they are, etc.) kind of correlate with what's going on with my neck... Maybe not.. But it's worth investigating. I don't have any other x-rays I'm afraid.

I'm still open to your suggestion of choreathetosis as it kind of describes some of my physical symptoms. - that's why I had the test done today. Well, we'll see what the results say and then can talk more.

My email address is: YYYY@YYYY .

I'll keep you updated as soon as I have more results. Expect a call on healthtap in a week or so.

Thanks a lot again!

Please just confirm you got the email address and I'll end the conversation.

Best,
XXXXXXX


doctor
Answered by Dr. Dariush Saghafi 27 hours later
Brief Answer:
Lots of luck on the tests

Detailed Answer:
Sounds like you've got the full gammut of tests lined up. Let's see what the results of these tests come out to in a few weeks.

We'll see about the choreoathetosis although again, I think there is a better than average chance at this point based on everything we've talked about that Eagle's is pretty out front right now in terms of the most likely working diagnosis.

But again, we'll see after the tests are done.

Thanks for closing out this query and for your continued supportive comments. I look forward to getting the results. Don't forget that my direct webpage for personalized queries can be found at:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474

Take care and have a great rest of the week.
Above answer was peer-reviewed by : Dr. Yogesh D
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