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What Causes Muscle Spasms On Neck And Back?
Question: Hello,
I am a 40 yr old female with a history of asthma (since age 2), rheumatic fever (2006), osteoarthritis, a "thyroid storm"(2009), endometrosis (since age 20) and a host of other bizarre, minor health stuff. This past summer I had strange symptoms and ended up at my infectious disease doctor who wanted studies to rule out MS. After many tests and a neurologist consult, they determined that "it could all just be stress-related". Three weeks ago, I was sent to the ED by my overly-cautious family doctor because of severe neck/back pain, stiffness, headache and right-sided arm and leg weakness. After 2 CT scans, 2 MRI studies, 5 X-rays, an EKG and blood work , they sent me home with a dx of "muscle spasms", a steroid pack and a pain reliever. My CHIROPRACTOR obtained a copy of every report of every study I had done during my 25 hour hospital admission from the ED, and gave them to me last week. The chest studies showed nodules on the right side of my thyroid - that were to have follow-up ultrasound studies, stable biapical pleural parenchyma scarring, medically in the right lower lobe is a sub pleural 6.5 mm density that is slightly larger than on XXXXXXX 2011 (what?). It may represent pleural thickening or hypoventilatory changes and the recommended a 'follow up.' Architectural distortion in the upper left lobe image is stable. There is a common origin for the left common carotid and right brachiocephalic artery. The left vertebral artery originates from the aortic arch between the left common carotid artery and left subclavian artery. The head studies: A slight prominence of fourth ventrical with suggestion of mild hypo plasma of inferior cerebellar vermis and mildly prominent cisterna magna - most likely developmental variation. There are a few scattered foci of t2/flair hyper intensity in the sub cortical white matter which are non-specific but can be seen in patients with migraine syndromes or demyelinating processes. A mega-cisterna magna is again noted. Several minimal disc bulges are mentioned, and mild left foraminal narrowing and again mega cisterna magna is incidentally noted at the posterior fossa.
Can you please help me understand any part of these reports and let me know if follow up outside of my small community hospital is recommended? Not one physician mentioned any follow-up for the studies that said "follow-up." Thank you for your time, your assistance and knowledge. XXXX
I am a 40 yr old female with a history of asthma (since age 2), rheumatic fever (2006), osteoarthritis, a "thyroid storm"(2009), endometrosis (since age 20) and a host of other bizarre, minor health stuff. This past summer I had strange symptoms and ended up at my infectious disease doctor who wanted studies to rule out MS. After many tests and a neurologist consult, they determined that "it could all just be stress-related". Three weeks ago, I was sent to the ED by my overly-cautious family doctor because of severe neck/back pain, stiffness, headache and right-sided arm and leg weakness. After 2 CT scans, 2 MRI studies, 5 X-rays, an EKG and blood work , they sent me home with a dx of "muscle spasms", a steroid pack and a pain reliever. My CHIROPRACTOR obtained a copy of every report of every study I had done during my 25 hour hospital admission from the ED, and gave them to me last week. The chest studies showed nodules on the right side of my thyroid - that were to have follow-up ultrasound studies, stable biapical pleural parenchyma scarring, medically in the right lower lobe is a sub pleural 6.5 mm density that is slightly larger than on XXXXXXX 2011 (what?). It may represent pleural thickening or hypoventilatory changes and the recommended a 'follow up.' Architectural distortion in the upper left lobe image is stable. There is a common origin for the left common carotid and right brachiocephalic artery. The left vertebral artery originates from the aortic arch between the left common carotid artery and left subclavian artery. The head studies: A slight prominence of fourth ventrical with suggestion of mild hypo plasma of inferior cerebellar vermis and mildly prominent cisterna magna - most likely developmental variation. There are a few scattered foci of t2/flair hyper intensity in the sub cortical white matter which are non-specific but can be seen in patients with migraine syndromes or demyelinating processes. A mega-cisterna magna is again noted. Several minimal disc bulges are mentioned, and mild left foraminal narrowing and again mega cisterna magna is incidentally noted at the posterior fossa.
Can you please help me understand any part of these reports and let me know if follow up outside of my small community hospital is recommended? Not one physician mentioned any follow-up for the studies that said "follow-up." Thank you for your time, your assistance and knowledge. XXXX
Brief Answer:
You need further studies
Detailed Answer:
Hi, thank you for using Healthcare Magic. You mention strange symptoms this past summer but do not say what they were, but that your doctor was concerned about MS. I am concerned about your recent episode of pain with associated right-sided arm and leg weakness. These can be symptoms of MS. Sometimes the diagnosis of MS is difficult to make in the early stages. The symptoms can be intermittent, and come and go. The MRI showed some developmental abnormalities which are being ascribed to normal variants. However, there were also nonspecific findings (the scattered foci of hyperintensity) which can be seen in demyelinating processes.
Demyelination is a condition of nerves in which the outer covering of the nerve axons starts to deteriorate. The axon is the long process of the nerve that connects it to other nerves or to muscles. The axon is protected by a covering membrane that you can liken to a copper wire covered by insulation. When the covering is removed, the electrical impulses don't flow properly. This can cause episodes of numbness, weakness, and/or pain.
This is what happens in MS. The fact that you have had a couple of episodes that could be MS flares, and have some findings now on MRI, suggests the possibility that you may indeed have it. The diagnosis is made over time with recurrence of symptoms and progressive MRI changes. You should be followed up on a regular basis to see if that is the case. There are some other tests that can help in the diagnosis, including a spinal tap, but it may be that your doctors don't feel strongly enough about this possibility right now to recommend such a procedure. In that case, it's a matter of being rechecked when symptoms reoccur, and repeating the MRI at that time and perhaps every few years.
The blood vessels arising from your heart have some anatomic variations that are nothing to worry about. You mention a history of thyroid storm and nodules are noted on your thyroid. The nodules and thyroid storm are most likely related. You don't mention any treatment or follow up related to the thyroid storm, but it sounds like further follow up is needed now. I would be checking an ultrasound of your thyroid as well as thyroid blood tests.
You have scarring in the lungs, most likely related to your longstanding history of asthma and also possibly rheumatic fever. This appears to be unchanged since your last chest x-ray. The right lower lung has an abnormality that could be scarring or an area of lung that is not getting much ventilation. However, since it appears a little larger from last time, they recommend a follow up. This would be another chest x-ray that should be done in a couple of months to see if this spot resolves.
So what I would suggest is a repeat chest x-ray in a couple of months, an ultrasound of your thyroid as well as tests of thyroid function, and periodic re-evaluations for the possibility of MS. Hope this answers your query. If you have further questions, I would be happy to answer them.
You need further studies
Detailed Answer:
Hi, thank you for using Healthcare Magic. You mention strange symptoms this past summer but do not say what they were, but that your doctor was concerned about MS. I am concerned about your recent episode of pain with associated right-sided arm and leg weakness. These can be symptoms of MS. Sometimes the diagnosis of MS is difficult to make in the early stages. The symptoms can be intermittent, and come and go. The MRI showed some developmental abnormalities which are being ascribed to normal variants. However, there were also nonspecific findings (the scattered foci of hyperintensity) which can be seen in demyelinating processes.
Demyelination is a condition of nerves in which the outer covering of the nerve axons starts to deteriorate. The axon is the long process of the nerve that connects it to other nerves or to muscles. The axon is protected by a covering membrane that you can liken to a copper wire covered by insulation. When the covering is removed, the electrical impulses don't flow properly. This can cause episodes of numbness, weakness, and/or pain.
This is what happens in MS. The fact that you have had a couple of episodes that could be MS flares, and have some findings now on MRI, suggests the possibility that you may indeed have it. The diagnosis is made over time with recurrence of symptoms and progressive MRI changes. You should be followed up on a regular basis to see if that is the case. There are some other tests that can help in the diagnosis, including a spinal tap, but it may be that your doctors don't feel strongly enough about this possibility right now to recommend such a procedure. In that case, it's a matter of being rechecked when symptoms reoccur, and repeating the MRI at that time and perhaps every few years.
The blood vessels arising from your heart have some anatomic variations that are nothing to worry about. You mention a history of thyroid storm and nodules are noted on your thyroid. The nodules and thyroid storm are most likely related. You don't mention any treatment or follow up related to the thyroid storm, but it sounds like further follow up is needed now. I would be checking an ultrasound of your thyroid as well as thyroid blood tests.
You have scarring in the lungs, most likely related to your longstanding history of asthma and also possibly rheumatic fever. This appears to be unchanged since your last chest x-ray. The right lower lung has an abnormality that could be scarring or an area of lung that is not getting much ventilation. However, since it appears a little larger from last time, they recommend a follow up. This would be another chest x-ray that should be done in a couple of months to see if this spot resolves.
So what I would suggest is a repeat chest x-ray in a couple of months, an ultrasound of your thyroid as well as tests of thyroid function, and periodic re-evaluations for the possibility of MS. Hope this answers your query. If you have further questions, I would be happy to answer them.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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