What causes pain in cervical spine with constant muscle spasms?

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Posted on Wed, 2 Jul 2014 in Brain and Spine
Question: I am a 43 yr old female who has a history of prior migraines, DDD and L5/S1 partial discectomy and laminectomy. After the first lumbar surgery I had several more ruptured disc. At the time we chose conservative treatment and deferred surgery until no other measures helped. My pain has progressed and began affecting my blood pressure when my pain was uncontrolled. I was started on blood pressure medication as to I was in constant pain. Recently I began having pain in my cervical spine with constant muscle spasms that did not respond to muscle relaxers. While at work I turned my head and heard a pop that shot pain up into my head. The pain was the worst pain in my life. I ended up in the ER being treated for pain and my BP. IV pain meds and IV bp meds were ineffective in helping my pain or bp. I had burning, stinging, stabbing, pressure, and it felt like a drill was being drilled into my spine and head. I also had weakness in limbs and uncontrollable spams up to my face. It affected my right eye and I also had pins and needless pretty much every where. I had a MRI with findings of prominent CSF space medial to the left temporal lobe. There are a few tiny flair hyper intense foci at supratentorial white matter which are noted predominantly in a subcortical distribution and may reflect stigmata of punctuate microvascular ischemic change. CT of spine C3-C4 Uncovertebral spurring contributing to moderate left exiting foraminal stenosis as well as moderate left lateral recess stenosis. Mild disc bulge. C5-C6 Uncovertebral spurring, right greater than left, contributing to mild exiting foraminal stenosis. Mild degenerative facet arthropathy, right greater than left. I have some days in the past that upon waking I was obtunded. At the time we attributed it to lack of sleep quality due to pain. My previous brain mri's were all negative. I am still in constant pain with spastic muscles and my bp goes up as my pain does. I am questioning MS along with my spine problems. I have also had some depth perception issues lately.
doctor
Answered by Dr. Sudhir Kumar 8 hours later
Brief Answer:
MS is less likely

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your symptoms and reports of MRI brain and CT spine.

The brain lesions on MRI are non-specific and do not fulfil the criteria for diagnosis of multiple sclerosis (MS). These findings are more common with migraine and ischemia (lack of blood flow to brain). Ischemia commonly occurs due to high blood pressure.

CT spine shows degenerative changes and disc disease, which are compressing nerves in the neck region. As a result, you may get neck and arm pain.

As of now, you need medications such as pregabalin or gabapentin capsules for pain relief.

In addition, physiotherapy with neck extension exercises, and ultrasound/IFT for pain relief, would also help.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sudhir Kumar 55 minutes later
I have been on Neurotin 600mg tid for several years now for the nerve damage from my first lumber surgery. Just recently changed over to Horizant. Also on XXXXXXX Tid, Opana 15mg bid, and Percocet 10mg Qday. I have tried steroid injections and PT. Planning facet joint block in 2 weeks. Not getting much by way of pain releif. My concern is that my bp spikes severely when my pain gets out of control. All previous brain mri's were negative even a year after my last migrain. The concern for MS is because my sister was recently diagnosed and I have noticed alot of our symptoms cross over. Especially the spastic muscles and pain intensity.e
doctor
Answered by Dr. Sudhir Kumar 4 hours later
Brief Answer:
Facet joint block may help.

Detailed Answer:
Thank you for getting back with more details.

Yes, I agree that your pain is severe and almost refractory to medical treatment. Here, facet joint block would be helpful.

If the suspicion of MS is high, further investigations may be done, such as lumbar puncture (CSF analysis to look for oligoclonal bands) and evoked potential studies (including visual, brainstem and somatosensory).

These investigations would be helpful in making or excluding a diagnosis of MS.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudhir Kumar 2 days later
This whole situation has been quite perplexing to me. Daily dizziness, severe headaches that spike my bp to stroke level, loss of strenghth in my arms and legs, neck and spine pain. Spastic muscles that travel to my face and affect my eye on the right. I still need to be able to work and it will be weeks before I can see a neurologist. I feel trapped. I do not like having to run to an ER when my pain gets uncontrollable. Any suggestions. Some of my family want me to just go the ER of the larger hospital likeDuke University in XXXXXXX They feel I will get a better work up.
doctor
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
Medications would be helpful.

Detailed Answer:
Thank you for getting back with more details.

I can understand your discomfort on account of pain and spasticity, and delay in seeing a neurologist.

At this stage, medications such as pregabalin capsules would help in reducing neuropathic pain and baclofen tablets would reduce the spasticity.

I agree that consulting a doctor at Duke would definitely be helpful.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Sudhir Kumar

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