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What Causes Unsteady Gait And Intermittent Lower Extremity Muscle Twitching?
Question: My father is 68 years old. His balance/gait/walking has been declining for the past two years or so. At first just unsteady, to now he is using a cane. He has seen several doctors including: ENT and Ortho. He has had a negative brain mri, a whole slew of blood work that has been negative. Today he had an EMG done that was negative. He can walk for a small amount of time before "wearing" out. After he rests for a bit he can get up and walk a little more. At times he has lower extremity muscle twitching. He did see a DO who suspected Alcoholic Neuropathy because he is a recovery alcoholic. He drank for approximately 54 years but again all of his labs in relation to this suspicion were fine. We are at a loss, as no one seems to know what is going on with him.
Brief Answer:
This could be claudication of the artteries
Detailed Answer:
Welcome to HCM: This seems to be challenging, however, has peripheral vascular disease been ruled out? Was he a smoker, if so this makes this more likely. What happens is that the arteries become stiff and cannot expand to deliver more blood/oxygen to the muscles and thus he tires quickly, it is almost like lactic acid buildup, and then when her rests this becomes better, this would need a cardiology and or vascular surgeon who can narrow this down with precise graded testing. I hope this sheds some light, good luck and take care.
This could be claudication of the artteries
Detailed Answer:
Welcome to HCM: This seems to be challenging, however, has peripheral vascular disease been ruled out? Was he a smoker, if so this makes this more likely. What happens is that the arteries become stiff and cannot expand to deliver more blood/oxygen to the muscles and thus he tires quickly, it is almost like lactic acid buildup, and then when her rests this becomes better, this would need a cardiology and or vascular surgeon who can narrow this down with precise graded testing. I hope this sheds some light, good luck and take care.
Above answer was peer-reviewed by :
Dr. Yogesh D
Lactic acid was tested. Negative. He has had a stress test. Negative. He is a non smoker. One thing I did not mention was his spine MRI results. Disc bulges, stenosis etc.
Impression
Impression:
1. C3-4 disc bulge with a right central to foraminal protrusion and
severe right foraminal stenosis.
2. C4-5 right facet hypertrophy and bilateral uncovertebral hypertrophy
with severe right foraminal stenosis.
3. C5-6 disc bulge.
4. C6-7 disc bulge.
MRI lumbar spine without contrast
Indication: Imbalance
Comparison study: None
Procedure comments: Without contrast, multiplanar multi-sequential MR
images of the lumbar spine are obtained
Findings: There is curvature of lumbar spine convex to the left which
maybe positional or related to scoliosis. There are 5 nonrib-bearing
lumbar vertebral bodies. The conus medullaris ends at L1 and appears
normal. There is anterior osteophyte formation at multiple levels.
There are degenerative endplate signal changes at multiple levels.
There is desiccation of disc spaces at all levels of the lumbar spine.
There is narrowing of the disc spaces of the lumbar spine with relative
sparing at L2-3. There are Schmorl's nodes but otherwise vertebral body
heights appear normal. There is no anterolisthesis or posterolisthesis.
At T11-12, there is a right central to foraminal disc extrusion with
inferior migration which does not contact the right T11 nerve root or
significantly narrow the right foramen.
At L1-2, there is posterior disc osteophyte complex with morphology of
a disc bulge. There is no foraminal stenosis. There is no canal
stenosis.
At L2-3, there is a minimal disc bulge with no neural foraminal
narrowing or central canal stenosis.
At L3-4, there is a disc bulge. Superimposed on this, there is a disc
extrusion extending from left subarticular to lateral location with
superior migration in the left subarticular/proximal foraminal region,
displacing the traversing left L4 nerve root. There is no canal
stenosis. There is mild left foraminal stenosis.
At L4-5, there is a disc bulge. There is no significant foraminal
narrowing. There is impression on the posterior lateral thecal sac by
mild facet arthropathy.
At L5-S1, there is a posterior disc osteophyte complex with morphology
of a disc bulge with a superimposed left subarticular to lateral disc
protrusion contacting the traversing left S1 nerve and exiting left L5
nerve root and with mild-to-moderate left foraminal and moderate right
foraminal narrowing. There is moderate right and mild left facet
hypertrophy. There is no canal stenosis.
Impression:
1. T11-12 right central to foraminal extrusion with inferior migration.
2. L1-2 disc bulge.
3. L2-3 disc bulge.
4. L3-4 disc bulge with left subarticular to lateral extrusion
displacing left L4 nerve root with mild left foraminal stenosis.
5. L4-5 disc bulge.
6. L5-S1 disc bulge with left subarticular to lateral protrusion, mild
to moderate left foraminal narrowing, and moderate right foraminal
narrowing.
Signed By: Skillicorn, XXXXXXX
Component Results
There is no component information for this result.
General Information
Collected:
10/21/2015 9:07 AM
Resulted:
10/21/2015 9:39 AM
Ordered By:
Services Nonstaff Imaging
Result Status:
Final result
This test result has been released by an automatic process.
MyChart® licensed from Epic Systems Corporation, © 1999 - 2013.
Impression
Impression:
1. C3-4 disc bulge with a right central to foraminal protrusion and
severe right foraminal stenosis.
2. C4-5 right facet hypertrophy and bilateral uncovertebral hypertrophy
with severe right foraminal stenosis.
3. C5-6 disc bulge.
4. C6-7 disc bulge.
MRI lumbar spine without contrast
Indication: Imbalance
Comparison study: None
Procedure comments: Without contrast, multiplanar multi-sequential MR
images of the lumbar spine are obtained
Findings: There is curvature of lumbar spine convex to the left which
maybe positional or related to scoliosis. There are 5 nonrib-bearing
lumbar vertebral bodies. The conus medullaris ends at L1 and appears
normal. There is anterior osteophyte formation at multiple levels.
There are degenerative endplate signal changes at multiple levels.
There is desiccation of disc spaces at all levels of the lumbar spine.
There is narrowing of the disc spaces of the lumbar spine with relative
sparing at L2-3. There are Schmorl's nodes but otherwise vertebral body
heights appear normal. There is no anterolisthesis or posterolisthesis.
At T11-12, there is a right central to foraminal disc extrusion with
inferior migration which does not contact the right T11 nerve root or
significantly narrow the right foramen.
At L1-2, there is posterior disc osteophyte complex with morphology of
a disc bulge. There is no foraminal stenosis. There is no canal
stenosis.
At L2-3, there is a minimal disc bulge with no neural foraminal
narrowing or central canal stenosis.
At L3-4, there is a disc bulge. Superimposed on this, there is a disc
extrusion extending from left subarticular to lateral location with
superior migration in the left subarticular/proximal foraminal region,
displacing the traversing left L4 nerve root. There is no canal
stenosis. There is mild left foraminal stenosis.
At L4-5, there is a disc bulge. There is no significant foraminal
narrowing. There is impression on the posterior lateral thecal sac by
mild facet arthropathy.
At L5-S1, there is a posterior disc osteophyte complex with morphology
of a disc bulge with a superimposed left subarticular to lateral disc
protrusion contacting the traversing left S1 nerve and exiting left L5
nerve root and with mild-to-moderate left foraminal and moderate right
foraminal narrowing. There is moderate right and mild left facet
hypertrophy. There is no canal stenosis.
Impression:
1. T11-12 right central to foraminal extrusion with inferior migration.
2. L1-2 disc bulge.
3. L2-3 disc bulge.
4. L3-4 disc bulge with left subarticular to lateral extrusion
displacing left L4 nerve root with mild left foraminal stenosis.
5. L4-5 disc bulge.
6. L5-S1 disc bulge with left subarticular to lateral protrusion, mild
to moderate left foraminal narrowing, and moderate right foraminal
narrowing.
Signed By: Skillicorn, XXXXXXX
Component Results
There is no component information for this result.
General Information
Collected:
10/21/2015 9:07 AM
Resulted:
10/21/2015 9:39 AM
Ordered By:
Services Nonstaff Imaging
Result Status:
Final result
This test result has been released by an automatic process.
MyChart® licensed from Epic Systems Corporation, © 1999 - 2013.
Brief Answer:
The lactic acid I speak of is different than what they tested,
Detailed Answer:
Lactic Acid they check is for infection, not hypoxemia to musculature, in any event, I think that he will benefit from a graded strengthening program, that MRI does collaborate his symptoms with narrowing compromising vascular and neurological efficacy. Have you talked and pressed a neurologist for options of treatment, her obviously has global vertebral disease. There is no severe foraminal narrowing but I wonder if the number of the narrowing described is enough to cause issues with your father..
The lactic acid I speak of is different than what they tested,
Detailed Answer:
Lactic Acid they check is for infection, not hypoxemia to musculature, in any event, I think that he will benefit from a graded strengthening program, that MRI does collaborate his symptoms with narrowing compromising vascular and neurological efficacy. Have you talked and pressed a neurologist for options of treatment, her obviously has global vertebral disease. There is no severe foraminal narrowing but I wonder if the number of the narrowing described is enough to cause issues with your father..
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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