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Suggest Treatment For Degenerate Disc Disease
Question: I have burning with cold (can be freezing sometimes) and/or prickliness. Symptoms began last January -- arms are most prominent but also in legs - is patchy in these areas -- scared of paraneoplastic syndrome, esp lung cancer. (smoked for 20 years -quit at 41 years - now 57. These symptoms are persistent. Had nerve and muscle test in April of 2014 - nothing was detected. Neurologist will repeat the testing soon. MRI showed multi-level degenerate disc disease and multi-level foraminal stenosis which he said would not correlate with my symptoms. V scared.
Brief Answer:
Please upload MRI and follow-up with NCS and EMG.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through your detailed history and clinical course,after reading your previous discussions with the fellow consultants.If you would have presented to me as an outpatient,I would have told you that-"Yes;Of course,your symptoms are not classical for a length dependent peripheral neuropathy as caused commonly by vitamins deficiency or Diabetes".Diabetes however can cause this type of presentation too.So,your blood sugar result needs to be shared here.
Do you have any history of chronic alcohol intake?That can be one cause,which can lead to these symptoms commonly.
With a chronic smoking history,paraneoplastic or malignant neuropathy,of course becomes a consideration for this asymmetric onset,proximal neuropathy.Autoimmune etiology is another etiology to be ruled out.
The fellow consultant with whom you had a discussion in your previous query correctly pointed out that there is no direct indication for jumping to CT scan of chest.However,Chest X-Ray should be repeated and if anything suspicious is detected,even the slightest of infiltration or hilar prominence,CT chest should be done.CT scan should be a kept in plan here as this is not the evaluation for a classical neuropathy but atypical asymmetric proximal neuropathy.
Also,ESR(erythrocyte sedimentation rate),CRP(C-reactive protein) and ANA(Anti nuclear antibody) should be done to rule out vasculitis and autoimmune disorders.
Besides,first and the foremost task for you here is to upload the Nerve conduction studies(NCS) and Electromyography(EMG) reports.I also want to see the MRI spine image/CD as proximal asymmetric neuropathic symptoms can be due to radiculopathy also.You can upload the MRI CD on Google drive and share the link here.
Waiting for your follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
Please upload MRI and follow-up with NCS and EMG.
Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through your detailed history and clinical course,after reading your previous discussions with the fellow consultants.If you would have presented to me as an outpatient,I would have told you that-"Yes;Of course,your symptoms are not classical for a length dependent peripheral neuropathy as caused commonly by vitamins deficiency or Diabetes".Diabetes however can cause this type of presentation too.So,your blood sugar result needs to be shared here.
Do you have any history of chronic alcohol intake?That can be one cause,which can lead to these symptoms commonly.
With a chronic smoking history,paraneoplastic or malignant neuropathy,of course becomes a consideration for this asymmetric onset,proximal neuropathy.Autoimmune etiology is another etiology to be ruled out.
The fellow consultant with whom you had a discussion in your previous query correctly pointed out that there is no direct indication for jumping to CT scan of chest.However,Chest X-Ray should be repeated and if anything suspicious is detected,even the slightest of infiltration or hilar prominence,CT chest should be done.CT scan should be a kept in plan here as this is not the evaluation for a classical neuropathy but atypical asymmetric proximal neuropathy.
Also,ESR(erythrocyte sedimentation rate),CRP(C-reactive protein) and ANA(Anti nuclear antibody) should be done to rule out vasculitis and autoimmune disorders.
Besides,first and the foremost task for you here is to upload the Nerve conduction studies(NCS) and Electromyography(EMG) reports.I also want to see the MRI spine image/CD as proximal asymmetric neuropathic symptoms can be due to radiculopathy also.You can upload the MRI CD on Google drive and share the link here.
Waiting for your follow-up.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank-you for your valued opinion, Doctor.
I do not have diabetes - also many blood tests completed included electrophoresus serum. CRP was normal twice. No ESR was done. My MRI CD was kept by specialist hospital when I had follow-up when benign polyp of uterus was surgically removed in November. I don't think there are any vitamin deficiencies. I have not had tests for autoimmune disorder but I have done some research and they just don't seem to fit.
I have not been tested for anti-HU antibodies yet nor had a CT scan of lung (last chest x-ray was approx 6 months ago) My prominent and only symptoms are dysthesia. ( varies from burning prickliness to coolness to a combination of freezing and burning) Back, arms & legs which is patchy and shifts around but is overall more prevalent in arms but back and legs are also often felt. I have no loss of weight or other symptoms.
As I mentioned, my symptoms came on suddenly last January and threw my whole system off balance. I had post-menopausal bleeding which turned out to be a very large non-cancerous polyp. (had many ultrasounds) Had breast rashes which came and went. (ultrasound, mammography, and tomography were done) 3 breast surgeons said that I was o'k. I would just like to know if there is a chance for long-term survival if it is lung cancer with this type of neurological presentation. I am really scared because it looks like lung cancer is the only real possibility now.
By the way, I will upload the reports as soon as I have them. I had one elctrophysiological test last April which the neurologist told me was normal. I was sent for an MRI based upon those findings. The only result from that was Multi-level degenerative disc disease and multi-level right foraminal stenois. When I returned to his office in January 2015, he told me that this would not be the cause of these symptoms. I have another nerve and muscle test scheduled for this coming Monday at the same office. (It may be entirely different this time around)
I do not have diabetes - also many blood tests completed included electrophoresus serum. CRP was normal twice. No ESR was done. My MRI CD was kept by specialist hospital when I had follow-up when benign polyp of uterus was surgically removed in November. I don't think there are any vitamin deficiencies. I have not had tests for autoimmune disorder but I have done some research and they just don't seem to fit.
I have not been tested for anti-HU antibodies yet nor had a CT scan of lung (last chest x-ray was approx 6 months ago) My prominent and only symptoms are dysthesia. ( varies from burning prickliness to coolness to a combination of freezing and burning) Back, arms & legs which is patchy and shifts around but is overall more prevalent in arms but back and legs are also often felt. I have no loss of weight or other symptoms.
As I mentioned, my symptoms came on suddenly last January and threw my whole system off balance. I had post-menopausal bleeding which turned out to be a very large non-cancerous polyp. (had many ultrasounds) Had breast rashes which came and went. (ultrasound, mammography, and tomography were done) 3 breast surgeons said that I was o'k. I would just like to know if there is a chance for long-term survival if it is lung cancer with this type of neurological presentation. I am really scared because it looks like lung cancer is the only real possibility now.
By the way, I will upload the reports as soon as I have them. I had one elctrophysiological test last April which the neurologist told me was normal. I was sent for an MRI based upon those findings. The only result from that was Multi-level degenerative disc disease and multi-level right foraminal stenois. When I returned to his office in January 2015, he told me that this would not be the cause of these symptoms. I have another nerve and muscle test scheduled for this coming Monday at the same office. (It may be entirely different this time around)
Brief Answer:
You can plan CT Chest as a part of evaluation,repeat chest X-Ray beforehand
Detailed Answer:
Hi,
Thanks for being in follow-up and providing clinical history in details.
If MRI CD is not available,please upload MRI images atleast.I hope they must be available with you.Reviewing MRI and NCS-EMG will help me get in depth knowledge of your situation and I shall be in a better position to answer your query.
However,I feel concerned the way you are afraid about the fears of 'Lung cancer'.Lung cancer is not detected and you are asking about the survival?Ok..if that is a theoretical question,the answer is that the long term survival depends on the type of lung cancer(small cell or squamous or adenocarcinoma).It is poor in general.However,there is no point worrying about long term survival of a disease,when you are not having the disease.
I am of the opinion,that CT chest can be done as a part of your evaluation of neuropathy,but chest X-Ray should be repeated before that.I am just saying that it can be planned and not directing at present for the same,as we don't have a confirmatory diagnosis of neuropathy as yet.First,please upload the NCS-EMG reports so that we can be definite about neuropathy.Then,CT chest can be planned.
Hope I have answered your query for now.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
You can plan CT Chest as a part of evaluation,repeat chest X-Ray beforehand
Detailed Answer:
Hi,
Thanks for being in follow-up and providing clinical history in details.
If MRI CD is not available,please upload MRI images atleast.I hope they must be available with you.Reviewing MRI and NCS-EMG will help me get in depth knowledge of your situation and I shall be in a better position to answer your query.
However,I feel concerned the way you are afraid about the fears of 'Lung cancer'.Lung cancer is not detected and you are asking about the survival?Ok..if that is a theoretical question,the answer is that the long term survival depends on the type of lung cancer(small cell or squamous or adenocarcinoma).It is poor in general.However,there is no point worrying about long term survival of a disease,when you are not having the disease.
I am of the opinion,that CT chest can be done as a part of your evaluation of neuropathy,but chest X-Ray should be repeated before that.I am just saying that it can be planned and not directing at present for the same,as we don't have a confirmatory diagnosis of neuropathy as yet.First,please upload the NCS-EMG reports so that we can be definite about neuropathy.Then,CT chest can be planned.
Hope I have answered your query for now.If you have some follow-up questions,I shall be glad to answer else,please close the thread-rate it and write a review.Your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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