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Suggest Treatment For Lesions On Penis And Numbness On The Foot
Question: I was recently diagnosed with herpes after a priimary eruption/outbreak a couple of months ago. During the outbreak, I had a few lesions on my penis, numbness and tingling on the sole of my left foot, and numbness/tingling around my genitals and anus. The lesions have healed, and the numbness/tingling has mostly dissipated. However, I now notice a strange sensation running down my sciatic nerve when I bend my head forward. I do not feel the sensation in my spine, neck, arms or other leg. A neurologist on this site as well as my primary care physician do not think that it's MS, but I would like another opinion. Does this seem to be MS?
Brief Answer:
Cannot diagnose or rule out MS based on your presentation
Detailed Answer:
Good afternoon. I am a neurologist in the XXXXXXX OH area of the world.
Though I agree on first blush with your doctors that this is not MS since this is an odd presentation, however, having said that...it is not possible to entirely RULE OUT MS just based on what you've said. One would have to do much more of a history and then, get imaging studies of both the head as well as the lumbar spine to see what is there or more like it....WHAT IS NOT.
I also would say that unless your history suggests some other features of an MS type of picture such as bladder or bowel incontinence, spasticity, etc. a head imaging study looking for MS would be unnecessary given your symptoms. I would not disagree with an imaging study for the lumbar spine itself since you could very well have some mild form of sciatica or other lumbar spine problem....though it is a bit early for you being only 29 years old. Nonetheless, I would agree with that type of approach.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 16 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Cannot diagnose or rule out MS based on your presentation
Detailed Answer:
Good afternoon. I am a neurologist in the XXXXXXX OH area of the world.
Though I agree on first blush with your doctors that this is not MS since this is an odd presentation, however, having said that...it is not possible to entirely RULE OUT MS just based on what you've said. One would have to do much more of a history and then, get imaging studies of both the head as well as the lumbar spine to see what is there or more like it....WHAT IS NOT.
I also would say that unless your history suggests some other features of an MS type of picture such as bladder or bowel incontinence, spasticity, etc. a head imaging study looking for MS would be unnecessary given your symptoms. I would not disagree with an imaging study for the lumbar spine itself since you could very well have some mild form of sciatica or other lumbar spine problem....though it is a bit early for you being only 29 years old. Nonetheless, I would agree with that type of approach.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 16 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for responding, doctor. Aside from L'Hermitte's sign, I've had no other symptoms (i.e. fatigue, blurry vision, spasticity). My primary care physician ordered an x-ray to check for compressions and/or pinched nerves. If this fails to shed any light on the situation, then he said he'd recommend an MRI to rule out MS. Would you agree with this approach/assessment? Should I skip the x-ray and just go for the MRI.
Brief Answer:
Your description cannot be called Lhermitte's sign
Detailed Answer:
Thank you for your response. Perhaps, I'm not interpreting what you wrote correctly but if what you said that every time you flex your neck forward you get a shooting sensation in your "sciatic nerve" running into the leg then, you are over-interpreting that as Lhermitte's sign. Lhermitte's or The Barber shop sign specifically is a shocklike sensation that runs down the back either from directly behind the neck or from within at most 1-2 spinal segments below the neck. However, in no instance would we label what you have as Lhermitte's since the sensation is from you lumbar spine into the leg and CAN BE SEEN in patients with MS. It is by no means highly specific for MS and let's assume a patient starts out as having a true Lhermitte's sign...it would be a mistake to work backwards and conclude that they either had or had a high probability of having MS. That needs to further elucidated. I think that an imaging study of the lumbar spine is an appropriate diagnostic option (MRI of the lumbar spine) but beyond that I would not necessarily agree for an MRI of the brain based on your symptoms. I might go with something such as an EMG/NCV of the back and lower extremities or if there the imaging showed something suspicious I would consider a CT MYELOGRAM. Many facilities like the idea of doing an X-RAY PLUS and MRI of the spine at the same time. However, in your case, I think an MRI of the lumbar spine wold be quite sufficient to look for a problem. If that were clean then, I'd go for the x-ray and possibly an EMG/NCV study.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 12 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Your description cannot be called Lhermitte's sign
Detailed Answer:
Thank you for your response. Perhaps, I'm not interpreting what you wrote correctly but if what you said that every time you flex your neck forward you get a shooting sensation in your "sciatic nerve" running into the leg then, you are over-interpreting that as Lhermitte's sign. Lhermitte's or The Barber shop sign specifically is a shocklike sensation that runs down the back either from directly behind the neck or from within at most 1-2 spinal segments below the neck. However, in no instance would we label what you have as Lhermitte's since the sensation is from you lumbar spine into the leg and CAN BE SEEN in patients with MS. It is by no means highly specific for MS and let's assume a patient starts out as having a true Lhermitte's sign...it would be a mistake to work backwards and conclude that they either had or had a high probability of having MS. That needs to further elucidated. I think that an imaging study of the lumbar spine is an appropriate diagnostic option (MRI of the lumbar spine) but beyond that I would not necessarily agree for an MRI of the brain based on your symptoms. I might go with something such as an EMG/NCV of the back and lower extremities or if there the imaging showed something suspicious I would consider a CT MYELOGRAM. Many facilities like the idea of doing an X-RAY PLUS and MRI of the spine at the same time. However, in your case, I think an MRI of the lumbar spine wold be quite sufficient to look for a problem. If that were clean then, I'd go for the x-ray and possibly an EMG/NCV study.
I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?
Also, if there are no other questions or comments, I'd appreciate it greatly if you would CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary.
Please direct more comments and questions to me in the future at:
bit.ly/drdariushsaghafi and I would be honored to answer you and continue this discussion.
All the best.
The query has required a total of 12 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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