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What Causes Weakening Of Leg And Burning Sensation In Right Calf?
Question: Hello,
I live with Brown-Sequard syndrome which is a result of two operations of my backbone in the area of Th6-7 because of disc herniation. A stabilisation was also done in the area of Th5-8. My right leg used to have quite good motor function but I lost sensation in it while my left leg is paralyzed completely, but it is somehow oversensitive. Nowadays, my right leg is getting worse in strenght and especially in the evening I can feel very strong burning on my right calf (outer side). Beside this there is also quite strong pain in tibia when I stand up on the right leg and try to walk at least a few steps. Can you advise me what this could be?
I live with Brown-Sequard syndrome which is a result of two operations of my backbone in the area of Th6-7 because of disc herniation. A stabilisation was also done in the area of Th5-8. My right leg used to have quite good motor function but I lost sensation in it while my left leg is paralyzed completely, but it is somehow oversensitive. Nowadays, my right leg is getting worse in strenght and especially in the evening I can feel very strong burning on my right calf (outer side). Beside this there is also quite strong pain in tibia when I stand up on the right leg and try to walk at least a few steps. Can you advise me what this could be?
Brief Answer:
Brown Sequard Complications
Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am a neurologist from XXXXXXX OH, USA
Unfortunately, your picture is rather typical for how Brown-Sequard patients can progress when the elements of complex regional pain syndrome begin to set in. This is known by the more antiquated name of REFLEX SYMPATHETIC DYSTROPHY which is a painful syndrome that comes about after some type of traumatic injury to the peripheral nerves in a limb or wherever.
I believe that the motor function in the right leg (while it was good at one time) began to deteriorate based upon worsening sensory function. In other words, the less you were able to feel that right leg, the less easy it became to use it in a motor type of way. This then, would lead to a form of disuse atrophy which would simply become worse and with worsening sensory issues leading to pain and discomfort you would be less inclined to try and use that limb which would lead to more motor disuse hence weakness, and possibly atrophy (loss of muscle bulk). The burning sensations are part of a neuropathic picture which comes from disruption of the sensory tracts from T5-T8 that were compromised due to the operations.
The pain in the tibia may be due to a loss of calcium (osteopenia or osteoporosis) which is likely coming about because of lack of use, muscle atrophy, and eventually pain due to increasing fragility of the skeleton and less ability to bear weight.
If you are not receiving any type of calcium support which includes an aggressive exercise rehab program then, these are the expected symptoms of progression that one would see as one with Brown Sequard survives longer and longer.
Your physician should send you to a neurologist who has good experience with such cases of autonomic dysfunction so that pain relief can be looked at as well as a way to get both sensory as well as motor stimulation back into the limbs...even though the left leg is actually paralyzed. You can't afford that right leg to become as paralyzed as the left simply based on disuse.
I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.
Don't forget that my webpage to keep me abreast as to how you're doing is:
bit.ly/drdariushsaghafi
All the Best
This query has required a total of 60 minutes of physician specific time to read, research, and compile the return envoy to the patient.
Brown Sequard Complications
Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am a neurologist from XXXXXXX OH, USA
Unfortunately, your picture is rather typical for how Brown-Sequard patients can progress when the elements of complex regional pain syndrome begin to set in. This is known by the more antiquated name of REFLEX SYMPATHETIC DYSTROPHY which is a painful syndrome that comes about after some type of traumatic injury to the peripheral nerves in a limb or wherever.
I believe that the motor function in the right leg (while it was good at one time) began to deteriorate based upon worsening sensory function. In other words, the less you were able to feel that right leg, the less easy it became to use it in a motor type of way. This then, would lead to a form of disuse atrophy which would simply become worse and with worsening sensory issues leading to pain and discomfort you would be less inclined to try and use that limb which would lead to more motor disuse hence weakness, and possibly atrophy (loss of muscle bulk). The burning sensations are part of a neuropathic picture which comes from disruption of the sensory tracts from T5-T8 that were compromised due to the operations.
The pain in the tibia may be due to a loss of calcium (osteopenia or osteoporosis) which is likely coming about because of lack of use, muscle atrophy, and eventually pain due to increasing fragility of the skeleton and less ability to bear weight.
If you are not receiving any type of calcium support which includes an aggressive exercise rehab program then, these are the expected symptoms of progression that one would see as one with Brown Sequard survives longer and longer.
Your physician should send you to a neurologist who has good experience with such cases of autonomic dysfunction so that pain relief can be looked at as well as a way to get both sensory as well as motor stimulation back into the limbs...even though the left leg is actually paralyzed. You can't afford that right leg to become as paralyzed as the left simply based on disuse.
I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.
Don't forget that my webpage to keep me abreast as to how you're doing is:
bit.ly/drdariushsaghafi
All the Best
This query has required a total of 60 minutes of physician specific time to read, research, and compile the return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello,
I would like to add some more information to get more information about my stage:
The loss of sensation in the right leg was there right after the first operation of my backbone. The only I can feel is anything what is cold and this causes terrible pain. The warm things or warm water I feel like cold one.
Can you also tell me more about Brown-Sequard syndrom because doctors here hardly know something about it so I often face situation in which it is a doctor who is asking me what kind of disease is this. I already searched the net for some information but there are less and I want to know more especially for the prognosis. I read it can be quite good for people who get help up to 6 hours from the injury, but this is definitely not my case. I got help regarding my back simply too late as there were 4 moths since the herniated disc was discovered (already 8 mm in the spinal cord) and the first operation.
Could you also tell me where in the world Brown-Sequard is treated in a good way?
In your answer you mentioned aggressive exercise rehab programme? Can you tell me what kind of programme is this and what does it include? I have my own personal physician and if possible I would like to explain for her what else we could add in our programme.
Thank you
Kind regards
XXXX
I would like to add some more information to get more information about my stage:
The loss of sensation in the right leg was there right after the first operation of my backbone. The only I can feel is anything what is cold and this causes terrible pain. The warm things or warm water I feel like cold one.
Can you also tell me more about Brown-Sequard syndrom because doctors here hardly know something about it so I often face situation in which it is a doctor who is asking me what kind of disease is this. I already searched the net for some information but there are less and I want to know more especially for the prognosis. I read it can be quite good for people who get help up to 6 hours from the injury, but this is definitely not my case. I got help regarding my back simply too late as there were 4 moths since the herniated disc was discovered (already 8 mm in the spinal cord) and the first operation.
Could you also tell me where in the world Brown-Sequard is treated in a good way?
In your answer you mentioned aggressive exercise rehab programme? Can you tell me what kind of programme is this and what does it include? I have my own personal physician and if possible I would like to explain for her what else we could add in our programme.
Thank you
Kind regards
XXXX
Brief Answer:
Brown Sequard Syndrome
Detailed Answer:
The places that best know how to attend to the complications of the Brown-Sequard syndrome would be those places that treat spinal cord injury patients because in fact, that is exactly what it is...a spinal cord injury of what is referred to as the hemisection type. It is an INCOMPLETE spinal cord injury that can have mild neurological deficits or severe one associated. As you are already aware this type of injury causes paralysis on one side of the body when severe (weakness in the milder forms) and loss of temperature as well pain on the opposite side from the injury.
There are also other symptoms that are lost from the same side of the injury such the sense of PROPRIOCEPTION which is the ability to know where the limb is in space and also spasticity and hyperreflexia can also set in to the limb since it is what we call an upper motor neuron lesion.
It is not an UNCOMMON type of problem so I'm a bit surprised when you say that doctors in your area "don't know about it...." What is challenging about treatment is good patient education so that they understand the loss of function that can come about when such a spinal cord injury has occurred whether it be from trauma, surgery, stroke, infection, or other means.
A doctor readily recognizes the problem when patients tell them that that they have loss of motor function on one limb of the body which as I said can be also spastic and weak (or in your case paralyzed) and at the same time have loss of pain and temperature sensations on the opposite side.
As far as a specific rehabilitation program is concerned; well, I'm sure you're not surprised to hear that the sooner one gets started on such a program the more likely they are to have good results...this is not to say that all patients have the same chance of recovering function because it depends in large part on the severity of the initial lesion. In other words, if a bullet were to lodge and cause a large spread of damage to the spinal cord at a certain level with bleeding, loss of tissue or muscle, severe other traumatic injuries, that individual may not be expected to do quite as well no matter how aggressive the rehabilitation was compared to a more minor type of injury.
I will provide you a short list of treatment goals and objectives that I always expect my physical therapists to employ on patients with Brown-Sequard- indeed any patient with spinal cord injury should receive these sorts of items of care:
Therapy goals include the following:
Maintaining strength in neurologically intact muscles
Maintaining range of motion in joints
Preventing skin breakdown by proper positioning and weight shifting
Improving respiratory function by positioning and breathing exercises
Achieving early mobilization to increase tolerance of the upright position
Providing emotional and educational support for the patient and their family.
Functional movement therapy begins with bed mobility, followed by transfers, wheelchair mobility, and, in time (hopefully), ambulation.
Appropriate equipment is prescribed (depending upon progress and need), and of course, patients must be taught the the proper use of this equipment. Family and caregivers also must know how to use the equipment and how to call for repair or maintenance as needed.
I do hope this gives you some ideas to discuss either with your doctors or with your therapists if you've access to such services. I'm sure you will find people well versed in treating this NOT SO UNCOMMON spinal cord injury scenario and I believe given the time factor of only 4 months you should still give aggressive therapy a good chance. I'm sure there are still things that you can accomplish despite the deficits you have to this point.
I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.
Don't forget that my webpage to keep me abreast as to how you're doing is:
bit.ly/drdariushsaghafi
All the Best
This query has required a total of 82 minutes of physician specific time to read, research, and compile the return envoy to the patient.
Brown Sequard Syndrome
Detailed Answer:
The places that best know how to attend to the complications of the Brown-Sequard syndrome would be those places that treat spinal cord injury patients because in fact, that is exactly what it is...a spinal cord injury of what is referred to as the hemisection type. It is an INCOMPLETE spinal cord injury that can have mild neurological deficits or severe one associated. As you are already aware this type of injury causes paralysis on one side of the body when severe (weakness in the milder forms) and loss of temperature as well pain on the opposite side from the injury.
There are also other symptoms that are lost from the same side of the injury such the sense of PROPRIOCEPTION which is the ability to know where the limb is in space and also spasticity and hyperreflexia can also set in to the limb since it is what we call an upper motor neuron lesion.
It is not an UNCOMMON type of problem so I'm a bit surprised when you say that doctors in your area "don't know about it...." What is challenging about treatment is good patient education so that they understand the loss of function that can come about when such a spinal cord injury has occurred whether it be from trauma, surgery, stroke, infection, or other means.
A doctor readily recognizes the problem when patients tell them that that they have loss of motor function on one limb of the body which as I said can be also spastic and weak (or in your case paralyzed) and at the same time have loss of pain and temperature sensations on the opposite side.
As far as a specific rehabilitation program is concerned; well, I'm sure you're not surprised to hear that the sooner one gets started on such a program the more likely they are to have good results...this is not to say that all patients have the same chance of recovering function because it depends in large part on the severity of the initial lesion. In other words, if a bullet were to lodge and cause a large spread of damage to the spinal cord at a certain level with bleeding, loss of tissue or muscle, severe other traumatic injuries, that individual may not be expected to do quite as well no matter how aggressive the rehabilitation was compared to a more minor type of injury.
I will provide you a short list of treatment goals and objectives that I always expect my physical therapists to employ on patients with Brown-Sequard- indeed any patient with spinal cord injury should receive these sorts of items of care:
Therapy goals include the following:
Maintaining strength in neurologically intact muscles
Maintaining range of motion in joints
Preventing skin breakdown by proper positioning and weight shifting
Improving respiratory function by positioning and breathing exercises
Achieving early mobilization to increase tolerance of the upright position
Providing emotional and educational support for the patient and their family.
Functional movement therapy begins with bed mobility, followed by transfers, wheelchair mobility, and, in time (hopefully), ambulation.
Appropriate equipment is prescribed (depending upon progress and need), and of course, patients must be taught the the proper use of this equipment. Family and caregivers also must know how to use the equipment and how to call for repair or maintenance as needed.
I do hope this gives you some ideas to discuss either with your doctors or with your therapists if you've access to such services. I'm sure you will find people well versed in treating this NOT SO UNCOMMON spinal cord injury scenario and I believe given the time factor of only 4 months you should still give aggressive therapy a good chance. I'm sure there are still things that you can accomplish despite the deficits you have to this point.
I'd appreciate the favor of your providing a STAR RATING and some brief written feedback if your questions have been satisfactorily answered. In addition, CLOSING THE QUERY on your end will also be most helpful.
Don't forget that my webpage to keep me abreast as to how you're doing is:
bit.ly/drdariushsaghafi
All the Best
This query has required a total of 82 minutes of physician specific time to read, research, and compile the return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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