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  • Balancing problem while walking, compression on spinal cord

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    Old 07-26-2011, 04:02 AM   #1
    dheerajhll
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    Balancing problem while walking, compression on spinal cord

    Dear friends,
    My brother is 28 years old, since last one month is facing problem ans it was started with heaviness sensation in both legs after two days he felt belt type sensation in upper abdominal part. Due to heaviness in both legs he started moving with support of wall and others persons/object, without support he feels like he might be fall down on floor. We consulted with drs and have gone through MRI (3Tesla) opf spine (Cervical/dorsal/lumbar) and brain. Reports of Brain MRI is quite ok but dorsal section specially D1-D2 having compression on spinal cord due to slip disc.

    herewith i m giving his MRI report of cervical dorsal region alongwith MRI of brain which reveals some compression in D1-D2 portion and Brain MRI is normal.

    MRI cervico-dorsal spine (Contrast)

    Multiplanner MR images of the cervico-dorsal spine were obtained using combination of T1 T2 turbo spin echo an FFE sequence. The T1 weighted images were repeated after contrast administration.

    Curvature of cervical spine is well preserved.

    Posterior central protrusion of C7-D1 disc with posterior abbular tear. Posterior central and right paracentral D1-D2 disc protrusion causing compresssion of thoracic cord, right exiting with changes of cord edema at D1,D2 thoracic cord.

    The cord opposite D1 and D2 vertebral levels display isointense signal on T1W images and hyperintense signal on T2W and STIR images suggestive of cord edema. The protuded disc at D1-d2 level shows peripheral enhancement on contrast administration.

    Posterior cebtral and right paracentral protrusion of D2-D3,D3-D4 and D4-D5 disc with indentation on anterior thecal sac without any significant thecal sac or root compression.

    The cervial and thoracic vertebral bodies are nomal in height and marrow signal intensity.

    Posterior elements are nomal in morphology and signal.

    Costotransverse and costovertebral joints are normal.

    Paravertebral and paraspinal musculature is normal.

    impression : cemri cervico dorsal spine findings are suggestive of : Posterior central and right paracentral protrusion of the D1-D2 with compression of thoracic cord with changes of cord edema in D1,D2 thoracic cord.
    Posterior central and right paracentral protrusion of multiple thoracic discs at C7-D1,D2-D3,D3-D4 and D4-D5 with indentation of anterior thecal sac without any nerve root compression.

    MRI Brain (Plain and contrast)
    Multiplanar MR images of the brain were obtained using T1 and T2 weighted SE. TSE amd FLAIr sequences. The T1 weighted images were repated after contarct administration:
    The cerebral gray and white matter shows normal MR morphology and signal intensity.
    No focal area of altered signal intensity is seen within the brain parenchyma.
    Post contrast images show no abnormal meningeal/parenchymal enhancement.
    No mass effect / midline shifts.
    The basal ganglia,thalami,brainstem and cerebellum are normal.
    Corpus callosum is normal.
    sellar and parasellar regions appear unremarkable.
    The ventricular system and basal cisterns are normal.
    major flow voids are normal.
    cerebellar tonsils are normal in location.
    Visualized paranasal sinuses are clear.
    IMPRESSION : essentially normal study.

    He was admitted in hospital for app 7 days and was given treatment as below but not relief in fact.
    medicine tried :
    inj monocef 2 gm IV OD,
    inj optineuorne 1OD IV
    inj solumedrole 500 mg+ normal saline 250 ml Iv in 8 hourly in 2 hours time.
    inj human actrapride 5/12/10 units SC1/2 hrs before breakfast.
    Tab mhagesic -M 4 mg BD
    Cap methylcobal 500 mg TDS
    Cap Gabapin 300 mg HS OD

    afterthen we moved to different hospital and treatment is being given as below but agian not much relief: here again i would like tp draw ur attention.. my brother feel heaviness in both legs equally and he is not heaving any pain anywhere in body which is generally we see in case of spine problem (e.g slip disc) .

    Tab decdan 2 mg BD for 5days , followed by OD for 3 days.
    Tab Pan 40 mg OD.
    Tab Liofen (baclone) 10 mg OD
    Cap Nervup OD

    Among the above medicine , he got a littil benefit in stuffness in lower limb with medicine Liofen as it is supposed to be a muscle relaxtent.

    i request you please suggest me wat to do now as we family is very disturb and worried for my younger brother he is only 28 years old and has lost control in balance making while walking.

    Since last 3 days we also started massage therapy with medicated oil on whole body to release toxins from body .. and we find after having massage over legs he feel much relief in terms of less heaviness. but still same problem is as it is in imbalance while walking.. on his own feet.

    Regards

     
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    Old 07-26-2011, 09:30 AM   #2
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    Re: Balancing problem while walking, compression on spinal cord

    That C7/D1 level looks problematic, and the D1/D2 even more so. I hope someone here can speak to the question of whether the cord compression at D1/D2 could cause the leg symptoms, as that's beyond my limited understanding of these things. It would seem that the neurologist there in India must have an opinion...

     
    Old 07-26-2011, 10:16 AM   #3
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    Re: Balancing problem while walking, compression on spinal cord

    Absolutely cord compression at that level can cause problems with balance and walking. That's my story. Need to see a competent surgeon to evaluate.
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    Old 03-08-2012, 06:36 PM   #4
    dheerajhll
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    Re: Balancing problem while walking, compression on spinal cord

    Thank you very much for your suggestion given at time when i was so much worried for my younger brother. As u suggested me, i contacted many docs in delhi,gurgaon(india) for the best treatment and all of them reached on a single point conclusion that there was a compression on D1-D2 (or T1-T2) due to which by brother was feeling lots of pain and a belt type sensation/pressure over his upper abdominal. And based on their diagnosis, we agreed for the operation for D1-D2 (spinal cord decompression via inplant of screws).

    And definitely he is now app 80% recovered..there is no belt type of sensation and heaviness on his legs.. but still he is facing problem in making balance while walking.. having lower back pain. i need further guidance what to do .. as per doctors he ll be recovered but how many days it will take .. they are not confident.. please suggest where to go for further treatment.

    Regards

     
    Old 03-09-2012, 05:54 AM   #5
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    Re: Balancing problem while walking, compression on spinal cord

    Dheerajhll... I'm sorry, but what to do about thoracic problems (I'm assuming that "D1" is the same as "T1" in the U.S.) is beyond my limited understanding. Maybe someone on the Back Problems board can help? They are more accustomed to dealing with non-cervical spinal issues.

     
    Old 03-10-2012, 10:03 AM   #6
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    Re: Balancing problem while walking, compression on spinal cord

    i am assuming the same thing web. what i am wondering here, and this solely depends more upon just 'exactly" what specific 'parts/spinal tracts' were being impacted by both, the actual cord compression itself, along with the addition of also having the edema too which could also add its own 'form' of actual compression as well.

    we have like 20 some 'spinal tracts' that run thru our spinal cords bringing all of the needed signals to and from the outter periphery to thebrain and then back again that would pretty much govern/tell our bodies what to do, and how things would also simply 'feel or BE" as well depending upin ANYTHING that just can add any levels of compression to the cord too. things would change if deep enough.

    there is one particular spinal tract called the spinocerebellar that i also have some pretty significant damage to myself that also governs among other things our balance and gait, the 'gait" is simply 'way' we just walk'? ALL of the spinal tracts also run to the more high function areas of our brain as well(they are ALL correlated that way), so if anything stops or 'deranges' signals to brain then back again, it CAN seriously generate symptoms that are very directly in relation to what THAT particular high function part of the brain the tract simply "runs to, and the 'functions that part of our brain also functions or the 'things' it does for us in a more "autonomic/automatic" way.

    the spinocerebellar tract governs ALOT including what is called our 'proprioperception' which is how any given individual will 'percieve' their own body parts in relation to space, or where our body parts are simply located when our eyes are shut? i have pretty significant damage to three spinal tracts with one of them also being my cerebellar too. my most prominant 'outward/inward' symptoms of this specific tract damage show themselves as not being able to tell, only when my eyes are closed and this just 'kicks in' at all(the closing of the eyes starts this) exactly where my legs are like as soon as i lie down to go to bed at night and i shut my eyes, my legs are simply NOT "in" my brains actually even just seconds ago 'memory" anymore as far as where i would just KNOW without a doubt even how they are posistioned? unless i actually move them around and touch like the sheets or blankets or simply open my eyes, i just only know where i 'left them' not actually where they are anymore? does that make ANY real sense to you or am i just confusiong you? you CAN look up "spinal tracts' and kind of look at them and also the MRI report and esp the films to see how the areas on film compare to the areas of specific spinal tracts which also, on a good site, shows exactly how they are laid out within the cord too along with explanations of just what the specific tracts actually door govern as well. the thing is, given what your brother just 'had' there more towards the anterior or front of the actual cord and 'paracentral, meaning it did also go more 'off' to at least one side to some extent. that cerebeller is ALSO located more towards the front, then off to the side as well. it is also a pretty large tract in comparrison to the many others in our cords too, therefore, much easier to actually 'impact' mostly becasue of its size and being in a much more likly to be be 'hit' area even with herniations that simply impact that cord tissue itself too.

    but among other things that the cerebellar tract does when it has been impacted/damaged, is for me, i always will veer off to the L whenever i walk too(my "posterio left" or L side towards the front(that was from the 'tunneling into my cord FROM that posterio starting point) of my cord took the most damage in me with my cord so that i guess is why i tend to veer off THAT way vs the R side?). but even just trying to take lil slow baby steps down my hallway in my house, i will eventually STILL, even tho i am trying like heck to stay in the middle, end up into the L wall, but only when things are REALLY showing themselves.

    i am just wondering if your brothers 'cord injury" by either deeply hitting the tract(during his surgery/lifting of the compression) or just by the sheer compression force or forces depending upon just where that cord compression was(and for how long) along with what can simply occur too with extra fluid being within that space as well that left its mark', that he very easiliy could have been left with, esp if rehab was simply really a needed thing and was not done(did ANYTHING kind of get 'knocked out of commission" post op?) actually created specific 'symptoms.' has he been complaining about ANYTHING being different besides with the legs? any vision problems which is also governed by an area of our cerebellums too. you can end up with various types of eye impacts, like ANY double vision probs depending upon the level of potential damage from this tract. but this tract really DOES hit the legs in many ways moreso than anything.

    he could also be dealing with a certain level of real spasticity too which would feel kind of like an 'over tightness"/or rubber band type 'feeling in the legs" there to outright hypersensitive reactions to touch making them kind of 'bounce" rather abruptly? this can also just occur whever what are called the 'upper motor neurons' are simply being impacted at all, which is usually the case whever there just IS cord contact?

    the one way to kind of 'test" the level of any potential spasticity that you can do at home like the neuros do in office, would be to simply have him sit in a chair with his leg not touching the floor at all(you CAN "very lightly" go behind each leg as you are testing it and simply push it a bit forward while doing this(just do NOT 'hold it', push it), but the leg should be off the floor). then taking like the heavier end of a butter knife and just give that area kind of right under where his kneecap is a little tap til you get ANY type of 'reaction" to it, then see how quickly that lower leg simply 'bounces out' in each leg. it should be, as in 'normal' a more subtle type of simple 'bounce out'. but if there IS any actual spasticity present, it would be very different than the subtle bounce. it would be a much more 'brisk/rapid' kind of almost 'kick out, tho not a huge kick, but still much more 'there/prominant' than what the norm would be. you can test this on yourself to get an idea of what the 'normal' actually is, and then try it on him and see if there is any difference.

    do you recall at all(if you were present for this) or him telling you just exactly how he responded to this test that every neuro simply does as part of the standard neuro eval? it would also be noted in ANY of that neuros clinic notes too which i would very HIGHLY advise that he obtain if possible, along with any and all records from that actual surgery too. we CAN here in the US actually obtain our own medical records, but i do not know how things are there? any of the docs notes, both pre op and post op would tell alot about what that surgeons overall 'impressions' simply were before and after too. alot of good info is simply contained in ALL of the clinic and surgical records. so if you CAN obtain them, get them.

    while there also could be some levels of more specific types of damage to what just is the 'inner' make up of our cords that could just also be the underlying culprit in mostly his leg issues. like specific nerves and nerve fibers that DO affect the legs and feet depending upon what area(s) of the cord were impacted. my complete loss of my L leg was solely due to a very specific nerve that was running inside the cord that went to my feet being hit and lost off the monitor then coming back severley damaged. so the " inner cord nerve make up" needs to be considered here too. and this is where a good EMG may really help in tracking the impacted nerve(s) back to the source too.

    if he did NOT actually have ANY follow up post op(like after two to three weeks post op) types of rehab therepy to even 'try' and regain his balance and just help his legs try and regain what had kind of been 'changed' in him, that too can make a huge difference in his pre op symptoms within the legs still being there post op too. i had to do alot of ongoing rehab therepy post op after my cord was damaged during my surgery that made the BIGGEST difference for my impairments/disabilities that actually came FROM my actual surgery, but were not there pre op.

    what this realistically comes down to here in him, is what IS/WAS actually causing the leg issues to begin with that NEEDS to be tracked back to the original source(usually with much more indepth testing of various types). while it could be that spinocerebellar tract somehow being impacted(if he has the loss of knowing where his legs are when lying down, with not moving at all and his eyes being shut, it IS most defintiely somehow connected to that cerebellar tract) if not, then it could be much more of an 'inner cord innervation issue' that should be able to be tracked back by even using what is called an EMG/NCV test? this would show ANY actual nerve flow velocity loss to specific areas,even with inner cord damage like i had, mine DID show up too. but there are also other tracts that could also be somewhat more vulnerable to real compression as well that he could show symptoms of too.

    just DO look up the spinal tracts and read what that spinocerebellar actually governs(tho i did a ton of research on this moreso right after my surgery back in 03-04 and the other tract damage i have, it was quite awhile ago and cannot recall ALL of what is governed. my brain fog is horrible these days) and then compare those speficic things to any and all real symptoms he is either showing or telling you are there, or things that appear to be 'missing" that he once had as more abilities?

    but if he has yet to also have a good contrasted type of post op MRI at this point too, that just HAS TO be done now just to see how things 'look' in there now that compression has been lifted and to check if ANYTHING new is 'showing itself'or the edema also has changed(better or even potentially worse too,depending) post op. and they should do the very SAME type he had at the beginning as well using that "3 tesla" scan? that is a very much more in depth type of an MRI that sees three times more deeply into the areas being scanned(it simply uses a much much stronger magnet to obtain pics). much higher quality film pics get done using that 3T scan than ANY actual 'regular" type of an MRI could, even with contrast and esp if they are looking at the spinal cord. i had to have a 3T scan done on my brain when i had an aneurysm and could not use contrast becasue of having a kidney disease. people with an actual kidney disease cannot use contrast since it will impact their kidneys much harder as opposed to someone without kidney disease. so i was very glad they even HAD that 3T availiable since my 'regular MRI" did not show my aneurysm at all. but my really knowledgable NS who also did my cord surgery simply had a 'hunch' and he was right in that i actually even had one, but found only after the "right" testing was finally done(that three T along with an MRA).

    but i would very highly recommend that 3T follow up MRI being done, along with that EMG/NCVbeing done on his legs on up to the level of impact too. those two tests may tell alot more than anything right now. the one thing about certain types of spinal cord damage or injury is that it will NOT actually show itself in the best ways if you wait too long to even get that needed MRI. if there just is any deadened tissue(which would show the areas that could be actually cord injured), it will granulalize like mine eventually did, then be totally removed from the cord in a more natural process called myelomalacia.

    what we could just really 'see' of my cord injury and the surgical crap along with myelomalacia also kicking in at my two month post op MRI, at one year, my cord "looked' absolutely 'perfect". blew me away since i KNEW i had lost alot and ended up with a ton of real damage and disabilities too, and what i HAD seen with my own eyes on the post op films. chemical changes simply DO also occur mostly thru that inital first year if the cord has also been damaged in some way too. so seeing things NOW vs later will at least best document and also show his doc what WAS there at post op.

    and if by some chance he has yet to have ANY actual real rehab/PT done to simply help with trying to regain balance esp and regain strength if possible, he needs that too. i had to go thru that part myself, among other things i needed to try and regain. but they DO do very specific types of rehab JUST for regaining our balance. what will and will not always realistically even 'come back' or change in anyone really comes down to depth and levels of real solid damage and to what more specifically. good luck with your brother. i DO hope things will change for him. but there just ARE some tests and other things he simply really DOES also NEED right now too. please keep us posted, marcia
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